Of 345 water systems in eight Northeast Pennsylvania counties, only one – Hazleton’s – fluoridates its drinking water, according to state data supplied to the federal Centers for Disease Control and Prevention.
No other water system in the rest of Luzerne County, as well as in Lackawanna, Monroe, Pike, Schuylkill, Susquehanna, Wayne and Wyoming counties, adds fluoride to drinking water supplies.
Fluoridation, which is the adding of low levels of the naturally occurring mineral fluoride to drinking water systems to help prevent tooth decay, has been debated for decades and the issue has arisen anew with President Donald Trump’s pick of Robert F. Kennedy Jr., a former environmental lawyer, to lead the U.S. Department of Health and Human Services.
Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the CDC. Fluoridation was long considered one of the greatest public health achievements of the last century.
In 1950, federal officials endorsed water fluoridation to prevent tooth decay and in 1962 set guidelines for how much should be added to water.
RFK Jr.: Ending fluoridation will ‘Make America Healthy Again’
But Kennedy, who has long been at the forefront of the issue, and many people believe fluoride’s benefits are inflated and the mineral is harmful. During a stop in Utah on April 7 on a “Make America Healthy Again” tour, Kennedy said he plans to tell the CDC to stop recommending fluoridation of drinking water in communities nationwide.
Kennedy oversees the CDC, whose recommendations are widely followed but not mandatory. State and local governments decide whether to add fluoride to water, and, if so, how much — as long as it doesn’t exceed a maximum contaminant level set by the federal Environmental Protection Agency, which is currently 4 milligrams per liter.
Pennsylvania’s current drinking water standard for fluoride is more protective at a maximum of 2 milligrams per liter, according to the state. In 2011, the HHS and Environmental Protection Agency recommended lowering the level of fluoride in water systems to 0.7 milligrams per liter from the prior recommendation of a range of 0.7 to 1.2 milligrams per liter. Data indicates that fluoride exposure levels among the population have increased in the last 40 to 50 years, resulting in an increase in mild dental fluorosis on teeth, which is lacy white markings or spots on the enamel. Along with water, other common sources of fluoride include toothpaste, mouth rinses, prescription fluoride supplements, fluoride applied by dental professionals and dietary sources, such as food and beverages made with fluoridated water, according to the state.
Kennedy also said he’s assembling a task force of health experts to study fluoridation and make new recommendations. Also on April 7, the EPA announced it is reviewing “new scientific information” on potential health risks of fluoride in drinking water.
Kennedy has called fluoride a “dangerous neurotoxin” and said it has been associated with arthritis, bone breaks and thyroid disease. Some studies have suggested such links might exist, usually at higher-than-recommended fluoride levels, though some reviewers have questioned the quality of available evidence and said no definitive conclusions can be drawn.
The Pennsylvania Coalition for Oral Health, which is an advocacy group of leaders from across the state coming from schools of public health, philanthropic organizations, businesses, dental organizations, health insurance firms, other advocacy organizations, state agencies and others, supports water fluoridation “as the single most effective public health measure to prevent tooth decay.” The coalition works to rebut or clarify arguments against fluoridation.
Utah last month became the first state to ban fluoride in public drinking water, pushing past opposition from dentists and national health organizations who warned the move would disproportionately hurt low-income residents who can’t afford regular dentist visits. Kennedy praised Utah for emerging as “the leader in making America healthy again.”
“I’m very, very proud of this state for being the first state to ban it, and I hope many more will,” Kennedy said on April 7 in Utah.
During the week prior to Kennedy’s visit to Utah, a massive round of staffing cuts across federal agencies included elimination of the CDC’s 20-person Division of Oral Health that managed grants to local agencies to improve dental health and, in some cases, encourage fluoridation.
Fluoridation abounds nationwide
As a natural mineral released from rocks into the soil and water, fluoride can come from a number of sources but drinking water is the main one for Americans, researchers say. Nearly two-thirds of the U.S. population gets fluoridated drinking water, according to CDC data submitted to that agency from participating states. A 2022 CDC analysis said about one-third of community water systems — 17,000 out of 51,000 across the U.S. — fluoridated their water.
In Pennsylvania, there are more than 1,800 community water systems and each makes its own decision on whether to fluoridate its system, according to the state. A statement on fluoridation posted on the state’s official website says: “For over 75 years, people in the U.S. and worldwide have benefited from drinking water with fluoride, leading to better oral health. Community water fluoridation is recognized as one of the most cost-effective, equitable and safe measures communities can take to prevent cavities and improve oral health. The Pennsylvania Department of Health Oral Health Program (Program) endorses this public health achievement.”
In 2022, Pennsylvania ranked 40th in the nation in the percent of people served by community water systems with fluoridation, according to the CDC. Of 9.5 million people served by community water systems in Pennsylvania, 5.2 million people — or 55% — receive fluoridated water.
