Fluoride ban efforts show RFK Jr.'s reach

• New fluoride limits could upend an 80-year-old standard that's widely credited with reducing tooth decay by 25% and narrowing disparities for people without regular dental care.

State of play: The EPA last week released a preliminary plan for a study of potential toxic effects of fluoride exposure, which could be the basis of changes to drinking water standards.

• The federal government generally can't require communities to add or remove the mineral, but can set maximum allowable amounts.
• The current standard of what could result in harm is 4 milligrams of fluoride per liter of water — far above the Centers for Disease Control and Prevention's recommendation of no more than 0.7 milligrams per liter to improve dental health.
• The activity is a "mechanism by which you could see a federal ban or federal action on water fluoridation," said Melissa Burroughs, senior director of public policy at CareQuest Institute for Oral Health.

Where it stands: The agency's review of fluoride "will not prejudge any outcomes," EPA biologist Todd Zurlinden said during a webinar about the proposed work plan last week.

• But Kennedy said in a statement that "a growing body of evidence indicates that ingesting fluoride can cause neurological harm, and other adverse effects." EPA Administrator Lee Zeldin said he's "working in lockstep with Secretary Kennedy."
• The proposed study plan is open for public comment.

What they're saying: The American Dental Association is "hopeful that the EPA will use peer-reviewed, scientifically tested evidence rather than biased, mischaracterized studies," ADA president Richard Rosato said in a statement.

Context: U.S. cities have been adding extra fluoride — a naturally occurring mineral — to their drinking water since 1945 to improve dental health and prevent cavities.

• Excessive fluoride can cause cosmetic tooth damage, and some studies link very high exposure to lower IQ scores in children.
• But research shows that community water fluoridation isn't associated with lower IQ scores — and actually saves money though improved oral health.

Resistance to fluoridating water goes back decades, when the John Birch Society during the Cold War promoted conspiracy theories that it was part of a communist plot.

• Kennedy's MAHA movement has reignited the cause, arguing that adding fluoride to water infringes on medical freedom and that people can instead take supplements or get toothpaste.
• The Food and Drug Administration is also weighing removing prescription oral fluoride supplements from the market on similar safety grounds.
• Health and Human Services spokesperson Andrew Nixon told Axios that once studies on fluoride are completed, CDC and the Agriculture Department "will educate Americans on the appropriate levels of fluoride, clarify the role of EPA in drinking water standards for fluoride under the Safe Drinking Water Act, and increase awareness of the ability to obtain fluoride topically through toothpaste."

Zoom out: Utah and Florida became the first states to ban fluoride in water last year.

• Sixteen other states have introduced legislation to restrict or ban fluoridated water since the start of this year, per CareQuest Institute for Oral Health.
• "This is a much heavier load in terms of these statewide actions on fluoride compared to last year," said Burroughs, the group's public policy director.

The big picture: "I think this trend shows a core area of MAHA's true political strength," David Mansdoerfer, who worked at HHS during the first Trump administration, told Axios.

• Fluoride restrictions could help decrease overmedication of kids, he said. That's something that "resonates beyond the traditional Republican electorate — which is key in election years," he said.
• Conversely, 81% of U.S. adults surveyed by CareQuest last summer either support or aren't opposed to water fluoridation.

Between the lines: Losing access to fluoridated water will increase states' Medicaid costs as children present with more cavities, a new analysis from CareQuest shows.

• Florida's fluoride ban is expected to increase Medicaid costs by more than $6.3 million over three years due to growing dental health needs for children, per the analysis.

What we're watching: Kennedy said in April that he would put together a task force to study fluoride and tell the CDC to stop recommending communities add the mineral to drinking water.

• For now, the CDC's website continues to recommend fluoride to prevent cavities.