The small town of Abilene, Kansas, was the center of a fight over fluoride in drinking water last year, and a preview of battles that could play out in cities across the country as the next presidential administration puts a spotlight on the issue.
Incoming President Donald Trump’s pick to run the Department of Health and Human Services, Robert F. Kennedy Jr., is outspoken against fluoride, a mineral some cities add to their water to strengthen people’s teeth. Controversy over fluoride isn’t new, but Kennedy’s unsubstantiated claims that the mineral causes various health issues are reinvigorating fluoride debates.
Dental health experts are bracing for more cities to stop fluoridating their water.
“It's becoming normalized that people are talking about a possible fear of fluoride. There should be no fear,” Tanya Dorf Brunner, executive director of Oral Health Kansas said.
“It's settled science,” she added. “Study after study after study demonstrates it.”
After a resident brought up the issue, the debate started in Abilene. In April 2024, the City Commission voted 3-2 to stop fluoridating their water. About a month later, after outcry from dental health professionals and a small number of residents, the commission voted 3-2 to reverse that decision.
Skepticism over various public health measures, like fluoride and vaccines, became more common during the COVID-19 pandemic. Misinformation spread on social media adds fuel to the debates over fluoride.
What is fluoride?
Fluoride is a mineral that naturally occurs in water. It strengthens peoples’ enamel, the outer layer on teeth, which helps reduce tooth decay. Generally, there is not enough fluoride in water naturally to benefit peoples’ dental health, so water departments add some. Experts liken the amount to a teaspoon in a swimming pool.
Some cities started adding fluoride to their public water supply in the 1940s, with more following suit over the years. Now, according to data from the Centers for Disease Control and Prevention, about 72% of people receive fluoridated water. In Kansas, that number is around 65%.
A recent study by the National Toxicology Program, a governmental agency, linked high levels of fluoride consumption to lower IQs in children. People against public water fluoridation are pointing to the study as a reason to eliminate fluoride.
But Dorf Brunner said the study analyzed children outside of the U.S., who may have other factors impacting their IQs and who consume more than twice the amount of fluoride than people in the U.S. do.
“It is extremely regulated here. It's extremely carefully controlled here,” she said. “When you look at any substance in too much quantity, you're going to run into some problems no matter what.”
Dorf Brunner said there is nothing wrong with more research on fluoride, but she thinks we have the proof we need.
The Abilene example
The fluoride debate came up in Abilene when a concerned citizen wrote to the City Commission, said Abilene mayor, Brandon Rein.
Other than a brief stint outside of Abilene for college, Rein has been a lifelong Abilene resident. Outside of his work as a city commissioner, he’s a banker.
When he started the gig as mayor in January 2024, Rein said he didn’t expect a hot-button issue like fluoride to pop up in quiet Abilene.
“It's hard to believe a governing body in Abilene, Kansas, of 6,500 people, you can have some of these emotionally charged issues coming up,” Rein said.
Rein said the resident’s concern prompted the City Commission to study fluoride. He learned Abilene city commissioners voted to start fluoridating the water in the late 1990s, after a citywide vote failed. That doesn’t sit right with Rein.
“I don't believe that it's the role of a governing body to mandate elective health decisions on to the citizens,” he said.
At both of the commission votes on fluoride, Rein voted no. He said his decision to vote against water fluoridation had nothing to do with the safety or efficacy of fluoride and that he would support a citywide vote on the issue.
Rein said other than several emotional appeals on both sides of the debate from residents, he heard mostly from out-of-town dental advocates. The outside opinions were informative, but he wishes more residents would have spoken up.
“Regardless of your opinion, robust civic engagement is very important to me. I want to hear from people,” Rein said.
City commissioner Trevor Witt also voted against fluoride both times. In a statement to the Abilene Reflector Chronicle, Witt said he isn’t against water fluoridation but it’s not necessary for water safety and he doesn’t believe it’s his role to mandate it.
“I wouldn’t want the governing body making that decision,” Witt told the Abilene Reflector Chronicle. “I would want the general public to make that decision to add something extra.”
In defense of fluoride
When dentist Beatrice Brittan heard about fluoride being debated at the city commission, she sprang into action. She wanted residents to know what was happening and why it mattered.
“I wrote a letter to the editor. It was published in the newspaper,” Brittan said. “Then over the course of the next two weeks, I was able to meet with four of the five commissioners.”
Like Rein, Brittan grew up in Abilene then left for college. She lived outside of Abilene for about 15 years.
But Brittan said she spent a decade searching for a place like her hometown.
“Then I finally realized there kind of is no place like that except for the place where you grow up,” she said.
So in late 2023, Brittan moved back to Abilene. In January 2024, she opened Tallgrass Dental.
Brittan said she was shocked when she heard city commissioners wanted to get rid of fluoride in their water.
She said water fluoridation has long been recognized by the CDC as one of the 10 greatest public health achievements in the 20th century and has been proven over and over again as a safe and effective way to drastically reduce tooth decay.
Brittan said removing fluoride from the water would have a significant, negative impact on Abilene residents and their dental health. About a dozen of her patients reached out to her and expressed concern over losing fluoride.
Tooth decay is not just cosmetic. Brittan said it can lead to a host of other health problems. Kids and adults miss school or work because of it. For some people, especially those who cannot afford healthy food or dental care, fluoride in drinking water is one of their only tools to combat decay.
She said getting rid of fluoride would be “cruel.”
“The effects of that decision are painful. And it's not metaphorically painful. It is unnecessarily, physically painful for people whose dental disease could have been prevented had they had access to fluoridated water,” Brittan said.
John Kollhoff, an Abilene city commissioner who was outspoken about keeping fluoride in the city’s water, agrees. He said a small handful of residents reached out to him, too, asking to keep fluoride.
Kollhoff said he’d be most concerned for impoverished residents and their children. He said there are ways to remove fluoride from your water if you don’t want it, like reverse osmosis filters or drinking bottled water, but there’s not a cheap fix to add fluoride to your water.
“I've read that basically every dollar that's put into community fluoridation saves 20 or more dollars in dental care,” Kollhoff said.
Future threats to fluoride
Dorf Brunner of Oral Health Kansas said other than the fluoride debate in Abilene, she hasn’t heard of any new threats to fluoride in Kansas recently. Wichita, she notes, does not fluoridate water, and that debate has been ongoing for a long time.
Oral Health Kansas has a Statewide Water Action Team, which Dorf Brunner said is a way for Kansas community members to report conversations in city government about water fluoridation.
Though there aren’t any current threats to fluoride in Kansas on her radar, Dorf Brunner said she’s afraid rhetoric on the federal level and misinformation will drive more cities to end water fluoridation in the future.
She said initiatives Kansas has made strides on, like investing in the Medicaid program for dental care could also be impacted.
“I'm worried that a lot of the momentum that has been built,” she said, “could stall or go backwards.”
Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at r.shackelford@kcur.org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.
