Florida’s surgeon general, Joseph Ladapo, on Friday recommended that communities in the state stop fluoridating their water — a move that could be a sign of more public health shifts to come under the incoming Trump administration.
The guidance issued by Ladapo, which is not binding, points to research noting an association between decreases in IQ and fluoridation as well as the availability of fluoride from other sources. Experts tell STAT that despite the kinds of safety concerns cited in the announcement, the weight of scientific evidence favors water fluoridation as a way of preventing tooth decay. But the growing national influence of Robert F. Kennedy Jr. — President-elect Donald Trump’s nominee for secretary of Health and Human Services, and a vocal critic of fluoride as well as vaccines — has public health experts concerned that more state and local governments will follow suit.
“The recommendation by Joseph Ladapo to cease fluoridation of the Florida drinking water supply is exactly the concern that I have about the anti-science approach of RFK Jr. Even before he is confirmed as HHS Secretary, his anti-science agenda is taking shape in Florida,” says Lawrence Gostin, the director of the O’Neill Institute for National and Global Health Law. “Any idea that flies off the head of RFK Jr. gets rushed into policy and guidance. This is exactly the wrong way to set public health policy.”
Ladapo’s announcement follows the Florida city of Winter Haven voting last week to cease water fluoridation.
At the levels currently recommended by the Centers for Disease Control and Prevention, there is little data to suggest safety concerns with fluoride. At much higher levels, teeth can get stained, and at even higher levels, there is the potential for skeletal fluorosis, which is when fluoride attaches to bones and can make them more brittle.
“It is very disappointing since there is no scientific evidence warranting this, and millions of Floridians will have more cavities as a result,” said Steven Levy, a professor of dentistry at the University of Iowa.
In his guidance, Ladapo writes, “Floridians should be aware of safety concerns related to systemic fluoride exposure” and cites several European countries that do not fluoridate their water as models. But several of these countries provide fluoride in other ways, such as in salt. Ladapo, Levy said, “should expand other caries-preventive programs to make up for this, but that will cost many times more dollars to get similar amounts of prevention, especially to the underserved.”
If Kennedy becomes secretary of HHS, experts say he’ll be limited in what he can do about fluoride on the national level. But he could use his platform to encourage conservative local officials to stop the addition of fluoride.
“This announcement is the next frontier of the war on science and public health. It’s also the next logical step after Ladapo’s spreading of misinformation around vaccines,” says Matt Dallek, a political historian at George Washington University. “It also reveals the power RFK Jr. now has. Not only has he pushed vaccine skepticism to the fore of Trump’s policy, he’s also brought fluoridation into the debate.”
Ladapo, who has served as surgeon general of Florida since 2021, is known for spreading misinformation surrounding the Covid vaccines, for which he was rebuked by the CDC. He has also been floated as someone who could get a senior role at the HHS under RFK Jr.
“It’s a bad omen,” Dallek said of Ladapo’s new guidance. “What’s stopping red states like Texas, Georgia, and Ohio from following suit?”
If Kennedy suspects that evidence favors no longer fluoridating water, Gostin said, he would recommend that the Trump administration commission the National Academies of Science to conduct a study of the harms of fluoride, which could then guide policy decisions.
“That is what the Academies did when it reviewed the links between MMR vaccines and autism. It found no causal connection whatsoever,” Gostin said. “But that hasn’t stopped Kennedy from spewing falsehoods.”
