Miami-Dade County Commission votes to take fluoride out of tap water. What’s next?

On Tuesday, a bipartisan coalition of Miami-Dade County commissioners voted to end a public health program the county started in the 1950s: adding tiny amounts of fluoride into the water supply.

Long recognized by major medical groups as vital for reducing cavities across a population, the practice has come under fire from some researchers and some health officials — including Florida Surgeon General Joseph Ladapo.

Tuesday’s 8-2 vote puts Miami-Dade, Florida’s most populous county, on the forefront of the fluoride rollback movement. Backers of the movement say it’s a victory for freedom of choice amid worries about fluoride’s possible neonatal effects. Critics call it a baseless retreat from a safe anti-cavity measure that the federal Centers for Disease Control and Prevention (CDC) called one of the greatest public health programs of the 20th century.

If you’re one of more than 2.8 million people served by the county’s water system, what does the vote mean for you? Here are some questions and answers on the topic, based on interviews and research.

When will Miami-Dade stop adding fluoride in tap water?

We don’t know for sure, but it would likely be weeks away. The legislation that passed Tuesday requires the county Water and Sewer Department to halt adding fluoride within 30 days. While the legislation passed, it won’t take effect until Mayor Daniella Levine Cava has had enough time to veto the resolution. There’s a 10-day window for that, meaning the 30-day countdown would begin around April 11 if she does not issue a veto.

How frequently is fluoride added?

Every day, according to the Water and Sewer Department.

How much fluoride gets added to Miami-Dade water?

It’s tiny — for every million drops of ground water processed by the agency, less than one drop is fluoride is added.

Is brushing my teeth a good substitute if there’s no fluoride added to tap water?

Public health advocates see fluoridation as good for the population by increasing the odds that people across the economic spectrum get a baseline amount of fluoride daily. While not enough to replace regular brushing and flossing, the microscopic amounts of fluoride in the water supply reduce the chances of severe dental issues for people not getting enough fluoride through toothpaste, dentists said.

Dr. Courtney Chinn, a pediatric dentist and associate professor at New York University’s dental school, said it would be wrong to only look at income when it comes to the risks of ending fluoridation. Economic status is definitely a factor, Chinn said: A child of a parent working a night shift is probably less likely to have an adult supervising their nightly brushing routine.

But not having fluoride in the water will remove a daily boost to oral health for everybody, he said. “Every little bit helps,” he said. “For an older gentleman that takes a lot of medication that causes dry mouth, you’re at risk.”

Dr. Richard Mufson, an Aventura dentist who spoke against the county legislation, said he wouldn’t change his advice on oral health for patients concerned about no longer getting fluoride through tap water. “My advice would be to do the same as you’re doing every day: regular checkups, brush and floss your teeth,” he said. “Do everything as you would, but just know we all could be more susceptible to cavities than we were before.”

What about children who will be living somewhere without fluoride in tap water?

Brushing habits for children may not be as reliable as they are with adults, raising concerns about oral health for younger residents, dentists said. For anyone not getting enough fluoride through toothpaste and mouthwashes, an end to fluoride in the water will increase risks of oral problems, they said.

“Not everyone brushes their teeth sufficiently well,” said Dr. Rita Dargham, a Coconut Grove dentist. “Just because you’re brushing your teeth is not a guarantee you won’t be affected.”

Ingesting microscopic amounts of fluoride also helps strengthen teeth development in young people, according to the Cleveland Clinic. “The fluoride that’s ingested is beneficial for adolescents and kids as their adult teeth develop because that’s where it actually incorporates into the developing tooth,” Dr. Nathan Janowicz said in an article posted by the medical center.

Does all toothpaste have fluoride in it?

Most do, but some are marketed as “natural” and fluoride free.

Why are people against fluoride?

In his remarks to commissioners, Ladapo, the state surgeon general, said fluoride in toothpaste is plenty sufficient for dental health, and that drinking it causes health risks. He pointed to some research raising links between fluoride consumption in pregnant women and developmental issues with their children. One was a federal study released last year by the National Toxicology Program, part of the Department of Health and Human Services, that linked lower IQs in children with high levels of fluoride exposure — at rates about double the amount of fluoride that’s found in Miami-Dade and other municipal water systems.

Major medical groups, including the American Academy of Pediatrics, stuck with their pro-fluoridation stances after the study came out and other scientists cited flaws in the findings. And while the current federal health secretary, Robert F. Kennedy Jr., also opposes adding fluoride to drinking water, that’s not the current federal recommendation. The Centers for Disease Control and Prevention’s website includes U.S. Public Health Service recommendations that water systems maintain a minimum amount of fluoride in tap water to boost dental health.

Even if Miami-Dade stops adding fluoride in the water, will I still get it if I drink bottled water?

Most bottled water doesn’t contain fluoride.

I live in Miami and the city picks up my trash, not the county. Does this even affect me?

Yes. Most cities in Miami-Dade get their water from the county. There are only four cities with their own water systems — Florida City, Hialeah, Homestead and North Miami Beach — and each currently adds fluoride to their water supplies. Miami-Dade also provides water to some parts of Hialeah.

Is this a done deal?

Maybe not. Levine Cava said she supports fluoride in drinking water and also said she’s considering a veto.

If the mayor vetoes the legislation, then fluoride stays in the water?

No, not necessarily. The County Commission would have a chance to override her veto by a two-thirds vote of the commissioners present at the next meeting. That meeting would fall on May 6, based on the current calendar.

So are there enough votes to override the veto?

We don’t know.

If all 13 county commissioners attend the meeting, nine votes would be needed to override a veto — and eight commissioners voted Tuesday to stop fluoridation in the water. So supporters of the legislation likely need one other commissioner on their side to override a veto.

The votes to end fluoridation were from Commissioners Juan Carlos Bermudez, Kevin Cabrera, René Garcia, Oliver Gilbert, Danielle Cohen Higgins, Kionne McGhee, Anthony Rodriguez and the legislation’s sponsor, Roberto Gonzalez. Voting against were Eileen Higgins and Raquel Regalado.

Three commissioners weren’t at the meeting for the vote. Those are Marleine Bastien, Keon Hardemon and Micky Steinberg.

So if the mayor vetoes the legislation and there aren’t enough commissioners to override the veto, then fluoride stays in the water?

Yes, for now. But there is also legislation advancing in Tallahassee to ban fluoridation statewide.

This story was originally published April 3, 2025 at 5:30 AM.