Few EU countries still fluoridate their water supplies, but there is no evidence that they stopped because of health harms.
As US President-elect Donald Trump charts his second term in the White House, an unusual suspect is at the top of the health policy to-do list: removing fluoride, a naturally occurring mineral that helps prevent tooth decay, from the water supply.
Robert F. Kennedy Jr – an environmental lawyer, anti-vaccine activist, and Trump’s pick to lead the US health department – has called fluoride an “industrial waste” and said Trump will push to remove it on day one of his presidency in January.
The focus on fluoridation may seem mysterious to some, given the US and Europe started adding fluoride to drinking water to boost children’s dental health in the mid-1900s. It has been shown to reduce cavities by about 25 per cent.
In the US, state and local authorities decide whether to fluoridate water, but the government currently recommends a level of 0.7 milligrams of fluoride per litre of water, well below the World Health Organization (WHO)’s safety threshold of 1.5 mg/L.
However, there also appear to be some risks tied to long-term fluoridation above that level.
Research from countries with naturally high levels of fluoride suggests that excessive consumption is linked to bone weakening and lower IQ in children.
That has prompted backlash to fluoride over the years, with opponents claiming that European countries have “rejected” or banned fluoridation.
But is that really true? And how do European countries stack up when it comes to fluoride in drinking water?
Which European countries add fluoride to water?
Ireland, England, Wales, and parts of Spain currently add fluoride to water, according to researchers from Dublin City University.
About 10 per cent of England’s population has access to “optimally” fluoridated water, compared with 11 per cent in Spain and 73 per cent in Ireland, the British Society Foundation said in 2020.
Earlier this year, England moved to boost its fluoridation programme to cover more people in the northeastern part of the country, but the plan hasn’t moved forward.
Meanwhile, several Irish localities have stopped the practice, and Ireland’s government launched a comprehensive review in 2014 to assess the potential health risks tied to fluoridation.
They published their most recent findings earlier this year, concluding that there is no definitive evidence for the vast majority of health problems but that more research is needed on the potential impact on the brain’s nervous system and hormone-related conditions.
Why don’t most European countries add fluoride to water?
According to the Dublin City University researchers, 11 EU and UK countries used to add fluoride to water but have since stopped: the Czech Republic, Finland, Germany, Hungary, Northern Ireland, the Netherlands, Poland, Romania, Scotland, Slovakia, and Sweden.
Another 14 countries never adopted the practice to begin with, including Austria, Belgium, Bulgaria, Cyprus, Denmark, Estonia, France, Greece, Italy, Latvia, Lithuania, Luxembourg, Norway, and Slovenia.
Policymakers gave a number of reasons why they don’t fluoridate water, including people’s ability to get fluoride from tablets, toothpaste, or naturally occurring sources; out-of-date evidence that fluoridation helps with dental cavities; questions about individual rights and “mass medication”; and logistical hurdles in implementing a fluoride programme.
A few also reported public safety concerns, but they did not cite any actual health risks tied to fluoridation, the researchers found.
“There is no evidence that any country in the EU ceased adding fluoride because of evidence of harm,” they concluded.
Are European countries still debating fluoride?
Not really – and especially not the Dutch, according to Roberta Hofman, a senior scientist at the KWR Water Research Institute in the Netherlands.
The Netherlands began adding fluoride to some drinking water as an experiment in 1953, eventually reaching about 2.5 million people by the late 1960s.
However, in 1973, the Dutch Supreme Court ruled that there was no legal basis for fluoridation and that policymakers would have to pass a new law to add fluoride – without ruling on whether it is good or bad for people’s health.
The debate hasn’t been meaningfully revived since then, Hofman told Euronews Health.
“People started to say, ‘Well, the government should not give us some medicine [when] we cannot choose where to buy our drinking water from,” she said.
“In the Netherlands, we don’t want to add chemicals or anything to drinking water”.
