Orange County continues to fluoridate its community water

Amid the recent noise and chatter about fluoride in community drinking water, following Florida Surgeon General Joseph Ladapo’s call last month to end the decades-old practice of adding the mineral to protect against tooth decay, Orange County, which has fluoridated its water since 2004, is staying the course — at least for now.

Residents living in unincorporated Orange County will continue to get drinking water with fluoride added at 0.7 milligrams per liter of water — the concentration recommended by the U.S. Public Health Service for cavity prevention.

“We have not received any new direction from the Environmental Protection Agency or our state regulatory agencies,” Orange County spokesperson Jamie Floer told VoxPopuli via email.

Floer said Orange County water is highly regulated and monitored by lab technicians. “Our labs test to adjust the levels needed,” she said. 

The City of Ocoee is waiting to see what kind of guidelines come from the Florida Department of Environmental Protection before making any decisions about its fluoride program, according to Assistant City Manager Michael Rumer. The city commission first approved public water fluoridation in 1985, Rumer said. Currently, Ocoee water contains the recommended 0.7 mg/L of fluoride. 

“This is really hot off the press with Ladapo just here,” Rumer said in a phone interview. "Our consumptive use permit to provide safe drinking water is through the Florida Department of Environmental Protection. Whatever processes we use have been reviewed and approved, so we'll look to them for guidance.”

It’s a different story in Oakland where the town’s water comes from wells. Tested annually, the water contains trace amounts of fluoride. Mike Parker, the public works director, said they don’t add more. He said he’s heard fluoride is “unhealthy.”

So Oakland's water is simply disinfected with chlorine before it's pumped out to the community. 

“That’s all we’re required to do,” Parker said.

Winter Garden does not fluoridate its water either, according to City Manager Jon Williams. He told VoxPopuli via email that the city’s water naturally contains 0.21mg/L fluoride. That's about average for Florida's water, according to Johnny Johnson, DMD, MS, a retired dentist, now president of the American Fluoridation Society, which promotes science-backed research about community water fluoridation.

Dental Protection

Fluoride, naturally found in earth and water, began to be added to municipal water supplies in 1945 after researchers noticed that people who drank water containing natural fluoride had fewer cavities. Fluoride helps strengthen, protect and even repair tooth enamel that gets damaged as oral bacteria break down foods.

The Centers for Disease Control and Prevention (CDC) estimates that fluoridated water reduces the lifetime risk for cavities in children and adults by 25 percent. Even after fluoride toothpaste and mouth rinses came to market, fluoridated water was still considered a public health boon for cavity prevention. The CDC ranks fluoridated drinking water among the 10 great public health interventions of the 20th century.

“It is the most cost-effective way to get the right amount of fluoride to everybody in a community without a single change in their daily behavior,” explained Johnson.

As of 2022, the most recent year available, 72 percent of Americans were drinking fluoridated tap water, according to the CDC. In Florida, 78 percent of Floridians get fluoridated community water. The CDC maintains a national database by state, listing which counties fluoridate their water.

The Department of Defense actually considers fluoridated water a key factor in maintaining military readiness. In 2008, about 40 percent of select reserve troops could not deploy because of issues with tooth decay. The Department of Defense issued a 2013 memo, mandating that military installations with water treatment facilities serving at least 3,300 people had to fluoridate the water to prevent tooth decay and keep the military in a state of readiness for deployment.

“That's about as strong a commitment as you can get because the military doesn't spend a buck on anything,” said Johnson.

Fluoride’s foes

Fluoride has long had its detractors. But the calls to remove it from community water systems have become more mainstream recently. Robert F. Kennedy, Jr., the nominee to head the Department of Health and Human Services in the incoming Trump administration, wants to see all cities in the country end their fluoride programs.

Ladapo’s November announcement followed a September federal court ruling that requires the Environmental Protection Agency (EPA) to come up with a “regulatory response” to a 324-page National Toxicology Program (NTP) report that linked high levels of naturally occurring fluoride in water — 1.5 mg/L of water and higher — with lower IQ in children. That threshold is double the amount of fluoride that is added to community water systems. 

The NTP report analyzed studies done in China, Iran, India, Pakistan and Canada, and the report emphasized that it said nothing about the health outcomes of community water systems that added just 0.7 mg/L of fluoride as recommended by the U.S. Public Health Service for cavity prevention. 

Johnson said the NTP findings can’t be extrapolated to the United States because the report examined study results from countries where fluoride levels in water can naturally be as high as 14 mg/L and where people drink more than twice the water Americans do.

Nonetheless, Winter Haven recently voted to remove fluoride from its community water. Hillsborough County is said to be considering doing likewise, according to Axios.

“There's no scientific reason to stop fluoridation when you have nearly 7,000 pieces of scientific literature and research in PubMed,” Johnson said. “There's never been an adverse health effect associated with fluoridated water. None."

Recently, in 2022, Ireland’s Health Research Board published a review of 30 studies from nine countries (including Ireland which mandates country-wide water fluoridation at 0.7 mg/L) and found “no definitive evidence that community water fluoridation is associated with negative health effects.” It specifically noted that research into fluoridated water and thyroid and neuropsychological conditions were “limited” and “inconsistent” but that researchers were “unable to provide conclusive evidence” of a link between them.

Meanwhile, in Australia, researchers looked at 2,682 children from the National Child Oral Health Study and found no association between drinking fluoridated community water in the first five years of life and a child’s emotional state, behavior and executive function. Kids who drank fluoridated water for all five years and kids who had no fluoridated water took the same tests, and researchers saw no differences between the groups.

“Everything is in a bell curve," Johnson explained. "The overwhelming body of evidence [is] in the heaviest part of the bell, not on the tails on each side. We make the decisions based on the preponderance of evidence. Dr. Ladapo did not make a decision based on the preponderance of scientific evidence.”

The Florida Department of Health statement — that cavity prevention doesn't outweigh the "current known risks" for pregnant women and children  — not only avoids mention that the recommendation to end fluoridation is based on studies with double the amount of fluoride added to community water systems, it points to several European countries that have discontinued their fluoride programs to bolster Ladapo's argument about fluoridation causing health problems. Then it links to a document that states no European country stopped its fluoride program because of evidence of harm or adverse effects. Many stopped because of anti-fluoride lobbyists.