LEBANON, Ore. — Longtime denizens of this town of 20,000 recalled widespread tooth decay among children before the city council voted to add fluoride to the drinking water two decades ago. But a group of residents remained unconvinced.
They urged neighbors to do their own research, insisting it would reveal that the mineral embraced for generations to improve oral health was actually a dangerous substance that could harm their organs. They shared photos of corroded pipes and scarred arms they claimed were damaged by the acidic, concentrated form of fluoride. Was it worth $25,000 a year in tax dollars for the city to put fluoride in drinking water?
The skepticism prevailed on Election Day as Lebanon voters narrowly voted to remove fluoride from the water supply, mirroring how more Americans are starting to question a practice experts have lauded as one of the greatest public health achievements of the 20th century.
Robert F. Kennedy Jr., a longtime vaccine skeptic whom President-elect Donald Trump has chosen to be his Health and Human Services secretary, wants communities across the nation to follow Lebanon’s lead. Days before the election, Kennedy said the Trump administration on Inauguration Day would advise water districts to remove fluoride, which he referred to on X as “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.” Despite medical organizations characterizing Kennedy’s assertions as unfounded, Trump quickly supported the idea in an NBC interview.
The newfound national attention on fluoride injects the intense partisan passions of a Trump presidency into an issue that historically has been hyperlocal. Most Americans drink fluoridated water to strengthen their teeth. But backlash is growing because of research showing potential harms. A Florida city commission voted last week to remove fluoride, with one commissioner citing Kennedy’s comments.
“There’s a movement across the United States right now that is starting to rethink some of these practices that maybe we thought were normal or good for public health,” said Lebanon Mayor Kenneth Jackola, who joined others on the city council to refer the issue to voters.
Robert F. Kennedy Jr. has said he wants fluoride out of America's drinking water. Tension over the issue has already divided some Oregon cities. (Video: Fenit Nirappil, Elana Gordon, Drea Cornejo/The Washington Post)
Oregon, the third least fluoridated state, one where the mineral has long been a contentious issue, offers a window into the fluoride fights to come. Just 26 percent of Oregonians using community water systems drink fluoridated water, according to the Centers for Disease Control and Prevention, compared to 72 percent of Americans overall.
Portland is the nation’s largest city without fluoridated water, and voters have repeatedly rejected efforts to add it since 1965, most recently in a bruising 2013 ballot measure vote. In addition to conservative Lebanon, residents of Hillsboro, Oregon, a Democratic-leaning Portland suburb, voted in November against a ballot measure to fluoridate its water supply. About 20 communities nationwide in recent weeks have moved to remove fluoride, according to the Fluoride Action Network, a national organization that opposes fluoride.
The battles in Oregon illustrate how fear of fluoride spans partisan lines, tapping into distrust of authorities and mainstream science.
During a recent lunch hour at a 1950s-themed diner in quaint downtown Lebanon, patrons expressed mixed views about fluoride.
David Cox, a contractor, said he grew skeptical of fluoride after watching YouTube videos that described fluoride as a rat poison and a way Germans made prisoners docile during World War II. Both claims have been debunked.
His wife, Beverly Sherwin, a retired pharmacist and former nurse who said she gave her child fluoride tablets, pushed back: “It’s been in water for years, and it’s totally safe.”
Still, she opposes putting fluoride in drinking water, because she believes people should make their own choice.
Health concerns propel anti-fluoride movement
The discovery of fluoride’s oral health benefits traces to 1901, when a dentist in Colorado Springs noticed his patients had brown stained teeth that were oddly resistant to decay and cavities. It turns out they were drinking water from a spring with elevated levels of the naturally occurring fluoride mineral, which in large amounts can stain teeth.
Bacteria breaking down food produces acids that degrade the teeth, and fluoride works to replenish the lost minerals and strengthen the enamel.
Grand Rapids, Michigan, in 1945 became the first city in the world to fluoridate its drinking water, and long-term research showed the cavity rate plunged in children born after the mineral was added. By 1980, half of Americans drank fluoridated water after the practice rapidly gained steam — along with the conspiracy theories.
