It’s common for dentists and pediatricians in Vermont to prescribe fluoride tablets or drops to their patients as a way to prevent tooth decay — what causes cavities. But that option could soon go away.
That’s after an announcement from the U.S. Food and Drug Administration earlier this month, in which agency leaders said they intend to remove supplemental fluoride from the market by the end of October.
Many kids in Vermont don’t get fluoride in their drinking water — about 40% of residents are on well water, and the vast majority of tested wells are below recommended levels of 0.7 milligrams per liter, according to the Vermont Department of Health.
Even if a household is connected to municipal water in Vermont, fluoride is not a guarantee. Hundreds of municipal water systems in the state do not fluoridate their water, and over 40% of Vermonters served by public water systems do not get fluoridated water.
And kids can't always get into a dentist in Vermont — over 40% of Medicaid-enrolled children didn't get preventative dental care in the past year, according to the latest state data.
That lack of access is bad for kids’ health and increases the cost of dental treatment.
“Tooth decay is the most common chronic disease of childhood — it is the biggest one,” said Michelle Fay, director of Voices for Vermont’s Children. “It has a pretty profound effect on kids' wellbeing.”
Today, almost half of third-graders in Vermont have tooth decay, according to the Department of Health.
You want parents to have access to every tool possible, whether they live on a dirt road and have well water or are in a community that's opted not to fluoridate the water system.Michelle Fay, Voices for Vermont's Children
That’s why fluoride drops or tablets are often recommended by clinicians as a way to prevent dental disease for kids that don't have access to fluoridated drinking water.
“You want parents to have access to every tool possible, whether they live on a dirt road and have well water or are in a community that's opted not to fluoridate the water system,” Fay said.
Fluoride in drinking water or supplements serves a different role than in the fluoride in toothpaste, which doesn't stay in the body.
"[It] actually helps to re-mineralize our tooth enamel, which can make our enamel stronger," said Monica Benjamin, a pediatric primary care provider in Middlebury. "It also helps to prevent the growth of cavity-causing bacteria."
FDA leaders have pointed to a range of negative health impacts of fluoride supplements, which have been refuted by professional medical associations.
The FDA also said that many European countries do not fluoridate their water, but Benjamin says that's misleading.
"They will put fluoride in their table salt, they will put it in their milk," she said. "There's other ways they are getting ingestible fluoride in their diets instead of doing it in their water."
More from NPR: FDA alleges fluoride supplements cause gut harms. Scientists aren't convinced
Research has shown negative health impacts of fluoride at high levels of exposure, so providers will talk with families about their kids' exposures to make sure they remain within recommended levels.
"The daily limit for kids 9 and older is 10 mg per day. When we are prescribing a fluoride supplement, it caps out at 1 mg per day," Benjamin said.
The Department of Health also provides free well water testing for families with young children.
“We have overwhelming support among professional organizations about the safety and efficacy of fluoride as a preventive strategy,” said Dr. Heidi Schumacher, a pediatritian and researcher at the Vermont Child Health Improvement Program at the University of Vermont.
“That is, I believe, where our policies should start and end.”
In the FDA announcement, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. wrote, “ending the use of ingestible fluoride is long overdue."
The announcement said several states have moved to end fluoridation of public drinking water.
