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As an increasing number of U.S. municipalities consider the elimination of fluoride from their water supplies, health specialists at the Prevention Research Center (PRC) at Washington University in St. Louis are equipping local communities with clear, evidence-driven resources to facilitate informed decisions.

Fluoride, long celebrated as one of the most efficient and affordable means to combat tooth decay, has regained national scrutiny. This spring, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. publicly urged the Centers for Disease Control and Prevention (CDC) to cease recommending water fluoridation — a proposition that concerned numerous public health officials. Although the CDC’s recommendations are not obligatory, they significantly impact local administrations and health agencies across the nation.

Kennedy referenced widely contested assertions that fluoride negatively affects brain development and skeletal health. Nevertheless, prominent health organizations — including the CDC, the World Health Organization, and the American Dental Association — steadfastly affirm fluoridation as a proven success in public health. Weakened oral health also correlates with conditions such as heart disease, diabetes, respiratory issues, and complications during pregnancy.

Kennedy’s statements have invigorated opponents of fluoride and introduced confusion into policy discussions — especially in rural regions where public health frameworks are already vulnerable.

“Water fluoridation is among the most effective and just public health interventions of the last century,” asserted Ross C. Brownson, director of the PRC and the Steven H. and Susan U. Lipstein Distinguished Professor at WashU School of Public Health. “Removing it typically raises dental costs and results in additional untreated decay, disproportionately affecting low-income communities.”

The rural context

In rural Missouri, where dental practitioners are few and insurance coverage is minimal, nearly half of third-grade students have faced tooth decay — with elevated rates in non-fluoridated regions. Lacking fluoride in the water supply, children confront a higher incidence of untreated cavities, leading to persistent pain, absenteeism, and emergency dental services — usually at a significantly higher expense.

Amidst this scenario, the Rolla (Mo.) City Council decided in January to initiate the process of eliminating fluoride.

The subsequent months were marked by public discussions and outreach — including initiatives from the PRC and its collaborators to ensure that residents and city officials had access to credible scientific information.

Opportunity for engagement prompts action

For Renee Parks, senior research manager at the PRC within the School of Public Health and a prior Rolla resident, the issue became personal when she discovered in December that the city council was contemplating the removal of fluoride.

The timing was fortuitous — just weeks earlier, she had acted as a teaching assistant in “Translation of Epidemiology to Policy,” a course at WashU led by Brownson. Now in its ninth iteration, the course educates graduate students on using epidemiology to influence public health policies, with a strong emphasis on health equity. Parks had recently guided students in formulating strategies to communicate the advantages of community water fluoridation.

“I assisted the groups in considering target audiences, gathering relevant data, outlining key messages, understanding opposition, identifying effective channels, and determining the ideal messenger,” she noted.

With assistance from PRC colleague Madisen Brewer, a public health communicator adept at data visualization, Parks directed her efforts toward Rolla. She contributed to the creation of a specialized infographic featuring local oral health statistics, the latest water fluoride levels, and national scientific recommendations. The one-page document was crafted to be straightforward, unbiased, and accessible to Rolla residents and leaders.

Moreover, Parks collaborated with the Ozark Dental Society, the Phelps-Maries Counties Health Department, Missouri University of Science and Technology, and the Rolla School District. She also assisted local advocate Patti Fleck in drafting a letter to the Phelps County Focus newspaper, which, along with the PRC’s infographic, was distributed to city officials prior to the vote.

In the end, the Rolla City Council voted on May 19 to maintain fluoride in the city’s water supply.

“I would like to extend my gratitude to WashU for all the pertinent information collected and presented in a professional and simplified manner that enabled our city council to make a swift and informed decision regarding fluoride in our drinking water,” expressed Kevin Greven, mayor pro tem and a Rolla city councilman. “The welfare of the residents in Rolla, especially our children, was the primary motivation behind this decision, and I believe, based on this data, we reached the right conclusion.”

Enhancing public health discourse

The situation in Rolla illustrates broader challenges. Nationwide, local governments — particularly in underserved regions — are increasingly confronted with politically sensitive public health decisions.

This is where the PRC’s efforts become crucial. Translating research into actionable insights is central to its mission — whether through clear, community-ready infographics, concise policy briefs, or collaborations that empower decision-makers with evidence.

Currently, the PRC is collaborating with the Be Healthy QC coalition in the Quad Cities area of Illinois and Iowa to demonstrate how trails and greenways can enhance community health — and how legislators can support these initiatives.

In an era of escalating misinformation and political pressures, WashU researchers are breaking through the noise with scientific evidence and reliable guidance to empower leaders in making informed choices.

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