The US is sounding the alarm on fluoride in drinking water – what’s the story in the UK?

Published

7 months ago

December 8, 2024

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The debate around whether fluoride should be added to tap water is not new.

The practice, which is aimed at reducing tooth decay, has been ongoing for 60 years.

But since fluoride toothpaste became more widely available around the 1970s, more questions have been raised about whether adding it to the drinking supply is still necessary.

And with Donald Trump’s health secretary pick Robert F Kennedy Jr saying he would ban it, the issue has entered public debate yet again.

Despite RFK being well known for his outlandish views on public health, it seems the fluoridation issue isn’t one that can be totally dismissed.

One study in the US has linked fluoride to a lowering of children’s IQs, while another in the UK has questioned its overall effectiveness when added to water.

So what is fluoride, what do experts say – and what’s the story in the UK?

What is fluoride and what does it do?

It’s a natural mineral found in rocks, which leaches into soil, rivers and lakes.

It helps dental health by strengthening the tooth enamel, making it more resistant to tooth decay, and also reduces the amount of acid the bacteria on your teeth produce, according to the Oral Health Foundation.

Fluoride is known to be particularly beneficial for children’s teeth, as past studies have suggested ingesting it during the period of tooth development makes the enamel more resistant to later acid attacks and subsequent development of tooth decay.

Dr Kunal Patel, who has been a private and NHS dentist for 15 years, told Sky News the benefit of fluoride is “drilled into” dental students, adding there are “scientifically proven benefits of having fluoride within your oral hygiene regime”.

Fluoride is essentially a passive way of protecting your teeth, he says.

“If you decide not to use fluoride then the technique of brushing your teeth, your flossing and other methods of cleaning have to be that much better,” he adds.

How do we get fluoride?

Almost all water contains some naturally occurring fluoride, but it’s normally not enough to prevent tooth decay.

Some areas do have water supplies where the amount of fluoride is naturally at a high level – a point that will be covered later.

We get trace amounts of fluoride from much of our food and drink, but brewed tea in particular proves a big source because tea plants take up fluoride from soil.

Most toothpastes now contain fluoride to give you extra protection from decay.

When did adding it to the water supply become a thing?

Many oral health experts believe adding fluoride to water – an act known as fluoridation – is the most effective way to widely reduce dental problems, particularly in underprivileged regions.

The practice began in 1945 in Grand Rapids, Michigan, after scientists noticed that people had less tooth decay in areas with naturally higher fluoride levels in the tap water.

It was first added to the water supply in England in 1964, when a pilot scheme was launched in Birmingham.

Over the years it’s been rolled out to about 75% of America’s population, compared to about 10% of England.

The World Health Organization (WHO) estimates some 400 million people in 25 countries are getting artificially fluoridated water, while about 50 million have naturally occurring fluoride at the same level as the artificial schemes.

What is the ideal amount of fluoride in water?

The WHO recommends a maximum level of 1.5mg per litre.

In its guidelines, it says the level is aimed at creating a middle ground where tooth decay is minimised, but the risk of dental fluorosis and skeletal fluorosis is too.

Dental fluorosis is a common cosmetic condition caused by ingesting too much fluoride during tooth development, and can leave white flecks, spots or lines on teeth.

Skeletal fluorosis, a much rarer occurrence, is a chronic metabolic bone and joint disease caused by ingesting large amounts of fluoride.

The UK government aims for fluoride levels of 1mg per litre in drinking water, while the level of fluoride is kept at about 0.7mg per litre in the US.

Potential danger to children’s IQs

Fluoridation has been a contentious subject in the US, with more than 100 lawsuits over the years trying to get rid of it without success, according to the American Fluoridation Society, an advocacy group.

And the anti-fluoride group Fluoride Action Network says more than 150 towns and counties across the US have voted to keep fluoride out of public water systems or to stop adding it.

But the movement against it really gained momentum earlier this year when a US government report concluded that fluoride in drinking water at twice the recommended limit was linked with lower IQ in children.

The report, based on an analysis of previously published research, said it reached its conclusion “with moderate confidence”.

It cited a 2019 study, published in the well-respected journal JAMA Pediatrics, which found that IQ levels were slightly lower in three and four-year-old children whose mothers had higher measures of fluoride in their urine when they were pregnant.

A federal judge in California used the report to order the nation’s Environmental Protection Agency (EPA) to strengthen its regulations on fluoridation in September, saying the current levels were posing an unreasonable risk to children.