The John Birch Society and Sen. Joseph McCarthy in the 1950s charged fluoridation was part of communist plots against the United States, arguments later parodied in the 1964 film “Dr. Strangelove.”
Kurt Ferré, a retired dentist in Portland who has crusaded for fluoridation in Oregon for more than two decades, says he has confronted a dizzying array of anti-fluoride arguments in communities across the state. It would spoil the taste of beer. It would interfere with salmon runs. It was tantamount to putting an industrial pollutant in drinking water.
“It’s much easier to scare the public than to unscare them,” said Ferré, treasurer of the American Fluoridation Society & American Fluoridation Institute.
As Kennedy touts his “Make America Healthy Again” agenda, he refers to fluoride as a “dangerous neurotoxin” that he argues reduces IQ in children, even at low doses.
“I think fluoride is on its way out,” Kennedy said in an NBC News interview hours after Trump secured victory. “I think the faster that it goes out, the better.” He said he would not compel water districts to remove the mineral but rather, advise them of their legal obligation to their constituents.
In recent months, the anti-fluoride movement has gained legitimacy from credible institutions that have cast doubt on fluoride and spurred intense scientific debate.
An August report from the federal National Toxicology Program examining fluoride research concluded with “moderate confidence” that higher levels of fluoride are associated with lower IQ in children. The underlying research came primarily from countries with fluoride levels above what health authorities consider safe; the report noted that there was not enough data to determine whether the levels used in the United States would affect children’s IQ.
A federal judge in September ordered the Environmental Protection Agency to further regulate fluoride in drinking water based on that report and other studies. The judge noted that his ruling responded to a potential risk and did not “conclude with certainty that fluoridated water is injurious to public health.”
The American Dental Association argued that the underlying studies were flawed and contradicted a body of research demonstrating fluoride’s benefits.
An extensive review of studies by the Cochrane Library, considered the top-tier systematic analysis of scientific evidence, published in October found fluoridation may slightly reduce cavities and tooth decay in children, but the effect has become smaller since 1975, when fluoridated toothpaste became widely available. A co-author of the review cautioned that it should not be used to justify removing fluoride from drinking water.
Fluoride proponents point to evidence in Calgary, Canada, and Juneau, Alaska, where dental problems rose last decade after fluoride was removed. Anecdotally, pro-fluoride Oregon dentists say they can easily spot whether patients grew up with fluoride when they lie back and open their mouths; those with the most cavities often grew up in Portland or other communities without fluoridated water.
Staci Whitman, a Portland dentist who opposes the fluoridation of drinking water after once supporting it, said those observations are not backed by rigorous data. She said she, like many of her colleagues, was once quick to dismiss fluoride skeptics as a “tinfoil hat brigade” of “pseudoscientists.” She even campaigned for a 2013 Portland ballot measure to add fluoride. But she said she started to doubt the lessons she learned in dental school as she heard opponents cite studies about health consequences, including for the brain.
So when Hillsboro, a city where she once practiced, took up its own ballot measure this year, Whitman spoke out against it.
“If there’s any question about what it could be doing to a child in their brain health, in their thyroid health, in their bone health, in their microbiome health, I think we really need to be having a nuanced professional conversation about it and start moving away from the judgment and knee-jerk reaction,” Whitman said in her North Portland dental office plastered with signs offering healthy diet tips as an alternative to fluoride to protect teeth.
The scars of Portland’s last fluoride ballot measure, which resoundingly failed, still sting more than a decade later after the charged campaign went beyond a simple scientific discussion.
Lisa Bozzetti, a Hillsboro-based dentist, was reluctant to join the suburb’s fight for fluoride this year after passersby, while canvassing for the Portland measure, accused her and her colleagues of trying to kill their children.
But she was ultimately swayed by Beth Mossman, a Hillsboro pediatrician who spearheaded the campaign after seeing patients in dental crises, including one whose parent had to sell a car to afford oral surgery.
