US fluoride shortage linked to Middle East war disrupts supply

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Some U.S. drinking-water utilities have reported difficulty maintaining recommended fluoride levels as disruptions to the Middle East war affect parts of the public-health chemical supply chain, according to the Association of Metropolitan Water Agencies. Fluoride is used in water systems as a preventive measure to help ward off tooth decay, and the association said a small number of utilities have recently described supply disruptions in the past few weeks. As the conflict continues, the association warned that additional communities could face shortages.

Dan Hartnett, the association’s chief policy officer, linked the supply problem to disruptions affecting fluoridation inputs. Israel is among the world’s top exporters of fluorosilicic acid, and the U.S. Environmental Protection Agency data cited in the reporting also show the United States is among the world’s top five importers of the product. Hartnett said at least one Israeli supplier has faced workforce challenges because many employees have been called into active military service, which he said led to decreased production and supply shortages for the U.S. market.

The association said the number of affected water utilities so far is small, but the shortage has reached large customer bases. Hartnett said hundreds of thousands of people could be affected and that, as the conflict continues, “there will likely be additional stressors placed on the supply chain, leading to shortages in additional communities.” The reported concern is that the availability of the specialized chemical used for fluoridation may tighten further.

In Maryland, WSSC Water—described in the reporting as the eighth largest water and wastewater utility in the state—was among the systems facing a shortage. On April 7, officials lowered the fluoride level in the water to 0.4 milligrams per liter, down from the recommended 0.7 milligrams per liter. Chuck Brown, a spokesperson for the utility serving 1.9 million customers, said officials did not know how long the shortage would last but that they believed they could stretch it out for “a couple more months.”

In Pennsylvania, the borough of Lititz told water customers it had to halt fluoridation for a couple of weeks last month because of supply issues, according to the reporting. The situation has prompted questions from residents about whether short-term changes in fluoride levels affect drinking water safety or whether people need to change routines.

Dentists and public-health experts said lower fluoride levels for a short period are not expected to create an immediate safety risk for most people. Dr. Scott Tomar, an American Dental Association community water fluoridation expert, said that a few months’ drop in fluoride levels is probably not a cause for concern for most people. He pointed to research from places that stopped fluoridating, including Calgary, Canada; Juneau, Alaska; and Israel, saying those studies found that lower levels can have an impact over the span of years.

Tomar said that, based on the best available information, “below about 0.5 milligrams per liter, you’re probably not going to see effective preventive exposure.” He said younger children would be the first group to experience tooth decay because fluoride strengthens enamel as teeth are developing and once they have grown in. For people in shortage areas, he recommended brushing twice a day with fluoride toothpaste and keeping routine dental appointments, and he said people concerned about insufficient fluoride should discuss options with their dentist before taking a fluoride supplement or other treatment.

Public-health messaging also stresses that fluoridation remains beneficial even when people can access fluoride through toothpaste and other products. Nearly two-thirds of the U.S. population gets fluoridated drinking water, according to Centers for Disease Control and Prevention data cited in the reporting. The American Dental Association credits water fluoridation with reducing tooth decay by more than 25% in children and adults.

The reporting also noted that misinformation about fluoride safety has circulated widely in recent years. Last year, Utah became the first state to ban public water fluoridation, and Health Secretary Robert F. Kennedy Jr. has repeatedly sown doubt about fluoride’s safety and restricted its dental-health use, according to the reporting. Tomar said the levels used in the United States are safe and that “there are no adverse health effects associated with the levels we use in our drinking water.”