When U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr. came to Salt Lake City Monday, he celebrated Utah’s new ban on adding fluoride to public water systems.
But oral care experts expect the ban to hit low-income Utahns hardest. They’re less likely to buy fluoridated hygiene products and visit the dentist regularly, said Dr. James Bekker, a pediatric dentist and associate dean at the University of Utah School of Dentistry.
Utah’s new fluoride law takes effect May 7. Its sponsor, Republican Rep. Stephanie Gricius, said it is about letting people decide for themselves if they want fluoride. It also adds fluoride to the list of drugs pharmacists can prescribe, but Bekker said making that change will be complicated.
Removing fluoride from drinking water adds logistical and financial barriers to getting it, said Sasha Harvey, executive director of the free and low-cost Salt Lake Donated Dental Services.
“When our patients are not in a position to floss their teeth every day, it is very difficult to convince them to go and pick up the prescription and administer it to their children regularly at the right doses,” she said. “The studies show that people just won't do it, regardless of their feelings about fluoride.”
A peer-reviewed study of fluoridation in two Canadian cities, one which stopped fluoridation and the other which continued it, found more people took fluoride supplements in the city without fluoridated water. But the number was still low and the difference between them was small, 6.4% compared to 5%.
Calgary, the city that stopped adding fluoride to its water, has since moved to bring it back.
Based on his experience as a private practitioner, Bekker said figuring out the right dosage for fluoride pills is complicated. It depends on how much fluoride occurs naturally in a community’s water. That’s one reason he doesn’t see tablets as a viable replacement for fluoridated water.
“You have to adjust the dose of the pill to match [a patient’s] community so you don't give them more than the optimal amount.”
Bekker said topical fluoride treatments like toothpaste and varnish at the dentist help the teeth already in your mouth. But fluoride in drinking water, he said, helps teeth as they develop, which benefits children.
Drinking fluoridated water decreases cavities around 25%, according to the Centers for Disease Control and Prevention. Dentists can tell by looking if a patient drinks fluoridated water.
“Since the fluoride battle began, I've asked every dentist who's come into our clinic to volunteer, or who works in our office, to tell me if they can tell the difference between patients that are coming from fluoridated and non-fluoridated areas,” Harvey said. “And hands down, every single one of them said, ‘Yes, I can.’”
Harvey said some of their free services already have a wait time of over six months, and she expects this change to make those waits even longer.
“Twenty-five percent might not seem like a huge increase [in cavities], but it is going to put a strain on community clinics like Donated Dental that are already overwhelmed by the high demand and limited resources.”
Harvey said she felt angry and frustrated when the bill became law.
“I think this is going to cause a lot of dental pain and suffering among Utah children and low-income populations that is unnecessary and preventable,” she said. That could lead people to miss school or work.
Plus, Bekker said improving oral health benefits the entire body. A 2019 study from the University of Utah found that improving oral health for those in substance abuse treatment helps them get jobs and stay housed.
“If your smile is gone, if you have really bad oral health, it's really hard to get a job,” he said.
Harvey said the new policy will hurt the poorest patients, including those who can’t afford a $5 prescription.
“Fluoride in the water is a public health measure that represents a safety net for a lot of people who can't afford to buy fluoridated toothpaste, who can't afford to visit a dentist every six months and get a fluoride varnish on their teeth, who can't afford to buy a fluoride mouth rinse,” she said.
New Utahns might also be disproportionately affected. Some immigrants might be afraid to seek healthcare because of their legal status, Bekker said. And, according to Harvey, they may face language barriers or be accustomed to a different standard of care.
“They might know from childhood to brush their teeth twice a day, but they might not know exactly how. They might not know to do professional cleanings regularly,” she said. “There are some patients that we see in our clinic that have never heard about fluoride.”
Now, Bekker said oral health advocates are stepping up their education efforts.
“All the dentists around the state that are in [the Utah Dental Association] have been going to schools for years and doing this education. That effort now will be double,” he said. That includes giving kids fliers to take home and teaching them what it takes to have “happy teeth.”
Harvey expects to see more oral health advocates offering fluoride varnishes at community events, though she noted that’s less effective than adding it to drinking water.
Macy Lipkin is a Report for America corps member who reports for KUER in northern Utah.
