A few months ago, Oklahoma officials removed the state’s recommendation for fluoride in drinking water as part of the "Make Oklahoma Healthy Again" campaign, which was announced alongside the U.S. Health Secretary Robert F. Kennedy Jr. But according to a recent report, ending community water fluoridation could come with a hefty cost.
Data from the American Dental Association estimates a nearly $507 million price tag over five years in dental care costs for Oklahomans if fluoride were removed from community water systems. Around 57% of the state has fluoride exposure due to community water systems, according to the report.
Fluoride is a naturally occurring mineral in almost all water supplies, and many communities add small amounts to their water to prevent cavities and promote oral health, per the CDC. The federal agency notes that fluoridated water reduces cavities by about 25% in both children and adults.
Kennedy has called fluoride an “industrial waste” and said it could lead to serious health problems when added to public water. But in a statement amid his confirmation process, the American Dental Association emphasized an analysis Kennedy cited refers to much higher concentrations than the 0.7 mg per liter recommended in the U.S.
Conversations around community water fluoridation have been inflamed under the Trump administration, with at least 21 states introducing bills during 2025 legislative sessions to prohibit or repeal provisions related to the addition of fluoride in public water systems.
Matt Steele is the director of state and local advocacy at the CareQuest Institute for Oral Health. The nonprofit based in Boston focuses on access to quality oral health care, and Steele said it intends to be involved in Oklahoma through the defense of Medicaid amid federal cuts and protecting community water fluoridation.
“We believe Oklahomans deserve equitable, cost-effective preventative care and fluoridization is that in the oral health care space,” Steele said. “And removing it would take away one of the simplest and most effective tools we have.”
Steele said nearly 12% of Oklahoma adults are already missing six teeth or more. He acknowledged there are concerns about costs related to fluoridation systems, as they require “some real upfront investments.”
But communities of 1,000 or more see an average estimated return on investment of $20 for every $1 spent on water fluoridation, according to the CDC. That number increases as the community size increases.
“While there’s some need to maintain the systems that introduce fluoride to our community water systems, not having it there in the long run far increases the cost to our oral health care,” Steele said.
Fluoridation exposure is advantageous in rural communities, said Dr. Tim Fagan, a pediatric dentist who’s been practicing in Oklahoma for 40 years. Most of Oklahoma’s counties are health professional shortage areas for dental care, according to July data from the Health Resources and Services Administration.
Fagan said some people can’t afford to travel to access dental care, meaning they miss out on preventive services. He saw the impacts of disparities faced by children living in rural communities during the decades he spent practicing in Enid.
He said very few kids he served living in Enid had cavities, which he attributes to fluoride exposure.
“A lot of the rural communities around Enid that did not have fluoride, or not a sufficient amount, they were the kids that we saw a ton of cavities on,” Fagan said. “So, in my own mind, that's proof to me that fluoride in the drinking water works here in the state of Oklahoma.”
Fagan said he worries most about the impact removing fluoride from community water systems could have on children. The American Dental Association report notes this would cost around $118 million over five years in dental care costs for Oklahomans ages zero to 19.
“We have tight state budgets now. Are they going to add another $118 million to our state budget to cover these people who are projected then to get more dental cavities? Are they going to cover that care?” Fagan said. “Almost half the kids in the state of Oklahoma are covered by Medicaid. And so are they going to increase the money to our state Medicaid system to cover all these kids who are going to start getting more cavities? That's the question I have.”
Fagan said when Oklahomans can't access routine dental care, they can end up in the emergency room. He said his pediatric dental residents are called into the emergency department a couple of times every week.
“Kids have facial swelling – not just swelling of the gums around the tooth, but their cheeks are swollen and stuff,” Fagan said. “And if that isn't dealt with quickly, then that can go ahead and spread, and unfortunately, there have been kids that have died from dental infections.”
In his executive order, Stitt gave the Oklahoma State Department of Health and Department of Environmental Quality 90 days to submit a written report documenting fluoridation practices across municipal water systems and rural water districts. Following this report, agency heads have 60 days to revisit and revise any formal positions on fluoridation.
“Cities and water districts, they can still choose to do what they want based on their constituents and the science," Stitt said in June. "But it's no longer going to be a recommendation from the State Health Department.”
Steele from CareQuest said he doesn’t think fluoride is going to resolve all of the issues related to oral health care.
“But removing it without any sort of plan to help kind of step in on that preventative space in the oral health care spectrum is just going to accelerate the problem that we're facing within oral health care nationally, within Oklahoma, so on and so forth,” Steele said. “So we really hope that the residents of the state can fight to preserve it.”
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