The debate over fluoride in drinking water has intensified with Utah’s House Bill 81 (HB 81), which prohibits the addition of fluoride to public water systems. This makes Utah the first state in the US to ban fluoridated public water. The ban took effect May 7, 2025.1

This legislation is the latest chapter in Utah’s decades-long debate over water fluoridation. In a letter from the American Dental Association (ADA) to Utah Governor Spencer Cox, the ADA emphasized the widespread support of fluoridated water systems as an effective healthcare measure, stating, “With the weight of the evidence and nearly universal support of community water fluoridation in all corners of the health care sector, we urge your veto of HB 81.”3 And yet, despite the stated consensus of health professionals on the importance of fluoridated water, conservative groups and some lawmakers argue that it may pose cognitive risks and should not be a mandated public health measure. The Utah Dental Association (UDA) and ADA strongly opposed HB81, citing its potential negative impact on public health. In a statement, the UDA emphasized that community water fluoridation is a safe, effective, and equitable way to prevent tooth decay and reduce oral health disparities.2 Meanwhile, the ADA reaffirmed its stance against the bill, maintaining that community water fluoridation is a critical public health measure.3

Does Fluoridated Water Lower IQ?

A U.S. government report, published in August 2024, concluded that the amount of fluoride in drinking water would have to measure at twice the recommended limit before it impacted children’s IQs.4 This report, released by the National Toxicology Program (NTP) and based on an analysis of international studies, is the first time a federal agency has determined that high fluoride exposure is associated with lower IQ scores in kids.4

The report reviewed studies conducted in Canada, China, India, Iran, Pakistan, and Mexico, concluding that drinking water with more than 1.5 mg/L of fluoride is consistently linked to lower IQ levels. However, the U.S. recommended fluoridation level is 0.7 mg/L, and fewer than 0.6% of the U.S. population receives water with fluoride levels above 1.5 mg/L.4

While some studies suggest a 2–5 IQ point decrease among children exposed to excessive fluoride, the report does not determine risks at lower fluoride levels and calls for further research.4

Why Has Utah Passed a Fluoride Ban?

Despite overwhelming evidence supporting fluoride’s role in preventing tooth decay, Utah’s HB81 passed with the support of conservative lawmakers who argued that individuals should have the choice of whether to consume fluoridated water. Rep. Stephanie Gricius contends that a California court ruling identified potential cognitive risks associated with fluoride, and she believes the Environmental Protection Agency (EPA) should reassess its safety standards.1

Several areas in Utah fluoridated their water systems prior to the ban, including Salt Lake and Davis counties and Brigham City. In November 2023, Brigham City voters overwhelmingly rejected Proposition 3, which would have removed fluoride from the city's drinking water. The measure, which was initially introduced as a cost-saving proposal rather than an anti-fluoride initiative, was decisively defeated thanks to advocacy from health professionals, including the UDA and the Utah Oral Health Coalition.5 However, HB81 overrides local decisions, banning fluoridated water statewide regardless of public vote.

The bill passed in the Utah Senate on an 18 to 8 vote, with some lawmakers opposing the ban, arguing that local governments, not the state, should decide fluoridation policy.1

What Happens Now?

With HB81 signed into law, Utah is the first state in the union to prohibit fluoride statewide, despite fluoridation being endorsed by the Centers for Disease Control (CDC), ADA, and World Health Organization (WHO). Nationally, 72% of public water systems contain fluoride, and research suggests that fluoridation reduces cavities by about 25%.6

Without fluoride in the water supply, dental professionals recommend alternative sources of fluoride, like fluoride varnish. In response to HB 81, Ultradent is donating roughly 70,000 samples of Enamelast™ fluoride varnish to clinics and health service providers throughout Utah, specifically in underserved areas.

The Future of Fluoridation in the U.S.

With Gov. Cox signing HB81 into law, Utah is setting a precedent for other states to possibly follow suit. While some communities have debated fluoride removal, Utah’s bill is unique in that it prohibits fluoridation statewide, eliminating local choice.

