We live in confusing times, and the waters aren’t getting any clearer, figuratively and, in some cases, literally. One topic on my mind is water quality, with concerns such as who controls it and why the end user has such little say in it.

Over the last 12 months, a growing trend has emerged to remove fluoride from municipal drinking water. Across the country, counties and municipalities have begun to perform research and update correlating studies, with findings suggesting that medicating the public through drinking water may have adverse effects.

My interest in this issue sparked about a year ago when Union County, North Carolina, where I raise my family, decided to eliminate fluoride from its municipal water supply. At first, I was shocked. As water professionals, we’ve been told fluoride’s benefits are indisputable for years. 

I’ve attended public health meetings with representatives from the American Dental Association (ADA) presenting compelling arguments in favor of its use, citing studies and statistics that advanced their goal of increasing fluoride usage.

For those who know me, it’s no secret that I care deeply about the health outcomes of future and present generations. However, the more I researched this topic, the more confused I became. Ultimately, I questioned not only the potential health impacts of fluoride but also its effects on our water systems. Let me explain.

Measuring and learning from data

Fluoride is well-known for its calcifying properties. The ADA, for example, touts its ability to harden enamel, protecting teeth from erosion. However, as I delved deeper, I came across studies exploring fluoride’s calcifying effects on the human body, particularly the pineal gland, an essential part of our physiology. These findings were unsettling, as calcification in this gland can affect numerous bodily functions, many of which we don’t fully understand. 

A 2020 study published in Applied Sciences magazine states (https://bit.ly/4genb3W): “Although these data come from older individuals (studies were conducted on a group of deceased people aged 70 to 100 years), this does not disprove the idea that the pineal gland may be considered the most fluoride-saturated organ of the human body.” 

Additionally, studies are increasingly linking fluoride exposure to neurotoxicity and IQ effects, starting from birth and transmitted by the mother. So, why is the left hand (science) not talking to the right hand (builders)?

Learning from new data can be shocking at first, but education and measurement are necessary tools for progress. This is why I’m a firm advocate for water sampling and management plans for everyone, not only hospitals but all built environments with occupants.

Recently, while sampling water at our community pool, a lifeguard asked me, “What the hell are you doing?” I explained that measuring trends and creating my own markers helps identify what we’re doing wrong and how to correct it. Initial results might be alarming, but they spark necessary conversations and guide us to smarter solutions. 

This principle of measuring and learning applies to our municipal water systems, too, especially in light of decades of fluoride exposure and the increasing number of waterborne pathogens that cause illness. 

Unintended consequences

Fluoride’s widespread adoption began in the 1960s and continued steadily through 1980, when estimates suggested that 50% of the American public received fluoridated water. The origins trace back to the early 1900s when research on “dental mottling” sought to mitigate brown stains on teeth (https://bit.ly/4aq3TqK). 

In 1914, drinking water standards were enacted, and by 1943, Reader’s Digest published an article titled, “The Town Without a Toothache,” sparking further interest. By the mid-1940s, nearly 577,683 Americans were receiving fluoridated tap water, marking the start of a nationwide experiment. However, unintended consequences, a hallmark of human intervention, are now coming to light.

My first concern was for underprivileged children, especially considering what we’ve been propagandized with by companies such as Crest when it introduced the first fluoridated toothpaste, promoting its necessity. Without fluoridated water, will their oral health, a critical component of overall well-being, suffer due to the softness of the corroding material? 

Then it hit me: removing fluoride could impact our water infrastructure and piping in ways we haven’t fully considered.

The Centers for Disease Control and Prevention, in cooperation with the American Water Works Association Research Foundation, reported (https://bit.ly/3C5CG03): “Most of the fluoride interaction will be to form a precipitate that will be incorporated into pipe scale (the deposits on the inside of [pipe] that are mostly calcium) or removed by routine system flushing.” 

This raises significant concerns as “routine flushing” is far less common in many building water systems than it should be.

Fluoride’s calcifying properties may not only protect our teeth but also affect our piping systems. Over time, it has likely contributed to the hardening of internal pipe surfaces, potentially slowing biofilm growth, a mixture of organic and inorganic matter. If left unchecked, this biofilm can harbor harmful bacteria such as Legionella, which causes Legionnaires’ Disease. 

Drinking water’s future

Without fluoride, could we see an increase in waterborne illnesses? Will removing fluoride leave our piping vulnerable to corrosion or lead to more leaks and defects in solder joints? These are serious questions that need answers.

The future of drinking water lies in collaboration. Purveyors can no longer work in silos. Epidemiologists, plumbers and forensic scientists are updating studies and advising us on risks, but who is thinking about the piping systems themselves? That’s where my focus lies, and it’s a sobering thought. Without fluoride, we could see increased leaching of lead and copper, more biofilm shearing and unforeseen consequences for public health.

While the idea of “medicating” the public via drinking water is controversial, the reality is that these decisions have far-reaching implications. Education is our greatest tool, and data will help us navigate these uncharted waters. We must strike a balance between safeguarding human health and protecting the integrity of our water systems.

So, this is me starting a public conversation about fluoride and its broader implications not only for our health but for the infrastructure we rely on every day to maintain and service good health. More studies are needed to explore the long-term effects of fluoride removal. With greater understanding, we can make informed decisions and ensure clean, safe drinking water for future generations. 

As I sit here today, I am reminded of how crucial it is to recognize that the future is now, not some distant idea, and just how important that mindset will be. The decisions we make today, just like those made in the early 1900s, will shape our world for centuries.