Kentucky lawmakers voted in favor of legislation Thursday that dental experts say could set state oral health back decades.
House Bill 141 adds the word “optional” to the state’s water fluoridation program.
Rep. Mark Hart, a Republican from Falmouth who is the lead sponsor for the bill, has filed nearly identical legislation five other times, but it has never before received a committee vote or progressed to a chamber floor for a vote.
“My bill does not remove fluoride from the water. My bill just allows a local option. It undoes an unfunded mandate,” Hart said.
Any water system serving more than 3,000 people is required to add fluoride to the water if it doesn't naturally occur in the water, according to a state law. Hart’s measure would add language that leaves the decision to fluoridate to the governing body of a water system.
The House Standing Committee on State Government voted 16-1 in favor of the bill. One Democrat, Rep. Tina Bojanowski of Louisville joined with Republicans in support. It now moves to the House floor for consideration.
Several Republicans said they believe there is conflicting research on the health benefits of water fluoridation, and would rather leave the matter to local control. However, the executive director of the Kentucky Dental Association told committee members a majority of evidence shows the overwhelming benefits of fluoridation.
“We have a preponderance of evidence that shows the benefit of this program. And I would just really hate to see the state mandate removed,” Steve Robertson said. “I understand the push for local control, but there are a lot of things that we don't get to decide locally. I just feel this shouldn't be one of the things on that list.”
Robertson said that Kentucky is already low in the national rankings for dental health. He believes eliminating state requirements for fluoridated water would leave people in counties that opt out in an even worse standing, he said.
“We are struggling with oral health in Kentucky. And obviously, that's not something any of us are happy with. We have access-to-care issues. We have provider issues. We have a Medicaid program that's not funded at a high enough level for people who participate to remain in business,” Robertson said. “But if we remove fluoride, do we actually want to see it get worse?”
There has been significant research on the effects of fluoride on children and the general public since before states began implementing fluoridation programs in the 1960s — Kentucky was one of the earliest states to mandate its use.
As a result, more than 99% of the state’s population is served fluoridated water, according to the latest data U.S. Centers for Disease Control and Prevention.
The CDC has recognized community water fluoridation as one of the greatest public health achievements of the 20th century. On average, it’s believed to save an average of $32 per person in avoided dental treatment costs. Nationwide it’s estimated to save more than $6.5 billion per year.
Despite the well-researched benefits of water fluoridation, skepticism of the program goes back decades. It was back in 1964 the movie “Dr. Strangelove or: How I learned to stop worrying and love the bomb,” satirized conspiracies around fluoride as a communist plot meant to “impurify” Americans’ precious bodily fluids.
More recently, a 2013 episode of Parks and Recreation pitted the show’s protagonist against a city council member intent on keeping the city’s water from having fluoride to boost sales at his dental practice.
Republican Rep. William Lawrence from Maysville said he considers requiring every county to use fluoride to be coercive.
“Honestly, it is forced medication. That's what we're doing and that this bill, whether you're for or against fluoride, this bill has nothing to do with that,” Lawrence said. “This is about local control. Let the local water districts decide what's best for their districts.”
One nurse who spoke as an expert witness in front of the committee Thursday said she researched fluoride after having children and found it may harm childhood development.
However, a 2020 review on fluoride toxicity showed that the evidence pointing to fluoride neurotoxicity is highly flawed and reliant on large-scale studies that did not control for the huge number of variables which can affect human development. It concluded that “based on the totality of currently available scientific evidence” fluoridation at safely controlled levels is not a developmental neurotoxin.
Jennifer Hash, a dental hygienist and member of the Kentucky Oral Health Coalition, also spoke against the bill. She noted that Kentucky is already suffering from a shortage of dental care, especially dentists who take Medicaid. She questioned whether the state would be able to bear the cost of increased Medicaid spending for medical emergencies for children suffering from more dental problems.
She said that most of her experience has been in caring for patients in underserved areas and said that many of the kids she treated struggled with dental issues and pain.
“I ended many clinical days in tears, overwhelmed at the disparities we were seeing and the overall lack of resources for children to find care,” Hash said. “Without water fluoridation, dental decay rates could increase by up to 25%. And this is an increase that our strained dental workforce cannot handle.”
LPM's state government and politics reporting is supported in part by the Corporation for Public Broadcasting.
