Water Fluoridation in West Virginia
This Science and Technology Note discusses the status of water fluoridation, related mandates in West Virginia, and potential benefits and challenges to the practice.
Research Highlights
Fluoride has been added to community water sources around the US since the mid-1900’s and has decreased tooth decay by about 25%
The vast majority of West Virginians are serviced by a community water supply that has added fluoride
Individuals without access to a fluoridated community water supply are at increased risk of tooth decay and West Virginia has multiple practices in place to address these needs
Critics argue community water fluoridation takes away their invidual freedom to choose to opt-in
Two states have recently enacted fluoride bans while other communities have reversed bans after observing large increases in cases of tooth decay.
Tooth decay is caused, in part, by bacteria dissolving minerals on the surface of teeth. In the mid-1900’s, fluoride, a naturally occurring mineral found in rocks and soil, was thought to help replace lost minerals and therefore mitigate tooth decay. This theory was tested in Grand Rapids, Michigan in the 1940s, which resulted in a 60% decrease in pediatric tooth decay. Communities around the country began fluoridating public water, including West Virginia in 1950. Since then, the rate of tooth decay has decreased by about 25% and the US CDC has listed water fluoridation as one of the 10 great public health achievements in the United States in the 20th century. This Science and Technology Note discusses the status of water fluoridation and water fluoridation mandates in West Virginia and some potential benefits and drawbacks of the practice.
Recommended Fluoride Levels
The recommended fluoride concentration to promote oral health via water fluoridation is 0.7 parts per million (ppm). Most natural water sources fall short of the 0.7 ppm recommendation. In these cases, fluoride is often added into the water supply. West Virginia allows fluoride supplementation requirements to be made at the local level.
Image Source: Cleveland Clinic
Water Fluoridation in West Virginia
Most West Virginians receive water from a community water system (CWS) that is supplied by two sources. Surface water supplies the majority of water for public consumption in West Virginia and typically has fluoride levels ranging between 0.01-0.3 ppm. About 20% of water for public consumption is groundwater. Fluoride levels in groundwater vary depending on the local geology. West Virginia groundwater fluoride levels range from 0.1-12 ppm. Most sources with more than 2.0 ppm are located in the northwestern part of the state.
Most communities in West Virginia fluoridate their CWS supply and a higher proportion of West Virginians receive fluoridated water from a CWS than the national average. Every $1 spent on water fluoridation is estimated to have a return on investment of $20 with an additional $32 in savings for individuals. Moreover, West Virginia children aged 3-5 have lower rates of tooth decay than the national average. Not receiving fluoridated water from a CWS is likely due to local laws either only mandating it if the CWS serves a minimum threshold of people or not mandating it at all. The Clarksburg Water Board, for example, just elected to stop purchasing fluoride for their water supply beginning next year.
15% of West Virginians get water from individual systems which require permits. Water quality monitoring is generally the system owner’s responsibility and can be processed through a state-approved lab for a fee. West Virginia (similarly to Kentucky, Ohio, Maryland, Pennsylvania, and Virginia) does not provide assistance with additives such as fluoride to the water but provides information for federal and non-profit assistance.
Individuals without access to fluoridated water are at particular risk of tooth decay. West Virginia has implemented several programs through the Department of Health and Human Resources to address these needs, including permitting any healthcare professional to apply fluoride varnish to teeth. Additional school-based programs that offer free fluoride mouth rinse or dental sealants (small coatings that protect the surface of teeth from decay) have increased enrollment each year, helping over 7,600 students in the 2022-2023 school year.
Water Fluoridation in Other States
There is no country-wide fluoride mandate in the US. Some states (including Kentucky, Virginia, and Ohio) have statewide supplementation mandates. Other states (such as Maryland and Pennsylvania) allow local governments to determine mandates. Most jurisdictions only require fluoride supplementation if the water source serves a minimum threshold of people. Ohio, for example, only requires supplementation if the water source services at least 5,000 individuals.
Concerns About Water Fluoridation
Critics argue that water fluoridation takes away their ability to decide whether or not to receive fluoride. Some critics, including HHS Secretary Robert F. Kennedy Jr., reference an analysis arguing that increased fluoride levels are correlated with lower IQ in children, however this analysis primarily observed fluoride levels that were multiple times higher than 0.7 ppm. A study on communities with fluoride levels closer to 0.7 ppm found no effect on cognitive development. Some have raised concern over cancer risk after a study was published showing that fluoride consumption led to increased risk of osteosarcoma in male rats, however further studies examining human data did not support this claim. An additional cause for concern is fluorosis, tooth discoloration due to consuming too much fluoride. Fluorosis is generally caused by fluoride levels of 1.5 ppm or higher, about twice the recommended concentration for water.
Water Fluoridation Bans
Multiple states introduced legislation in 2025 seeking to ban fluoride in public water and bans were passed in both Utah and Florida. These bans were met with opposition from medical organizations including the American Dental Association. Fluoride was previously banned in Calgary, a city in Alberta, Canada, in 2011 and reintroduced about 10 years later after observing an increase in pediatric tooth decay. Similarly, Windsor, Ontario, Canada banned fluoride in 2013 and then reintroduced it in 2018 after seeing a 51% increase in cases of pediatric tooth decay.
This Science and Technology Note was prepared by Nathan G. Burns, PhD, West Virginia Science & Technology Policy Fellow on behalf of the West Virginia Science and Technology Policy (WV STeP) Initiative. The WV STeP Initiative provides nonpartisan research and information to members of the West Virginia Legislature. This Note is intended for informational purposes only and does not indicate support or opposition to a particular bill or policy approach. Please contact info@wvstep.org for more information.