Robert F. Kennedy Jr.’s goal of removing fluoride from the water supply faces challenges regardless of what role he plays on health care in the new Trump administration.  Days before President-elect Trump’s election, Kennedy wrote on the social platform X that “the Trump White House will advise all U.S. water systems to remove fluoride from public water.”   But water fluoridation is a local government decision, and it’s unclear if Kennedy could compel municipalities to do away with the cavity-fighting chemical.  It's also unclear whether Kennedy will have a formal role in the Trump administration, though he has been floated as a potential secretary of Health and Human Services (HHS), and Trump has said he will let the former independent presidential candidate "go wild" on public health. Kennedy wrote that fluoride was “associated” with a host of medical issues, though many of these claims are linked to exposure to fluoride doses far higher than what most people would experience drinking fluoridated water and brushing their teeth.   Fluoride is a naturally occurring substance that helps to prevent tooth decay by strengthening and rebuilding weakened tooth enamel. Water fluoridation has occurred in the U.S. since 1945.   While Trump has yet to say what role Kennedy will have in his second administration, he hasn’t rejected the idea of removing fluoride, saying it “sounds OK to me.”   A local decision  The Centers for Disease Control and Prevention (CDC) says online that “state and local governments decide whether to implement water fluoridation.”  The CDC has hailed water fluoridation as one of the top 10 greatest public health achievements of the 20th century due to its effect in drastically reducing tooth decay.   There are no federal laws that require water fluoridation, though some government agencies provide limits and recommendations on how much fluoride can or should be in drinking water.   "Fluoride is an example of something that is a hyper local decision. Even within states, most local authorities decide whether or not fluoride is added to the water. Now, that is a policy decision that can happen in any level of government,” Chrissie Juliano, executive director of the Big Cities Health Coalition, told The Hill.  The U.S. Public Health Service recommends fluoride levels — a maximum of 0.7 milligrams per liter — for maximum oral and reduced risk of potential harm, but these standards are not enforceable, and any water fluoridation in community systems is done voluntarily.   Possible avenues to a ban The incoming Trump administration could theoretically use the Toxic Substances Control Act of 1976 (TSCA) as means of prohibiting water fluoridation. The TSCA grants the Environmental Protection Agency (EPA) the authority to regulate chemicals in the U.S.  “The new administration, with or without RFK’s influence, could seek to ban water fluoridation, or revisit the levels of fluoridation, through several avenues, including TSCA. Whether it will or not remains to be seen as the legal and public health implications of ‘banning’ water fluoridation are significant,” said Lynn L. Bergeson, managing partner of the law firm Bergeson & Campbell. The Trump administration could also limit water fluoridation through the Safe Drinking Water Act of 1974, which grants the EPA authority to regulate water quality in all states.  “The federal government presumably could revisit the maximum contaminant level under the Safe Drinking Water Act for fluoride in drinking water and effectively disallow the fluoride. Not quick or easy, but an option,” Bergeson said.  “HHS would need, again presumably, to revisit its recommendation that the current level of fluoride in drinking water ... is desirable, as the [American Dental Association] reaffirmed on September 25th in its statement, to prevent tooth decay,” she added.  “Pursuing any such option would be expected to invite significant backlash as well as praise despite the largely uncontroverted support fluoridated drinking water has enjoyed for decades.”  Previous legal challenges The EPA sets legal limits on 90 different contaminants in drinking water, including fluoride.     Per EPA standards, drinking water may not have more than 4.0 mg/L of fluoride, with the agency citing bone disease and children possibly getting mottled teeth as the potential long-term health effects.    These standards were challenged in a 2017 lawsuit filed by a coalition of groups opposed to water fluoridation, claiming in their complaint that the chemical was the cause of negative neurological impacts in humans.  The federal judge presiding over the case, Obama appointee U.S. District Judge Edward M. Chen, earlier this year ordered the EPA to address the potential impacts of fluoride in drinking water on IQ levels, writing there was “unreasonable risk” stemming from fluoride in drinking water.   Chen also noted, however, that his unreasonable risk finding “does not conclude with certainty that fluoridated water is injurious to public health; rather … the Court finds there is an unreasonable risk of such injury.”    The lawsuit was filed after the EPA denied a citizen petition filed by the plaintiffs, which TSCA allows for following a 2016 congressional amendment.  Bergeson said she does not interpret the law to mean that a citizen petition and subsequent judicial appeal can serve as a replacement for the risk evaluation of chemicals.  “The implications of getting to a risk management rulemaking via this route leads to a ton of unintended consequences and EPA budgetary and programmatic anomalies,” she said.  The National Toxicology Program (NTP) under the Department of Health and Human Services released the findings of its own evaluation earlier this year of fluoride’s impact on neurodevelopment and cognition   The NTP concluded that “higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.”   “It is important to note, however, 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,” the NTP added.   Ongoing debate According to Myron Allukian, a dentist of more than 50 years and former president of the American Public Health Association, anxieties and conspiracies around water fluoridation have existed for decades.   Allukian, who served as chair of the U.S. surgeon general's Work Group on Fluoridation and Dental Health for the 1990 Prevention Objectives for the Nation, was part of the early efforts to get cities like Boston to adopt water fluoridation.   “When I started out on this, you know, they thought it was a Communist plot. And there was a very active movement that the Communists were for this,” said Allukian, recalling how he later met with a health official from the Soviet Union who said people in his country believed fluoridation was a capitalist scheme.   “People against it have looked for different reasons to be against it,” he said.   Allukian, the former dental director for the city of Boston, said a fluoride-free environment would result in problems with bones and teeth as the chemical is a natural component of those body parts. He also emphasized that fluoride occurs naturally in waterways, so fluoride-free drinking water isn’t a realistic goal.  Jeffrey A. Singer, a surgeon and senior fellow at the Cato Institute libertarian think tank, is dubious about the studies linking fluoride to adverse effects like lower IQ.   “These are very poor-quality studies,” Singer said. “Most of them are just observational studies and, you know, correlation is not causation. And in fact, most of them use IQ as their evidence of neurotoxicity and IQ is not a good metric for measuring neurotoxicity.”   Singer opposes putting fluoride in the water supply, though his stance has more to do with his belief in the doctrine of informed consent.   Linda Birnbaum, a former federal scientist with the EPA, also opposes water fluoridation as she believes the evidence leans strongly against the practice, especially early in life and during pregnancy. Birnbaum was also the director of the NTP as well as the National Institute of Environmental Health Sciences.  “I think what has happened is, over the last 60 years, you went from where the only source of fluoride that most people got was from their drinking water to now people are getting fluoride every time they brush their teeth or use mouthwash,” said Birnbaum.   “So, the benefit of everybody drinking fluoridated water, as far as prevention of cavities is not clear like it used to be, and I think there's growing evidence that it, in fact, may not be very helpful anymore.”