RFK Jr.’s Fluoride Ban: Impact on Kids’ Teeth and Costs
Overview
Once celebrated as one of the greatest public health achievements of the 20th century, water fluoridation is now under unprecedented assault. Despite over seven decades of robust evidence demonstrating its safety and efficacy in preventing dental caries—especially among children—two U.S. states have already outlawed fluoride in public water supplies, and dozens of municipalities are debating similar measures. At the center of this controversy is U.S. Health Secretary Robert F. Kennedy Jr., known for his anti-vaccine activism and conspiracy theories, who has publicly pledged to remove fluoride from all American water.
Projected Oral Health Impact
In a landmark JAMA Health Forum study published May 2025, Harvard researchers Sung Eun Choi and Lisa Simon applied advanced predictive modeling to estimate nationwide outcomes if fluoride were eliminated:
- Over the first five years, dental decay prevalence among children and teens (ages 0–19) would climb by ~7.5 percentage points.
- This equates to an additional 25.4 million decayed teeth in U.S. youth.
- Dental treatment costs would reach at least $9.8 billion, a conservative figure that excludes indirect losses such as parental absenteeism.
- Quality-adjusted life years (QALYs) lost would total approximately 2.9 million, reflecting pain, school absences, and psychosocial impacts.
Extending the horizon to a decade, the cumulative burden jumps to 53.8 million additional cavities and nearly $19.4 billion in direct dental care costs.
Economic and Quality-of-Life Costs
The study’s health economics component drew on real-world data from the National Health and Nutrition Examination Survey (NHANES), Medicaid and private insurance claims, and American Dental Association fee schedules. Key cost drivers included:
- Restorative Care: Fillings, crowns, and extractions averaged $200–$600 per tooth, depending on complexity and anesthesia requirements.
- Preventive Visits: Biannual cleanings and sealants, lost entirely without fluoridation, cost $100–$150 per child annually.
- Emergency Care: Unplanned visits for severe pain or infection, at $500–$1,200 each.
Importantly, these figures exclude indirect costs like lost wages for parents and caregivers, thereby making the $9.8 billion estimate highly conservative.
Technical Modeling Approach
The Harvard team developed a stratified, agent-based microsimulation calibrated to national demographics (age, sex, race/ethnicity, income, and urbanicity). Their methodology included:
- Decay Risk Function: A logistic regression model linking fluoride exposure levels (mg/L) to cavity incidence, validated against NHANES decayed tooth prevalence.
- Sensitivity Analyses: Monte Carlo simulations varying fluoride uptake, baseline decay rates, and treatment adherence to generate 95% confidence intervals around cost and decay projections.
- Health-Adjusted Life Expectancy (HALE): Calculations of QALY losses per cavity, factoring in pain severity, treatment failure, and psychosocial effects from childhood through adolescence.
Equity and Social Impact Analysis
The adverse effects of removing fluoride would not be evenly distributed. Key at-risk groups include:
- Low-Income Families: Children on Medicaid or without dental insurance face barriers to preventive care, magnifying decay rates.
- Rural Communities: Limited access to dental clinics and specialists exacerbates untreated decay and emergency visits.
- Minority Populations: Historical disparities in oral health, combined with fewer fluoridation programs, result in higher baseline cavity rates.
“Fluoridation is one of the few public health measures that benefits everyone, regardless of income or access to care,” says Dr. Maria Santos, DDS, a pediatric dental epidemiologist at the University of Michigan.
Policy Implications and Global Context
Worldwide, over 425 million people receive fluoridated water; countries like Australia, Singapore, and the UK maintain national programs. In contrast, several European nations rely on alternative strategies such as school-based fluoride varnish programs and salt fluoridation. Analysts warn that a U.S. rollback would reverse decades of progress and clash with World Health Organization recommendations.
Recent policy briefs from the CDC reaffirm optimal fluoride concentration at 0.7 mg/L, a level that no credible study has linked to adverse neurological outcomes. Critiques of foreign studies alleging IQ loss often involve natural fluoride levels above 1.5 mg/L—more than twice U.S. standards—and suffer from confounders like arsenic and lead exposure.
Expert Opinions and Technical Commentary
Public health experts uniformly defend fluoridation as cost-effective and safe. A recent meta-analysis by the National Academies of Sciences, Engineering, and Medicine concluded that while excessive fluoride can cause dental fluorosis, there is no credible evidence of systemic neurotoxicity at levels below 1.5 mg/L.
“From a cost-benefit standpoint, every dollar invested in fluoridation saves approximately $38 in dental treatment costs,” explains Dr. Robert L. Jones, an economist at Harvard School of Public Health.
Conclusion
The evidence is unequivocal: removing fluoride from U.S. water supplies would trigger a public health disaster, devastated teeth for tens of millions of children, billions in added costs, and widened health inequities. As policymakers consider RFK Jr.’s proposal, they must weigh short-term political gains against decades of scientific consensus and the well-being of future generations.