Seminole County joined a growing list of at least 22 Florida communities that have chosen to stop fluoridating drinking water since November, when state Surgeon General Dr. Joseph Ladapo issued guidance against the long-recommended dental health practice.
County commissioners voted 4-1 last Tuesday to stop fluoridating water, with Lee Constantine casting the only dissenting vote.
The Centers for Disease Control and Prevention cites fluoride's cavity prevention benefits online, along with information about how tooth decay can lead to other, more serious health risks if left untreated. "If the cavity reaches your nerve it may cause an infection (abscess) that can spread in your body. It is rare, but this can cause death," the CDC's website reads.
However, the Department of Health and Human Services is directing the CDC to convene a panel of health experts to study fluoride and its potential human health risks. HHS Secretary Robert F. Kennedy Jr. has blamed the mineral for a range of health issues, from bone cancer and thyroid disease to lower IQs and neurodevelopmental disorders.
Ladapo has described fluoridation as "public health malpractice," a sentiment echoed by many within the anti-fluoride movement rapidly growing throughout the United States.
Recently, Utah became the first state to ban fluoridation of public drinking water — and Florida could be next. Proposed legislation that would ban fluoridation statewide is on the Senate's Special Order Calendar for Tuesday after making its way through committees this legislative session.
For longtime critics of fluoridation, it's an exciting moment. Many report feeling a sense of validation as concerns become increasingly mainstream.
"It's definitely come full circle," said Seminole County resident Jessica Tillmann. "It's one of those conversations that I may not have had 10 years ago so openly; it wasn't as widely discussed or even brought up."
Tillmann chairs the county's chapter of Moms for Liberty, a political group described as "far right" by the Southern Poverty Law Center. Moms for Liberty is focused on parental rights in education and doesn't take a stance on fluoridation, Tillmann said.
For Tillmann, fluoridation is an informed-consent medical issue, given that people who rely on public drinking water can't readily opt out. Her family has been filtering out fluoride from their water for more than 10 years, Tillman said, but not everybody has that option.
"It is a medication. The government doesn't have the right to medicate us," Tillmann said.
Like many critics of the practice, Tillman also has concerns about where fluoride added to drinking water actually comes from. Fluoride is a naturally occurring mineral, found in the groundwater of many places. But the compound used most widely for fluoridation in community water systems throughout the U.S. is fluorosilicic acid, or FSA, according to the Environmental Protection Agency.
"Production of FSA for water fluoridation takes place as a byproduct of the reaction to produce wet-process phosphoric acid," according to the EPA.
Naturally, fluoride is present in groundwater at concentrations of 0.6 milligrams per liter and above in many parts of Florida, including the Jacksonville area, according to the CDC. In the U.S., the level currently recommended for drinking water is 0.7.
Many in the anti-fluoride contingent point to a handful of high-quality studies on fluoride's potential health impacts that were included in the National Toxicology Program's metaanalysis, a synthesis of a large body of research in a given topic, published this year.
Of those high-quality studies, nearly all showed higher fluoride exposures in children (at concentrations of 1.5 and over) were associated with negative health outcomes, including lower IQs. But a majority of the studies were deemed to be low-quality.
For Constantine, that discrepancy underscores his key problem with the anti-fluoridation movement.
"It's great to question, and it's great to read, and it's great to look at things," Constantine said. "But what has happened is … they look for the thing that they believe, the one study that validates their opinion, and that's the only one that they regard as having any validity."
Overall, there were not enough data to determine if 0.7 milligrams per liter of fluoride exposure in drinking water affected children's IQ, according to the NTP's metaanalysis.
Resoundingly, the current body of credible, peer-reviewed science still finds the benefits of the practice outweigh potential cons. Fluoridation is primarily critical for children, especially those without reliable access to affordable dental health care, according to dentists.
Nearly 25 million Americans live in areas without enough dentists, according to new Harvard University research. Many of those "dental deserts" depend heavily on Medicaid, especially in rural and poor areas, but most dentists don't accept Medicaid, according to the American Dental Association.
In Florida, a 2023 study found children seek dental care through emergency departments at one of the highest rates in the country.
"If I'm going to make a decision, it's going to be based on science and not anecdotal hearsay," Constantine said. "The bottom line was, I just went with science."
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