US fluoride shortage: Iran war is affecting supply

Some U.S. water utilities are facing an unexpected challenge as the ongoing conflict in the Middle East disrupts their ability to maintain recommended fluoride levels in drinking water supplies.

The Association of Metropolitan Water Agencies reports that several water utilities across the country have experienced supply disruptions in recent weeks. This shortage affects the delivery of fluoride, which has been added to water systems for decades as a public health measure to prevent tooth decay.

The supply chain disruption stems directly from the conflict in the Middle East. Israel ranks among the world’s top exporters of fluorosilicic acid, according to the U.S. Environmental Protection Agency, with the United States being one of the top five global importers of this chemical.

Dan Hartnett, chief policy officer for the Association of Metropolitan Water Agencies, explained the root cause: “At least one Israeli supplier has been facing workforce challenges because many employees have been called into active military service. That has led to decreased production, and supply shortages for the U.S. market.”

While the number of affected water utilities remains relatively small, the impact is already reaching hundreds of thousands of consumers. Industry experts warn that as the Middle Eastern conflict persists, “there will likely be additional stressors placed on the supply chain, leading to shortages in additional communities,” according to Hartnett.

Among those affected is WSSC Water in Maryland, the nation’s eighth-largest water and wastewater utility. On April 7, officials announced they were reducing fluoride levels in drinking water to 0.4 milligrams per liter, down from the CDC-recommended 0.7 milligrams per liter.

Chuck Brown, spokesperson for WSSC Water, which serves 1.9 million customers, stated they were uncertain about the duration of the shortage but expressed confidence in their ability to “stretch that out for a couple more months.” Similarly, in Pennsylvania, the borough of Lititz temporarily halted fluoridation for several weeks last month due to supply constraints.

Health officials emphasize that the fluoride reduction poses no safety concerns for drinking water, as utilities add fluoride voluntarily as a dental health benefit rather than for water safety purposes.

Dr. Scott Tomar, a community water fluoridation expert with the American Dental Association, reassured the public that a temporary reduction in fluoride levels is unlikely to cause significant dental health concerns for most people. However, he noted that research from locations that have ceased fluoridation—including Calgary, Canada; Juneau, Alaska; and Israel—shows that lower fluoride levels can impact dental health over years.

“Based on the best available information we have, below about 0.5 milligrams per liter, you’re probably not going to see effective preventive exposure,” Dr. Tomar explained. He added that young children would likely be the first to experience the effects of reduced fluoride, as it strengthens enamel during tooth development.

For residents in affected areas, Dr. Tomar recommends maintaining rigorous oral hygiene practices, including brushing twice daily with fluoride toothpaste and keeping regular dental appointments. He advises against taking fluoride supplements without first consulting a dentist.

Nearly two-thirds of Americans receive fluoridated drinking water, according to CDC data. The addition of low fluoride levels to drinking water has long been considered one of the greatest public health achievements of the 20th century, with the American Dental Association crediting it with reducing tooth decay by more than 25% in both children and adults.

Despite its proven benefits, fluoridation has faced growing skepticism. Last year, Utah became the first state to ban public water fluoridation, and recently appointed Health Secretary Robert F. Kennedy Jr. has repeatedly questioned fluoride’s safety and restricted its use for dental health purposes.

Dr. Tomar firmly counters such concerns: “The levels we use in the United States are perfectly safe. Despite a lot of the misinformation, there are no adverse health effects associated with the levels we use in our drinking water.”

As the Middle East conflict continues, water utilities and public health officials will monitor the situation closely, potentially implementing additional conservation measures if the fluoride shortage persists or worsens.