As the fluoride debate continues, dental professionals remain firm in their stance: fluoridation is safe, effective, and critical for oral health. Now that HB81 has become law, Utah residents should seek alternative fluoride sources to protect their teeth and prevent the rise of tooth decay and cavities in the years to come. Should the ban go into effect in other states, it will become residents’ responsibility to ensure they and their children get enough fluoride through adequate dental care, humanitarian services, or fluoride prescriptions. 

 

F.A.Q.

 

  1. What does Utah’s HB 81 do?

HB 81 prohibits the addition of fluoride to public water systems, making Utah the first state in the U.S. to ban fluoridated public water. The law took effect on May 7, 2025.

  1. Why is fluoride in drinking water important?

Fluoride in public water is supported by the American Dental Association (ADA), Utah Dental Association (UDA), Centers for Disease Control (CDC), and World Health Organization (WHO) as a safe and effective way to prevent tooth decay. Research suggests water fluoridation reduces cavities by about 25% and helps reduce oral health disparities.

  1. Does fluoridated water lower IQ?

A U.S. government report (August 2024) found that children’s IQ may be affected when drinking water contains fluoride levels above 1.5 mg/L. However, the recommended U.S. fluoridation level is 0.7 mg/L, and fewer than 0.6% of the U.S. population receives water above 1.5 mg/L. At typical U.S. levels, there is no evidence of IQ reduction, though further research is recommended.

  1. Why did Utah lawmakers ban fluoride despite health organizations’ support?

Supporters of HB 81 argued that:

  • People should have a personal choice about consuming fluoridated water.
  • Court rulings have raised concerns about potential cognitive risks.
  • The EPA should reassess safety standards for fluoride.

Opponents, including the ADA and UDA, argued that the ban will negatively impact public health and removes local decision-making authority.

  1. What was the history of fluoride use in Utah before HB 81?
  • Some areas, such as Salt Lake and Davis counties and Brigham City had fluoridated water before the ban. Much of Utah’s public water was unfluoridated prior to the ban. In November 2023, Brigham City voters overwhelmingly chose to keep fluoride in the city’s water, rejecting Proposition 3. HB 81 overrides these local decisions, banning fluoride statewide regardless of local votes.
  1. What happens now that HB 81 is law?
  • Utah residents will no longer receive fluoride through public water.
  • Many dentists recommend alternative fluoride sources, such as fluoride varnish treatments or other alternates.
  • Ultradent announced a donation of about 75,000 doses of Enamelast™ fluoride varnish to Utah clinics and providers, specifically in underserved areas.
  1. Could other states follow Utah’s example?

Yes. Utah’s ban sets a national precedent. While some communities in other states have debated fluoride removal, Utah is the first to ban it statewide. If more states adopt similar laws, residents will need to rely on alternative fluoride treatments to protect against cavities and tooth decay.

References

  1. Gehrke R. Fluoride will be banned from Utah’s water supplies — but only if Cox signs this bill. The Salt Lake Tribune. Published February 24, 2025. Accessed March 14, 2025. https://www.sltrib.com/news/politics/2025/02/24/flouride-banned-utah-water-if-cox/
  2. Utah Dental Association. Response to HB81. Utah Dental Association. 2025. Accessed March 14, 2025. https://www.uda.org/government-affairs/fluoride.
  3. American Dental Association. Utah set to ban community water fluoridation. ADA News. Published February 2025. Accessed March 14, 2025. https://adanews.ada.org/ada-news/2025/february/utah-set-to-ban-community-water-fluoridation/
  4. Stobbe M. US government report says fluoride at twice the recommended limit is linked to lower IQ in kids. AP News. Published August 22, 2024. Accessed March 14, 2025. https://apnews.com/article/fluoride-water-brain-neurology-iq0a671d2de3b386947e2bd5a661f437a5
  5. American Dental Association. Utah city defeats ballot measure to remove fluoride from drinking water. ADA News. Published December 2023. Accessed March 14, 2025. https://adanews.ada.org/ada-news/2023/december/utah-city-defeats-ballot-measure-to-remove-fluoride-from-drinking-water/
  6. Warns, S. Fluoride in drinking water: What experts say. CNN Health. Published November 23, 2024. Accessed March 14, 2025. https://www.cnn.com/2024/11/23/health/fluoride-drinking-water-dg/index.html