Utah has made history as the first state in the United States to outlaw the addition of fluoride to its public drinking water systems, a move signed into law by Governor Spencer Cox last month and set to take effect on May 7.
The legislation, known as House Bill 81 (HB 81), marks a significant shift in public health policy, overturning decades of practice aimed at preventing tooth decay. As of today, with less than a month until implementation, the decision continues to stir debate.
The ban, finalized on March 27, prohibits any individual or entity—public or private—from adding fluoride to water intended for public consumption.
It also repeals prior laws that allowed communities to opt into fluoridation upon resident request or during emergencies. Utah’s move comes amid growing national scrutiny of fluoride, fueled in part by US Health and Human Services Secretary Robert F. Kennedy Jr., who assumed office in January and has long criticized water fluoridation as a potential health risk. Mr. Kennedy applauded Utah’s action on April 7, calling it a ‘model for the nation’ and urging other states to follow suit.
For nearly 80 years, since Grand Rapids, Michigan, became the first US city to fluoridate its water in 1945, the practice has been hailed as a public health triumph. The US Centers for Disease Control and Prevention (CDC) credits fluoridation with reducing cavities by about 25% across all age groups, a benefit echoed by the American Dental Association (ADA).
In Utah, however, only about 43.6% of residents received fluoridated water as of 2022, ranking the state 44th nationally. Now, that number will drop to zero.
A push for choice
The bill’s sponsor, Republican Representative Stephanie Gricius of Eagle Mountain, framed the legislation as a victory for personal freedom. ‘This isn’t about denying fluoride’s benefits—it’s about giving people the right to choose,’ Gricius said in a statement last week.
She pointed to a provision in HB 81 that allows pharmacists to prescribe fluoride supplements, with the state’s Division of Professional Licensing tasked with setting guidelines by June. ‘If families want fluoride, they can get it. But it shouldn’t be forced through our taps.’
Supporters also cite cost concerns. Adding fluoride to water systems, they argue, places an unnecessary burden on taxpayers, especially in rural areas where infrastructure upgrades can be pricey. Governor Cox, who grew up in a non-fluoridated community, reinforced this view in a March interview with ABC4, noting he saw no stark oral health disparities between fluoridated and non-fluoridated parts of Utah.
The decision aligns with a broader push from the Trump administration, with Mr. Kennedy vowing in November 2024 to ‘advise all U.S. water systems to remove fluoride’ due to alleged links to neurological and skeletal issues—claims that remain contentious among scientists.
Dental fears and economic fallout
Opposition has been fierce.
The ADA, Utah Dental Association, and local health advocates warned that the ban could reverse decades of dental progress, particularly for low-income families who rely on fluoridated water as their primary source of cavity prevention.
‘Cavities are already the most common chronic disease in kids,’ said Dr. Val Radmall, executive director of the Utah Dental Association.
Data from the Utah Department of Health and Human Services backs this up: communities with fluoridated water have seen declining dental disease rates, while non-fluoridated areas report increases. Nationally, the CDC estimates fluoridation saves $6.5 billion annually in dental costs. In Utah, where only 66 of 484 water systems added fluoride in 2024—most notably Salt Lake City—the ban could hit hardest in urban centers now losing that shield.
Local businesses are bracing for change too. Craft soda shops, a Utah staple, worry about rising dental issues boosting demand for sugary drinks already under scrutiny.
Science and Skepticism
The debate hinges on science as much as philosophy.
A September 2024 federal court ruling ordered the Environmental Protection Agency to regulate fluoride after finding that levels above 0.7 milligrams per liter—the US standard—might pose an unreasonable risk to children’s IQ. Yet, the same ruling found no conclusive harm at typical fluoridation levels.
A 2024 National Institutes of Health review of 74 studies linked high fluoride exposure to lower IQ, but experts note those levels—often from natural contamination in places like China—far exceed U.S. norms.
The ADA insists fluoridation’s benefits outweigh its risks, calling Utah’s ban a wanton disregard for public health.
Meanwhile, skeptics point to fluoride’s availability in toothpaste and supplements, questioning the need for mass application via water. ‘It’s an outdated fix,’ said anti-fluoride activist Tara Lee of Sandy, referencing a 2019 pump malfunction that briefly spiked fluoride levels in her town, sickening hundreds.
A national test case
Utah’s experiment is being watched closely. Florida, Ohio, and South Carolina are mulling similar bans, while efforts in New Hampshire, Tennessee, and North Dakota have faltered.
Kentucky’s optional fluoridation bill remains stalled. With two-thirds of Americans—over 200 million people—still drinking fluoridated water, Utah’s outlier status could spark a domino effect—or a cautionary tale.
As May 7 nears, Utahns face a new reality: a state without fluoridated taps, where dental health may hinge on personal initiative. Whether this proves a triumph of choice or a public health misstep, the world’s first fluoride-free state is stepping into uncharted waters.