The University of Pittsburgh’s School of Dental Medicine, the Pennsylvania Coalition for Oral Health and the University of Pittsburgh’s Collaboratory for Water Research, Education, and Outreach have teamed up to make water fluoridation data more accessible by creating an online, publicly-accessible, interactive community water fluoridation map for the state of Pennsylvania. The map shows that most of the fluoridation in Pennsylvania occurs in areas of Pittsburgh, Philadelphia, Allentown/Bethlehem/Easton, Lancaster, Harrisburg and Erie, among other smaller communities scattered throughout the state. The mapping also shows areas with partial fluoridation in water systems, and areas with water systems that do not add fluoride to drinking water supplies. The map is not relevant to private well water sources.
PAW neutral on fluoridation
Pennsylvania American Water, which is the largest water company in the state and serves 144,000 water customers in 80 communities in Luzerne, Lackawanna and Susquehanna Counties, is neutral on the issue of fluoridation of drinking water supplies.
The company will fluoridate water if a community requests it, and will follow EPA and DEP standards on fluoridation.
“We consider the fluoridation of drinking water supplies to be a community-based decision. This means that any system in which we currently fluoridate, Pennsylvania American Water is abiding by the wishes of all the local municipalities served by the water system,” the water company says on its website.
NEPA counties
In an eight-county region of NEPA, only Hazleton fluoridates its water, according to county information posted by the CDC:
Lackawanna: 34 water systems; none fluoridated.
Luzerne: 78 systems; only Hazleton’s system is fluoridated, serving a population of 36,505.
Monroe: 65 systems; none fluoridated.
Pike: 39 systems; none fluoridated.
Schuylkill: 39 systems; none fluoridated.
Susquehanna: 23 systems; none fluoridated.
Wayne: 38 systems; none fluoridated.
Wyoming: 29 systems; none fluoridated.
Hazleton keeps fluoridation
Efforts were unsuccessful to reach the manager of the Hazleton City Authority water system, which began fluoridating water when it built a treatment plant in 1993.
In October 2021, the authority planned to stop adding fluoride so the aging plant could treat enough water to supply two bottling companies that wanted to hook on, according to archives of The Standard-Speaker newspaper in Hazleton. Removing equipment and supplies for fluoridation would open space for chlorine treatment. The HCA started in October 2021 taking procedural steps to end fluoridation, but in December 2021 reconsidered and decided to keep fluoridation in place.
The Hazleton City Authority administration building on March 28, 2022. (STANDARD-SPEAKER / FILE PHOTO)
The pH of finished water is tested at Hazleton City Authority filtration plant on Jan. 18, 2023. (STANDARD-SPEAKER / FILE PHOTO)
Schuylkill Haven, Montrose/Bridgewater ended fluoridation
Schuylkill Haven Borough’s water system in Schuylkill County also was listed on the CDC website as having fluoridation, but that information was outdated because the Borough Council in 2008, in a cost-saving move, decided to end fluoridation, said borough Administrator Jessica Seiders.
“We removed fluoride from our water system in 2008,” Seiders said. “It was very controversial. Some folks wanted to keep it and some wanted to remove it.”
In Susquehanna County, the borough of Montrose and Bridgewater Township discontinued fluoridation in 2020, according to Pennsylvania American Water.
Scranton: much debate, no fluoridation
In Scranton, fluoridation was first debated seven decades ago, but never implemented. According to a Scranton Times article published Dec. 10, 1954, the Scranton District Dental Society’s mission followed a recommendation by the Welfare Council of Lackawanna County’s dental clinic study committee calling for fluoride to be added to Scranton’s water supply, in an effort to “eliminate the need for so much free work at local dental clinics by reducing the number of cavities caused in teeth of children.” The debate would ensue occasionally over the years. In 1966, 18 people spoke at a Scranton City Council meeting about the idea of fluoride being added to city water.
The president of the Lackawanna County Medical Society said there was “not one shred of evidence” of any harm from fluoridation, while one resident likened it to “using a Mack truck to deliver an aspirin.”
In 1967, the U.S. Public Health Service recommended adding fluoride to water used by Scranton and the larger region, but officials never moved forward on the plan. Talk of fluoride then waned until the Lackawanna County Dental Society raised it in 1974, and when a group of residents calling themselves the Citizens Committee Against Fluoridation opposed the idea.
State bill requiring fluoridation failed
In 1999, then-state Rep. Tom Tigue of Hughestown agreed to debate Dr. Paul Connett, a chemistry professor from New York and noted fluoride opponent, on the issue. Tigue, who had introduced a bill to require fluoride be added to most Pennsylvania water supplies, said the benefits “have been documented in scientific literature for more than 50 years,” according to a Sept. 2, 1999, Scranton Times article. Connett disagreed, saying improvements of children’s oral health around the world had more to do with “improved diet than added chemicals,” the article reported. Tigue’s bill never passed.
Hannah Schoenbaum and Mike Stobbe of the Associated Press contributed to this article.