The judge stressed that he was not concluding with certainty that fluoridated water endangered public health, but rather that it poses a risk.

Questions over fluoride’s effectiveness

In the UK, while the government is reviewing plans to raise fluoride levels for millions and roll it out into more areas of England, a major review has suggested fluoridation may only have a “modest” benefit.

Academics at Manchester, Dundee and Aberdeen universities compared 157 studies looking at the effect of fluoridation on the dental health of communities.

When the government began adding fluoride to tap water, it reduced the number of decayed, missing or filled teeth by two whole teeth on average among children with their baby teeth, researchers said.

However, once fluoride toothpaste became widely available, that number declined.

Now, it is equivalent to a reduction of a “quarter of a tooth” that is decayed, missing or filled, on average.

“Water fluoridation is only having a modest benefit on dental caries, and those benefits may take years to be realised,” said Professor Anne-Marie Glenny, of the University of Manchester, who co-authored the paper.

Could it actually be scrapped in the US?

Mr Kennedy Jr has claimed Mr Trump will push to remove fluoride from drinking water on his first day in office, referring to it as “industrial waste” in a statement on X.

He also claimed fluoride was associated with arthritis, bone fractures, bone cancer, neurodevelopmental disorders and thyroid disease.

While there have been studies regarding some of those claims, none of them have been conclusive.

After the comments, Mr Trump told Sky News’ US partner NBC News that while he had not spoken to his health secretary pick about trying to scrap fluoride yet, “it sounds OK to me. You know it’s possible”.

The decision on whether or not add fluoride to water is ultimately made by state and local health authorities, so Mr Trump’s government can only advise them to stop it.

‘It’s about risk vs benefit’

Stephen Peckham, professor of health policy at the University of Kent, previously led a study on fluoridation’s potential links to hypothyroidism – an underactive thyroid – and is now part of a research team investigating whether it could be causing IQ issues within the UK’s population.

He tells Sky News he accepts fluoride can be beneficial, but adds it is not a necessity, especially in water.

“We know that ingested fluoride is not an effective way of preventing tooth decay,” he says. “If you want to have fluoride, put it on your toothbrush and clean your teeth with it. It needs to be applied to the tooth and not swallowed.”

He says that while the benefit is limited, the children’s IQ study carried out in the US highlights a need for caution.

“What we do know is that ingesting fluoride does have a neurologic, neurotoxic effect. What’s less certain is at what level of fluoride that begins.

“The judge is saying, well, in that case, shouldn’t we be more careful? And limit in particular pregnant women’s access to fluoridated water or consumption of fluoridated water.

“And your maximum of fluoride depends on how much you drink. So if you drink more, you get more.”

It’s about the “balance of risk and benefit”, he says.

“But if there’s not much benefit, should you have any risk? The answer is no, you shouldn’t.”

‘Stick to the most deprived regions’

Dr Kunal Patel, who owns six private dental clinics in Surrey, including one for children only, says fluoridation was “great in a time where there was less education and less access to fluoride in toothpaste”.

He adds that before the IQ study came out, he would have been happy to see fluoride being added to any area in the UK because he’d have thought “anyone could benefit” without there being any negative effects.

Now, he says, he thinks it’s best to be “selective” and limit fluoridating water “to the areas that are suffering, where it’s more rural or more deprived”.

He gives the North West as an example, saying he recently did a charity event there to promote dental health among young people, and it was “shocking” to see how many of them did not even own a toothbrush.

He says it’s a “good idea” to expand to similar areas of the UK where dental health is low – but thinks it would be an even better idea to provide toothpaste to schools in such areas and increase their education regarding how best to look after their teeth.

“I think education is the way forward more so than fluoridated water.”

A Department of Health and Social Care spokesperson told Sky News: “The number one reason children aged six to 10 end up in hospital is to have their rotting teeth pulled out.

“Water fluoridation at levels permitted in this country is a safe and effective public health measure that reduces tooth decay.

“Prevention is always better than cure, and this government is committed to helping people stay healthy and keeping kids out of hospital.”

Is your water being fluoridated?

About 330,000 people live in areas of England with naturally occurring fluoride in drinking water, while around 5.8 million people get an artificial supply put in theirs.

It means some 10% of people in England live in areas where fluoride is added to the water, mainly in the West Midlands and the North East.

There is no fluoridation in Wales, Scotland or Northern Ireland.

