A Republican-backed bill to make the fluoridation of Kentucky’s tap water optional is progressing through the General Assembly over the concerns of experts who warn of the tooth decay in children that will likely follow, disproportionately impacting people with limited access to reliable dental care.

The House of Representatives approved House Bill 16 from Rep. Mark Hart, R-Falmouth, on Wednesday, which would remove the 1950s-era statewide mandate for drinking water systems to be fluoridated, instead wresting control of that decision to the local “governing body of a water system.”

The bill — which racked up more than 30 Republican co-sponsors — passed 68 to 29, with several GOP lawmakers casting no votes alongside most Democrats. It now heads to the Senate for consideration.

This bill “does not ban fluoride, nor does it prohibit . . . adding fluoride to the water,” Hart said on the House floor. “It allows water fluoridation to become a local option. Water fluoridation is a medical treatment without consent.”

Though the bill would lift the mandate fluoridating water systems and not mandate fluoride be removed, it is a bill rooted in a belief that fluoride exposure is harmful to the children and adults, even in trace amounts.

“The data is showing it does create an unreasonable health risk,” Hart told an interim legislative committee in October, teasing the bill he’d go on to file this session.

But the Centers for Disease Control and Prevention still endorses the “optimal” level of fluoridating drinking water at .7 milligrams per liter, which is the level of fluoride in Kentucky’s water — an amount akin to three drops of fluoride in a 55-gallon barrel.

Fluoride is a “cornerstone strategy” for reducing tooth decay, particularly in children, and because of this, one of the “10 greatest public health inventions of the 20th century,” the CDC said in May.

Though Kentucky Republicans have filed a dozen proposals since 2018 to end the mandate, House Bill 16 comes at a time when momentum to de-fluoridate water has high-profile backers: Health and Human Services Secretary Robert F. Kennedy, Jr., who called fluoride an “industrial waste,” and Republican President Donald Trump, whom Kennedy said will recommend fluoride be removed from drinking water.

At a Feb. 20 Health and Human Services Committee meeting, bill co-sponsor Rep. David Hale, R-Wellington, said “excessive use of this product was very detrimental,” and that fluoride caused “possibly harmful” side effects.

But he continued: “I want to emphasize: this does not mandate (fluoride) removal. All this bill does is just give control to the local water governing districts.”

“To remove fluoride,” Committee Chair Kim Moser, R-Taylor Mill, said, interrupting him. Moser was the only Republican to vote against the bill that day, but she voted in support of the bill on the House floor Wednesday.

“To remove fluoride,” Hale agreed.

But six opponents at from Kentucky Voices for Health, the University of Kentucky periodontal department, the Kentucky Dental Association and the director of UK’s pediatric dental program, illustrated the harms that would result from de-fluoridating water at that committee meeting last week.

They said it would be particularly harmful for a large swath of rural Kentuckians with no or limited reliable access to dental care. Since fluoride strengthens teeth, lessening the likelihood for cavities, de-fluoridating the water would surely cause a spike in cavities in children and adults, amplifying the need for dental care, they said.

“The studies do say that 1.5 to 2 parts per million, there is potential for fluoride to do damage,” said Dr. Steve Robertson, executive director of the Kentucky Dental Association.

“But the vast majority of studies say that 0.7 levels, which is what we use here in Kentucky, those negative effects do not occur and we get the benefit of the fluoride in the developing teeth of infants and young children, which helps protect those teeth as they age,” he added.

Dr. Brittany Camenisch, a Richmond-based professor in UK’s periodontal department and a practicing periodontist and former member of a mobile dentist team that traveled around Eastern Kentucky, said most of her patients already travel two and three hours to get to her.

“Access is a huge issue here,” she said.

Dental cavities are the most common chronic childhood disease in the United States, she said, and the severe tooth pain associated with cavities is one of the most frequently-cited reasons for school absences.

Nationwide, 46% of children ages 2-to-19 have had at least one cavity, she said.

