Most of the country’s population is served with water systems that have fluoridated water, but Robert F. Kennedy Jr., a key supporter of President-elect Donald Trump, has vowed to end that practice.

The debate over fluoride in drinking water isn’t new, but it has been elevated again with Kennedy’s push to remove the chemical, alleging it does more harm than good. However, proponents of fluoridated water have pushed back on the likely costly move to do so.

What Fluoride in drinking water does

The Centers for Disease Control and Prevention says adding fluoride to drinking water is “a cornerstone strategy for prevention of cavities” in the country and named it one of the 10 great public health inventions of the last century.

Implementation of water fluoridation is largely up to state and local governments, with the first city in the country to fluoridate its drinking water in 1945 being Grand Rapids, Michigan. The agency claims that research has shown the action improved the dental health of the greater population.

“Drinking fluoridated water keeps teeth strong and reduces cavities by about 25% in children and adults. This results in less mouth pain, fewer fillings or teeth pulled, and fewer missed days of work and school,” it says on the agency’s website.

Data from the CDC show in 2022, an estimated 209,135,866 people were on fluoridated water systems in the United States, accounting for roughly two-thirds of the country’s population.

What is the debate about fluoridated water

Kennedy has been a staunch opponent of the fluoridation of drinking water, claiming that adding fluoride causes problems for bones and neurodevelopmental disorders.

On January 20, the Trump White House will advise all U.S​. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease. President…

— Robert F. Kennedy Jr (@RobertKennedyJr) November 2, 2024

“On January 20, the Trump White House will advise all U.S​. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” Kennedy said in a post on X days before the Tuesday election.

The CDC and other health professionals have pushed back on the claims, and the CDC noted that “almost all water contains some naturally occurring fluoride.”

In recent years, concerns by some studies over the effects of fluoride in drinking water have led to some communities reconsidering adding it to their water systems.

With Kennedy’s informal anointing by Trump prior to the election to push a “Make America Healthy Again” agenda within his administration, the steps toward undoing government efforts to push fluoridated water could begin shortly after the president-elect is sworn in next year.

How likely is the proposal to remove fluoride from drinking water

The federal government does not currently mandate fluoride in drinking water, as the U.S. Public Health Service recommended fluoride level is not enforceable by law. Adding fluoride to drinking water is left to state and local governments, which could complicate efforts to remove fluoride in a sweeping fashion.

A report from Politico details a way the incoming Trump administration could use the Toxic Substances Control Act and a federal court decision from an Obama-appointed judge. The September ruling said fluoride in water provided enough of a health risk that it should be regulated under the Toxic Substances Control Act.

“EPA does have broad authority under TSCA, and if [the administration wants to be] really aggressive in its approach to implementing a ban, there are certainly the authorities there,” Robert Sussman, a former EPA deputy administrator during the Clinton administration, told Politico.

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The report points out that the law has been used to ban asbestos and methylene chloride in the past.

The price of removing fluoride from drinking water could be costly, though how much is currently unknown.