BIRMINGHAM, Ala. — Across Alabama, a growing number of cities and counties are reconsidering or halting the long-standing practice of adding fluoride to public water supplies, a trend that public health experts warn could worsen the state’s already declining oral health.
Madison, Alabama, is set to stop fluoridating its water on June 16 unless the water board reverses its decision, following vocal opposition and concerns that the public was not consulted. The debate has pitted residents who cite scientific evidence supporting fluoride’s benefits against those who argue against its use, often citing conspiracy theories or misinformation.
Other municipalities, including Orange Beach, Sylacauga, Childersburg and Abbeville, have already ended water fluoridation. In these places, decisions were made after public hearings and city council votes, but the result has been the same: less access to a proven cavity-fighting tool.
Dr. Tommy Johnson, the state dental director for public health, emphasized that fluoride is especially important in areas with limited access to dental care. Dental decay is the most chronic disease in childhood.
Recent studies show that only seven of Alabama’s 67 counties have water systems that are 100% fluoridated, and counties with the highest rates of tooth decay are those that lack fluoridated water. Over the past seven years, no new municipalities have started fluoridation, while several have stopped it.
The shift comes amid a broader retreat from evidence-based public health measures. Fluoride, once the subject of fringe conspiracy theories that compared it to a “communist plot,” is now at the center of a live political debate, fueled by distrust in government and science that has accelerated since the COVID-19 pandemic. While the science is clear—fluoride at recommended levels is safe and effective for preventing tooth decay—misinformation and conspiracy theories have gained ground, especially among some conservative groups.
Public health experts note that removing fluoride from water does not make scientific sense. The U.S. Public Health Service recommends 0.7 mg/L, a level shown to be safe and effective. The only significant risks, such as fluorosis or skeletal fluorosis, occur at much higher doses than are used in public water systems.
Despite this, the trend in Alabama is clear: more systems are stopping fluoridation than starting it. The result, experts warn, will be more children with bad teeth and more families without access to affordable dental care. The debate over fluoride, once a joke among conspiracy theorists, has become a real threat to public health—and the only real outcome is likely to be a generation of kids with worse oral health.