OAK GROVE, Miss.—The North Lamar Water Association is considering ending community water fluoridation, citing costs, equipment problems and operator safety. The system has not met recommended federal fluoride standards since 2020.
Community water fluoridation adjusts naturally occurring fluoride in drinking water to levels shown to help prevent cavities. Health officials say the practice has driven down cavity rates nationwide since it was first introduced in 1945. The Centers for Disease Control and Prevention calls it one of the nation’s major public health achievements, noting it helps prevent cavities by at least 25%.
Despite those benefits, North Lamar leaders say rising expenses, difficulty keeping fluoride levels steady and safety concerns for workers handling the chemical have pushed them to reconsider the program.
Cost Concerns
Kim Burge, office manager for the North Lamar Water Association, said expenses have become a burden and supplies have grown harder to find.
“It’s not just costly … fluoride has been hard to get a hold of since COVID,” she said.
The American Dental Association says community water fluoridation is the most cost-effective way to prevent tooth decay.
A 2016 study led by the Colorado School of Public Health, found communities of 1,000 or more people see an average estimated return on investment of $20 for every $1 spent on water fluoridation.
The return grows with population size, but even small communities save money. On average, fluoridated communities saved $32 per person each year by avoiding treatment for cavities.
Cameron Wooten, a college student who lives in the service area, said he favors keeping fluoridation even if that means higher rates.
“Everybody needs healthy teeth,” he said. “Research has shown it’s safe … it’s good for your teeth … once you don’t have healthy teeth, your health goes down.”
Johnny Johnson, a pediatric dentist and president of the American Fluoridation Society, said ending the practice would hurt low-income families most.
“The families who are the poorest—are living in poverty—get hurt the hardest, because they have the least ability to get to a dentist,” he said.
Maintaining Optimum Levels
While the CDC does not mandate community water fluoridation, the U.S. Public Health Service recommends 0.7 parts per million for oral health benefits. Natural levels in U.S. groundwater can range from very low to more than 4 ppm.
Consumer Confidence Reports show North Lamar’s fluoride levels have fallen below the recommendation since 2020. A 2019 report, the most recent with a high result, showed levels exceeded the target by more than double in 2017.
According to Burge, the lower-than-recommended levels are the result of fluoridation equipment that has been out of operation.
“That’s the reason we sent out letters … fluoride equipment at the wells, they have been down, and we were not able to get parts,” Burge said. “That started people not having fluoride in their water.”
Brian Street, a North Lamar Water Association customer, said learning fluoride levels have fluctuated—including a high reading in 2019—left him uneasy. Too much fluoride over time can cause dental fluorosis, a condition that changes the appearance of tooth enamel.
“Knowing it now, it does land a bit of a concern,” he said. “If we end up on the higher end for long enough, what damage could that do … and what added costs could that bring?”
Street said his family would adjust if fluoridation ends—by consulting dentists and relying more on toothpaste and other products. He said ultimately, he values household choice.
“Taking it out is a choice that can really give a lot more autonomy to the individual and decrease a lot of the risk that comes into play,” he said.
Concerns Over Operator Safety
Even as health experts hail fluoride as a tool for preventing cavities, North Lamar officials say it poses risks for workers who handle it.
“One of our operators, they said a drop got on the concrete and it ate through the concrete,” Burge said. “People don’t like to handle stuff like that, and when your customers don’t want it…”
Oak Grove firefighter Brandon Lee said, as someone who regularly deals with hazardous materials, he believes operator safety should be considered carefully.
“(The board) needs to listen … and take the biggest measures they can to protect those guys,” he said.
The American Dental Association says fluoridation is a safe, regulated process for operators and is subject to federal safety standards. The ADA says facility personnel who use proper protective equipment limit hazardous exposure to fluoride.
Veronica Gates, oral health director at the Mississippi State Department of Health, said handling fluoride is not a sticking point.
“There are no risks,” she said. “Water operators have the opportunity to be trained on the appropriate steps to take to apply fluoride to our water systems.”
This summer, the department offered grants to water systems with existing fluoridation programs to help cover equipment, on the condition of continuing fluoridating for at least three years and that all employees handling fluoride complete CDC training. No systems signed up.
“If they got a grant to be able to safely handle it—and if an exact amount goes into the system every single time—then, yeah, I’m for it,” Lee said.
Beyond North Lamar
According to Mississippi’s most recent statewide screening of third graders, in 2015–16, 61% of children had tooth decay and 22% had untreated cavities; 34% had dental sealants. Parents also reported barriers to regular dental care.
The state estimates about 55% of Mississippians receive fluoridated water. According to the Department of Health, 201 public systems adjust fluoride levels, 18 are naturally fluoridated and 46 are connected to a fluoridated system. Federal Preventive Health and Health Services Block Grant funds are available to communities that want to add fluoridation systems.
State officials say the grants help communities lower the prevalence of cavities by increasing access to fluoridated water. With more than 97% of Mississippi residents on public water systems, health leaders say there is significant room to expand fluoridation coverage.
The debate over fluoridation has also intensified nationally as U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has promoted unproven claims that fluoridation is dangerous. In April, Kennedy said he would move to end the CDC’s recommendation for community water fluoridation.
The American Dental Association reaffirmed support for fluoridation in response, calling it safe and effective at the recommended level. Fluoridation is regulated under the Safe Drinking Water Act, and additives must meet independent safety standards.
The ADA cites multiple studies indicating tooth decay tends to rise if a community ends fluoridation, even when products such as fluoride toothpaste and rinses are widely used.
Gates said supplements can fill the gap for some families if fluoridation ends.
“Fluoride supplements can be substituted for families who visit their dentist or have the financial means to purchase them,” she said. “These supplements must be provided through a prescription from a dentist. Access may be difficult for everyone.”
The North Lamar Water Association’s board will take public input on the proposal Oct. 6 at its Oak Grove office. Registration to speak will be open from 4:30 to 5:30 p.m.
This article first appeared on RHCJC and is republished here under a Creative Commons Attribution 4.0 International License.