“In 2023, 6,660 kids in 106 counties in Kentucky were examined. Cavities in our children were found to be significantly higher than the national average — in some areas, the rate was 85%,” she added, citing the Kentucky Department of Public Health survey.

“Based on a systematic review of 5,000 (research) papers, water fluoridation remains the most effective and socially equitable means of achieving community-wide exposure to the cavity-prevention effects of fluoride,” Camenisch added.

Camenisch and Robertson said de-fluoridating Kentucky’s water would spur an estimated annual increase in Medicaid expenses of more than $19 million in dental visits sought from an uptick in tooth decay and prevalence of cavities.

Are there risks with fluoride?

A proposal to make fluoridating Kentucky’s water systems optional is a perennial effort from Hart, the lead sponsor each year.

Hart has filed seven bills relating to fluoridation since 2018. The Kentucky GOP, all told, has filed a dozen bills in the last seven years to lift the fluoridation mandate, making Kentucky one of dozens of states that have moved to de-fluoridate its water systems in recent years.

The commonwealth, which put its first fluoride mandate into effect in 1951, is one of 13 states with a community water supply fluoride mandate. Roughly 72% of the U.S. population with public water drinking access in 2022 received fluoridated drinking water, according to the CDC.

Hart teased his latest bill before an Interim Joint Committee on State Government in October 2024.

The bill “does not ban fluoride,” he said. “It just removes the unfunded mandate and it brings it to a local choice.

“Let the people drinking the water decide what they want to put in the water.”

During that presentation, Hart and Cindi Batson, a registered nurse affiliated with Kentucky for Fluoride Choice, referenced a September ruling from U.S. District Judge Edward Chen, who ordered the Environmental Protection Agency to further regulate fluoride in drinking water, since it posed an “unreasonable risk” to the intellectual development of children.

Chen in part based his ruling in that case, which began in 2017, on a National Toxicology Program study released last summer that concluded drinking water containing more than 1.5 milligrams of fluoride per liter was associated with lower IQs in children.

Kentucky’s level of water fluoridation is less than half that rate, at .7 milligrams.

Separate research released in January and published in JAMA Pediatrics by researchers with the National Institute of Environmental Health Sciences also found a corollary between exposure to high levels of fluoride and lower IQ scores in children.

But none of the studies included in the analysis were conducted in the United States, only countries with much higher levels of fluoridation.

The study’s lead author, epidemiologist Kyla Taylor, told the New York Times the study was intended to contribute to the understanding of the safe and effective use of fluoride and was not intended to assess “the broader public health implications of water fluoridation in the United States.”

Rep. Adrielle Camuel, D-Lexington, who voted against Hart’s bill on the House floor, said fluoridating water remains “one of the most effective public health interventions of the last century,” and “allowing a patchwork of fluoridation creates inequitable health outcomes.”

Camuel blamed Hart’s proposal on a surge in “misinformation campaigns that disregard literally decades of scientific consensus.”

Still, Batson, during the October interim committee hearing, told lawmakers, “one thing Kentucky cannot do is ignore this risk.”

But the lengthy report didn’t reach any conclusions about the risks from adult or child exposure to lower levels of fluoride, instead saying more research is needed.

Chen ordered the EPA must study the impact of fluoride in drinking water, while adding that he wasn’t unequivocally concluding that fluoridated drinking water, broadly, endangered public health.

Authors of the report were explicit in this point, writing, “it is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ.”

But Chen in his ruling wrote that there was a preponderance of evidence that “water fluoridation at the level of 0.7 mg/L — the prescribed optimal level of fluoridation in the United States — presents an “unreasonable risk of injury to health or the environment, without consideration of costs or other non-risk factors, including an unreasonable risk to a potentially exposed or susceptible subpopulation under the conditions of use.”

Citing this ruling, Hart told lawmakers in October, “with the new risk and the new data that’s come out (with) the federal court ruling, at some point if the state continues to mandate (fluoride), at some point the state’s going to be responsible for that.”

Kentucky’s mandated water fluoridation created a “liability” issue, he said.

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