| Robert F. Kennedy Jr., a longtime vaccine skeptic tapped by Trump to be his Health and Human Services secretary, has said he will advise water districts to remove fluoride from drinking water. The naturally occurring mineral has been added to water in the United States for decades to strengthen teeth and prevent cavities. But some communities are rejecting the practice, citing concerns about health. For his part, Kennedy calls fluoride a “dangerous neurotoxin.” The newfound national attention on fluoride injects the intense partisan passions of a Trump presidency into an issue that historically has been hyperlocal. Oregon, the third-least-fluoridated state in the country, offers a preview of the battles to come after two communities recently voted against fluoride: Hillsboro, a Democratic-leaning Portland suburb, and Lebanon, a small conservative town. Here’s what audio producer Elana Gordon and I learned while reporting this story. Dentists see the toll of no fluoride There is limited data comparing cavities and tooth decay in Oregon communities with and without fluoridated water. Fluoride proponents point to evidence from Calgary, Alberta, and Juneau, Alaska, where dental problems rose after fluoridation ended. Pro-fluoride Oregon dentists also say anecdotally that they can easily spot whether patients grew up with fluoride; those with the most cavities often grew up in Portland or other communities without fluoridated water. Beth Mossman, a Hillsboro pediatrician, spearheaded a local ballot measure campaign to add fluoride after seeing patients in dental crises, including one whose parent had to sell a car to afford oral surgery. Lisa Bozzetti, the Hillsboro-based dental director of Virginia Garcia Memorial Health Center, argued that fluoridated water would help an entire community, including people without reliable access to dental care or who do not know about the value of fluoride. But concerns about fluoride are not entirely unfounded Recent reports from respected institutions back up some of the fluoride opponents’ concerns about side effects. An August report from the federal National Toxicology Program examining fluoride research concluded with “moderate confidence” that higher levels of fluoride are associated with lower IQ in children. A federal judge in September ordered the Environmental Protection Agency to further regulate fluoride in drinking water based on that report and other studies. But the American Dental Association argued that the underlying studies were flawed, because they primarily relied on other countries with higher levels of fluoride than what is considered safe in the United States. And, an extensive review of studies by the Cochrane Library, considered the top-tier systematic analysis of scientific evidence, published in October found fluoridation may slightly reduce cavities and tooth decay in children, but the effect has become smaller since 1975. Fluoride skeptics say they shouldn’t be forced to drink the substance when there are unresolved scientific questions about the trade-offs between risks and benefits — and when alternatives to receive fluoride are available. | 
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