MIAMI-DADE COUNTY, Fla. – Miami-Dade County commissioners voted Tuesday to remove fluoride from the county’s drinking water, reversing a decades-old public health measure that local dentists and public officials say has helped prevent tooth decay since 1958.
Miami-Dade District 7 Commissioner Raquel Regalado, who oversees the county’s Water and Sewer Department, opposed the move.
“They made this decision without a deep dive into the science and without talking to experts. It is a political decision that was made,” Regalado said.
The next step in the process involves decommissioning parts of the county’s water treatment facilities that have long adjusted naturally occurring fluoride levels to optimal standards for dental health.
“We have 30 days to take out the water completely,” Regalado said. “We start with eliminating the contracts of purchasing of the fluoride and finding someone who wants to buy the fluoride from us.”
Fluoride has been added to Miami-Dade’s water supply for over 65 years as a public service aimed at reducing dental decay in children and adults. Experts warn removing it could lead to increased dental problems, particularly for low-income families.
“We know as of 80 years of research that it is safe and effective to prevent tooth decay because it strengthens dental enamel,” said Dr. Beatriz Terry, immediate past president of the Florida Dental Association.
“I can’t believe we are having this discussion right now, because it is such a great public service — having fluoride in the water was the first line of defense.”
Terry said parents should turn to fluoridated toothpaste and rinses, but emphasized that topical applications aren’t as effective as systemic ingestion.
“Topical fluoride application does not meet the same needs as systemic ingestion of fluoride so it won’t be the same,” she said. “But if they’re seeing an uptick in decay, they need to be notifying their government officials.”
Miami-Dade would not be the first community to reverse fluoridation, and experts say history shows that decay often rises sharply after removal.
“My concern is we are going to have a higher incidence of decay — it has been shown,” Terry said. “There are other states, countries that have tried this only to go back and put fluoride in the water.”
One such example is Calgary, Canada, which removed fluoride in 2011 only to vote to restore it after dental infections at Alberta Children’s Hospital rose by 700%, with half the cases in children under five.
In Juneau, Alaska, and elsewhere, research has shown a roughly 25% increase in cavities following fluoridation cessation. Click here to review a 2016 study on this trend.
Back in Calgary, a plebiscite held in 2021 showed 62% of voters supported putting fluoride back into the city’s water.
In Buffalo, New York, Terry said some residents are suing their local government over increased decay.
“Parents need to be informed,” Terry said. “Recognize that the experts, the dentists are the ones pushing for fluoride. If it were bad for you, we would be in favor of taking it out. Actually, that would increase our business, right? We are doing it because we believe that as a profession, preventative care is most important.”
Regalado echoed legal concerns:
“I believe the county should not have done this,” she said. “I think they are stepping into a class action. All the counties who have done this in the past have been sued and will be sued, so I think we are exposing our residents to litigation unnecessarily.”
To help offset the impacts, Commissioner Roberto Gonzalez’s office shared a list of low-cost and free dental resources for families:
The American Dental Association states that community water fluoridation is “safe and effective in preventing tooth decay for both children and adults,” and public health decisions should rely on the “collective weight of scientific evidence.”
Critics of the decision say state leaders have relied on fringe or flawed studies to justify their stance. One such study linked fluoride exposure to lower IQ in children, but was based on levels more than twice the U.S. regulatory limit.
Florida Surgeon General Dr. Joseph Ladapo has acknowledged that fluoride helps strengthen enamel but recently told commissioners that the issue was “new” to him.
He suggested providing free toothpaste instead of fluoridating the water.
“There are two types of fluoride and they are both critically important,” said Dr. Richard Mufson, an oral surgeon based in Aventura. “You can’t just say let’s forget the systemic and just do topical because that is not nearly as good — you need both.”
Mufson warned of the long-term health consequences of untreated cavities, which can lead to facial infections, hospitalizations, and in some cases, death.
“Cavities are a bad problem because they become bigger cavities,” he said. “That develops into potentially a facial infection and hospitalizations and IV antibiotics and even death.”
Lawmakers passed a bill that would ban the public health tool of community fluoridation statewide. It awaits Gov. Ron DeSantis’ signature as of Wednesday evening. Click here for more information.
