Pulling fluoride from U.S. drinking water could leave millions of children with cavities and saddle families with billions of dollars in dental costs, according to a new analysis.

The Journal for the American Medical Association’s Health Forum study estimates that ending fluoridation nationwide would result in 25.4 million additional cavities in kids within five years — a rate equivalent to one in three children with tooth decay. That number could more than double to 53.8 million cavities in a decade.

Since becoming Health and Human Services secretary, Robert F. Kennedy Jr. has pushed to end water fluoridation, calling it “industrial waste” and citing potential neurotoxic risks. He also instructed the Centers for Disease Control and Prevention to stop recommending community fluoridation — a major break from decades of public health policy.

The researchers projected that filling the cavities would cost $9.8 billion over five years and $19.4 billion over 10, a figure they describe as likely to be conservative.

“It doesn’t take into account related issues,” study author Dr. Lisa Simon told NBC, “like whether a child has to go under general anesthesia … or if parents have to miss work to take children to the emergency room because of extreme toothaches.”

HHS did not respond to a request for comment.

Dr. Simon and a colleague examined CDC data from 8,484 children, ages 0 to 19, pulled from the National Health and Nutrition Examination Survey, which tracks diet, medical exams, lab work and dental visits.

Florida and Utah have already banned fluoride in public water, and more may follow as Mr. Kennedy rolls back federal dental health precautions.

“This is a tremendous increase,” said Dr. Tom Reid, president of the Wisconsin Dental Association, per NBC. “It’s another bit of proof that what we’ve been saying for over 80 years is 100% accurate: Proper dosing of community water fluoridation prevents cavities.”

What’s more, the financial and health burdens would disproportionately affect low-income families and children on Medicaid, according to Dr. Simon.

The U.S. has been adding fluoride to drinking water for decades. However, under Mr. Kennedy, the CDC’s oral health division has been gutted and fluoride critics are gaining momentum.

A 2024 report by the federal National Toxicology Program found that drinking water with more than 1.5 milligrams of fluoride per liter, which is more than twice the recommended level, was associated with lower IQs in children. The studies were conducted in Mexico, Canada and Iran, as well as several Asian countries.

The new study didn’t assess potential cognitive effects, noting that current fluoride levels “are not definitively associated with worse neurobehavioral outcomes.”

It did find that eliminating fluoridation would reduce cosmetic fluorosis — by about 200,000 fewer cases over five years — though the condition, which causes discoloration of teeth, is harmless.

Dr. Reid warned against repeating past mistakes: “It doesn’t take immense intellectual ability to realize that, boy, there are communities that have done this and regretted their decisions.”

• Emma Ayers can be reached at eayers@washingtontimes.com.