Estimated read time: 6-7 minutes
- HB81, a bill that bans fluoride in Utah's public water systems, raises concerns about impacts on underserved communities.
- Oral health professionals warn the bill could increase dental costs and worsen access to care for low-income residents.
- Opponents urge Gov. Spencer Cox to veto HB81, citing potential negative effects on vulnerable populations' oral health and finances.
SALT LAKE CITY — Some residents and oral health professionals in Utah are concerned that — if signed into law — a bill that seeks to ban community water fluoridation will disproportionately impact low-income and underserved communities.
HB81 would prohibit fluoride from being added to public water systems in Utah and would allow pharmacists to provide a prescription for fluoride rather than a doctor. The bill has already gained favor from both the Senate and the House and is awaiting approval from Gov. Spencer Cox to become law. If the bill is signed, Utah would be the first state to ban fluoride in public water systems.
Nearly 1.5 million Utahns receive fluoridated water in Salt Lake and Davis counties and in Brigham City. The Centers for Disease Control and Prevention considers community water fluoridation — or the practice of adjusting fluoride levels in drinking water to the recommended level for preventing dental decay — to be one of the Top 10 public health interventions of the 20th century due to its ability to improve oral health in a highly accessible and cost-effective way.
Many people concerned about prohibiting water fluoridation argue the bill will disproportionately affect vulnerable populations who may rely on fluoridation as a primary preventive measure for oral health.
Kat Smith is a Davis County resident and mother to a child diagnosed with a rare form of epilepsy caused by a genetic mutation that requires her to receive full assistance with everyday tasks such as eating, bathing and brushing her teeth. Due to her disability, Smith's 10-year-old daughter requires sedation under general anesthesia for any dental procedure, including routine teeth cleanings.
"We don't want her to have to undergo (general anesthesia) any more than necessary," Smith said, adding that "without that daily protective factor of drinking water that is fluoridated, she could potentially develop more cavities and require sedation more frequently … that's hard on her body, that's hard on her spirit, on all of us"
While Smith acknowledges she would like to take advantage of the bill's provision to make fluoride supplements more accessible, she believes it adds more challenges for caretakers of individuals with disabilities.
"My daughter is already on a cocktail of medications, and it's already challenging to give her the medications that quite literally keep her body from seizing and keep her breathing and alive," said Smith. "For me to have to add an additional medication that she could just ostensibly receive in the water is not only discouraging and frustrating but something that I don't even know if that will be tenable, to be honest."
According to a 2019 study by the Journal of the American Medical Association Pediatrics, fluoridated water can help reduce the gap in dental caries, or tooth decay and cavities, between socioeconomic groups, particularly benefitting low-income children and adolescents. As an employee of the Davis Education Foundation, Smith works with at-risk students in the Davis County School District to ensure they receive donated items to meet their basic needs. She anticipates the change will significantly impact families that struggle financially.
"I know, personally, that this will affect (the low-income) population more so than me," said Smith. "I'm quite fortunate, and if we have to sedate her more and have an increase of bills, we will do whatever we need to keep her alive, but not everyone has that opportunity. It will become a decision between feeding your family or filling a cavity. That pain of continuing to eat with a cavity — it's heartbreaking."
Many health professionals are concerned the legislation will create a greater need for dental services, which is especially concerning in areas that are already suffering from shortages of dental health professionals or for patients without adequate dental insurance. Community water fluoridation saves an average of $32 per person on dental expenses annually, according to the Centers for Disease Control and Prevention, meaning removing fluoridation from the water could potentially cost Utahns around $48 million a year.
"Across the country, where this has happened, where they take the fluoride out of (a city's) water or where they don't have fluoride, we see these underserved populations, the vulnerable populations of children with a high caries rate," said James Bekker, current board member and past president of the Utah Dental Association. "When the caries rate goes up, as it has been shown to do when this happens in other communities around the country, emergency room visits go up, children needing extensive dental restoration goes up ... health care costs, in general, go up when fluoride is not in the water."
While the decision to pass or veto HB81 is in the governor's hands, those opposing the bill still hope there is a chance to protect the right to community fluoridated water. Members of the Utah Oral Health Coalition have been vocal in opposing the bill, as well as other legislation against community water fluoridation, due to the mineral's ability to function as a prevention against tooth decay, lowering dental costs overall.
"As a coalition member, we've been opposing this bill ever since it was introduced in the Legislature because it is going to affect low-income communities disproportionately," said Sasha Harvey, executive director of Salt Lake Donated Dental Services, an organization that provides free dental care to underserved individuals. "Community water fluoridation has never been about those people who can afford or have access to a fluoride prescription. (Low-income communities) are the ones who need it available without the trouble of going through a doctor or pharmacy and getting a prescription, and paying for it out of pocket, or through any other means."
Several services exist for Utahns unable to cover the cost of dental help, including Salt Lake Donated Dental Services or the University of Utah School of Dentistry, that provide low or no-cost services and/or supplies. But, Harvey said, if oral health in the area declines and the demand for services increases, it will make affordable dental care less accessible to those who need it.
"This is devastating news for us because, as the community clinic, we already have a waiting list expanded as far as six to 12 months for low-income patients to access dental care, and without an adequate level of fluoride in the water, this is going to expand our client base, unfortunately," she said.
Bekker and other health professionals with the Utah Oral Health Coalition encourage anyone who opposes HB81 to contact and petition Cox to veto the bill.