As dental director of Virginia Garcia Memorial Health Center, a federally qualified facility that serves many Latino and immigrant patients, Bozzetti argued fluoridated water would help an entire community, including people without reliable access to dental care or who do not know about the value of fluoride.
“Yes, you can have fluoride tablets, you can go out and buy (fluoridated) toothpaste, but again, you have to have the means to be able to do those things,” Bozzetti said.
Mary Tran, a Pacific University dental hygiene student who campaigned for the Hillsboro ballot measure, did not want other children of immigrants to go through what she did growing up in areas of California and Hillsboro without fluoride.
Tran said she had so many cavities that she was embarrassed to open her mouth and had to be restrained when she got her cavities filled. Her parents grew up in Vietnam being told they only needed to swish water around to clean their mouths, but still encouraged her to brush and floss. Even if they had known about fluoride supplements, she’s not sure whether they would have been able to afford it.
“I had to wonder if I grew up with fluoride in the water, would I have so many cavities,” Tran said.
Caroline Black, a Hispanic mother and one of the leaders of the anti-fluoride group Clean Water Hillsboro, said the equity argument for community fluoridation was fundamentally flawed, because there are mobile dental clinics and other resources for people to get fluoride tablets and oral hygiene products.
“It’s not like it’s completely unavailable,” said Black, accompanied by her three young children at a celebration for their campaign, where organizers joked the cakes were fluoride-free. “Most of the Spanish speakers I have spoken with agreed with me: They like it being their choice and don’t want their choice taken away.”
She said she was thrilled when she learned fluoride also suffered a defeat in Lebanon and that Kennedy is bringing more attention to the issue.
“It’s not just a local thing anymore,” she said. “It’s got this large-scale audience now.”
A community abandons fluoride
In Lebanon, the flier left on Cordero Reid’s door struck him as absurd. It was an annotated manufacturer safety report on the acidic form of fluoride added to the city’s water supply, noting it is corrosive and may be harmful if swallowed. “Is it really fair to forcibly submit everyone to this controversial substance?” the flier asked.
The acid is highly diluted before it reaches taps, in line with other substances that can be harmful in their original forms before they are treated for human consumptions.
Reid mockingly posted a graphic warning of the dangers of “dihydrogen monoxide” (otherwise known as water) — including bloating and even death — on a popular community Facebook group.
But his joke didn’t seem to land, and the ballot measure prevailed with 52 percent of the vote. He said a relative who lives with him believes fluoride is a tool to control Americans.
“It also shows me how prevalent the anti-science movement in the United States has been,” Reid said.
Sabrina Mann, one of the leaders of the anti-fluoride movement in Lebanon, said she believes the science is on her side. There was no fluoride in the water in Texas where she grew up. When her husband Carl aided water purification efforts for the military, fluoride was never included in water systems they developed abroad.
The mental health worker resents how local media cast their successful effort as one orchestrated by right-wing activists. It should remain an apolitical issue about drinking water, she said, even if the Trump administration embraces defluoridation. Mann would not share how she voted for professional reasons.
Activists who want to remove fluoride in other parts of Oregon, including Beaverton, a Portland suburb where Nike is headquartered, and Scappoose, a tiny town nestled in forests, are turning to the anti-fluoride Lebanon activists to learn how they prevailed.
As dental supply stocks surged after Trump tapped Kennedy to be his health secretary last week and investors bet on a boom in visits to the dentist, city officials in Lebanon prepared to shut down the fluoride treatment room of the water treatment plant.
Two large tanks of hydrofluosilicic acid are tucked away in the back of a building with a sprawling network of pipes and membranes cleaning river water for human consumption. Workers must don extra protective gear, including respirator masks, chemical goggles and face shields to enter the fluoride room, because exposure to the acid before it is highly diluted can be dangerous — precautions that spooked city officials and citizens who toured the facility to learn about fluoridation.
With a press of a computer button, the pumps injecting fluoride will no longer operate.
By the end of winter, the fluoridation room is likely to be just another storage area stacked with salt bags.
Elana Gordon contributed to this report.