On February 27, 2025, the House Committee on Water held an informational hearing on fluoridation of public water supply—when communities add additional fluoride to their water.
The Committee received information supporting water fluoridation from a dentist from Abilene, Kansas, and representatives of the Kansas Dental Association and Oral Health Kansas. The Committee also received testimony against water fluoridation from a dentist from Overland Park, Kansas, and a biological dentist from the Institute for Biological Dentistry.
Additionally, the Committee received information about the Kansas Department of Health and Environment (KDHE) Bureau of Water’s role in fluoridation of public water supply systems.
What is Fluoride?
Fluoride is a chemical ion of fluorine, which is the 13th most common element in the Earth’s crust. It is naturally found in almost all soil, water, and many rocks. It is released into the environment when rocks or soil containing fluoride are dissolved by water. It can also be released from volcanic emissions or through man-made processes. (Centers for Disease Control, Community Water Fluoridation FAQs, posted May 14, 2024.)
How Did Fluoridation of Public Water Supply First Occur?
In 1944, the Grand Rapids, Michigan, City Commission voted for Grand Rapids to become the first city in the world to add fluoride to its public water supply system, which occurred in 1945. [Note: Research in water sources related to dental health first began in the early 20th Century.]
The then-named National Institute of Dental Research conducted a 15-year study, monitoring the levels of tooth decay in the Grand Rapids’ population of almost 30,000 schoolchildren.
After 11 years, the Institute announced that the rate of cavities in Grand Rapids’ schoolchildren had dropped by 60 percent. This finding, given the large sample size, was considered a remarkable scientific achievement at the time, as it was believed to be the first time in history that tooth decay was found to be a preventable disease. (National Institute of Dental and Craniofacial Research, “The Story of Fluoridation,” reviewed December 2024.)
Are there State Laws or Rules and Regulations that Require Water Fluoridation?
No. There is no state or federal requirement to add fluoride to public water supply systems. Water fluoridation is a local decision. The State of Kansas is precluded from requiring water fluoridation by KSA 68-171m, which explicitly states, “No primary drinking water standard or rule and regulation may require the addition of fluorides to public drinking water.” [Note: The statute was passed by the 1977 Legislature.]
KDHE’s Bureau of Water monitors public water standards, but has stated it is neutral on fluoridation and its benefits, and ultimately, it is a local decision whether a community fluoridates its public water.
Does the State Have a Role in the Fluoridation Addition Process?
Yes. KDHE’s Bureau of Water approves the addition of fluoride for a public water supply system based on several factors that are reviewed by the agency, including the:
- Form of fluoride chemical to be added;
- Point of application;
- Feeding mechanism and rate of flow;
- Storage and handling;
- Automatic controls, safety precautions, and laboratory procedures;
- Designation of Class II (or higher) certified operator; and
- A copy of the city ordinance or rural water district resolution authorizing fluoridation.
KDHE has stated that its general principle regarding fluoridation projects is that it should not be undertaken without the full cooperation and approval of the local administration, the public water utility, and the local health department.
Does the Federal Government Have a Role in Water Fluoridation?
Since 1962, federal agencies have recommended certain levels of drinking water fluoridation to promote dental health. Water fluoridation, however, is not required by federal law. Federal agencies, including the U.S. Environmental Protection Agency (EPA), adopt standards for drinking water under the federal Safe Drinking Water Act.
What are the Recommended Fluoride Levels in Kansas for Public Water Supply Systems?
Kansas, like most states, adopts the drinking water standards set by the federal Safe Drinking Water Act and its regulations. In 1986, the EPA established a regulation under the Act that set the maximum enforceable level of 4.0 mg/L to protect against adverse health effects, which Kansas has adopted.
The EPA has also issued National Secondary Water Supply Standards, which are non-enforceable guidelines for contaminants that may cause cosmetic or aesthetic effects. Should a public water supply system find fluoride levels to be higher than 2.0 mg/L but less than 4.0 mg/L, the EPA requires certain public notices to be made. Kansas adheres to this standard.
For oral health standards, the U.S. Public Health Service has found the optimal concentration level of fluoride for oral health is 0.7 mg/L. Kansas adheres to this standard.
Who Monitors Fluoride Levels in Kansas?
All public water supply systems monitor for fluoride levels. That includes all community water systems, rural water districts, and non-transient, non-community systems (such as self-supplied schools or industry). There is a testing schedule for systems that fluoridate their water or not, surface water, and some groundwater sources.
What Developments are there at the Federal Level?
In April 2025, the U.S. Department of Health and Human Services directed the Centers for Disease Control and Prevention to reconvene an independent panel to make new recommendations on fluoridating public water supplies, including the role it plays in public water systems and whether there are any negative affects to public health.
The EPA Administrator has stated publicly that the EPA would also review the scientific evidence regarding fluoride in public water supply and health outcomes based on fluoride consumption. (NPR, Kansas Public Radio, “HHS will review guidance on the addition of fluoride to drinking water,” “https://www.npr.org/2025/04/10/g-s1-59452/hhs-rfk-fluoride-drinking-water-epa)
By Heather O’Hara and Elaina Rudder.
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