Here is the full list of areas receiving artificial fluoridation in England, according to the British Fluoridation Society:

Cumbria – 120,000
Cheshire – 137,000
Tyneside – 643,000
Northumbria – 101,000
County Durham – 85,000
Humberside – 136,000
Lincolnshire – 250,000
Nottinghamshire – 287,000
Derbyshire – 43,000
Birmingham – 1,000,000
Solihull – 200,000
Coventry – 300,000
Sandwell – 300,000
Dudley – 305,000
Walsall – 253,000
Wolverhampton – 236,000
Staffordshire – 497,000
Shropshire – 22,000
Warwickshire – 431,000
Worcestershire – 253,000
Bedfordshire – 198,000

And here is the list of areas getting the “optimal” amount of fluoride naturally:

Hartlepool, County Durham – 89,000
Easington, County Durham – 47,000
Uttoxeter, Staffordshire – 13,000
Redbridge, London Borough – 180,000

Where else could fluoride be added to water?

The Conservative government introduced proposals to expand fluoridation schemes across the North East “because of the significant and long-standing inequalities in the region” when it comes to dental health.

A public consultation on the plans was launched in June and closed in July. Since Sir Keir Starmer’s Labour government won the election, it has not been clear whether the plans are still being pursued.

These are the areas the government proposed extending the fluoride supply to:

Darlington
Durham
Gateshead
Hartlepool
Middlesbrough
Newcastle
Northumberland
North Tyneside
Redcar and Cleveland
South Tyneside
Stockton
Sunderland

US

Texas floods: The victims and people missing that have been named so far

Published

1 hour ago

July 6, 2025

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Texas floods: The victims and people missing that have been named so far

Details of those who have died and those who are missing after US flash floods are slowly emerging – with several young girls among those unaccounted for.

At least 69 people have died from the flooding in Texas, with an unknown number of people – including 11 girls and a counsellor from Camp Mystic in Kerr County – still missing.

As much as 10ins (25cm) of heavy rain fell in just a few hours overnight in central Kerr County on Friday, causing the banks of the Guadalupe River to burst at around 4am local time.

Tributes to those who died, and appeals for those who are still missing, are now being shared.

Who are the victims?

Renee Smajstrla, eight

Renee’s uncle Shawn Salta confirmed the eight-year-old had died, and said she was one of 700 children staying at Camp Mystic.

“Renee has been found and while not the outcome we prayed for, the social media outreach likely assisted the first responders in helping to identify her so quickly,” he said.

“We are thankful she was with her friends and having the time of her life, as evidenced by this picture from yesterday.

“She will forever be living her best life at Camp Mystic.”

Sarah Marsh, eight

Mountain Brook mayor Stewart Welch confirmed the death of eight-year-old Sarah, from Alabama, who was a pupil at Cherokee Bend Elementary.

“This is an unimaginable loss for her family, her school, and our entire community,” he said. “Sarah’s passing is a sorrow shared by all of us, and our hearts are with those who knew and loved her.

“As we grieve alongside the Marsh family, we also remember the many others affected by this tragedy.”

Eloise Peck and Lila Bonner, both nine

Eloise’s mother Missy Peck told local broadcaster FOX4 that her daughter and Lila were best friends and cabinmates at Camp Mystic.

Writing about her daughter on Instagram, Ms Peck said: “She lost her life in the tragic flooding… our family is grieving and processing this unimaginable loss together.”

Lila’s family told NBC Dallas Fort Worth, a local affiliate network of Sky’s US partner network, that they were in “unimaginable grief”, and said: “We ache with all who loved her.”

Janie Hunt, nine

Janie’s family confirmed her death to a reporter from NBC Dallas Fort Worth, who said “her mother tells me she’s devastated”.

Richard ‘Dick’ Eastland, owner of Camp Mystic

Kerr County judge Rob Kelly told the Washington Post that Mr Eastland, who owned the camp died in a helicopter on the way to a Houston hospital.

Local outlet The Kerrville Daily Times reported he was killed while trying to save the girls from the flash floods.

“It doesn’t surprise me at all that his last act of kindness and sacrifice was working to save the lives of campers,” guest columnist Paige Sumner said in the Daily Times’ tribute to Mr Eastland.

Blair and Brooke Harber, 13 and 11

RJ Harber told CNN his daughters died during flooding in Kerr County, saying Blair “was a gifted student and had a generous kind heart”.

He added that Brooke “was like a light in any room, people gravitated to her and she made them laugh and enjoy the moment”.

He also said both his parents were still missing.

Jane Ragsdale, owner of Heart O’ the Hills camp

On Heart O’ the Hills’s website, the camp confirmed it was “right in the path of the flood” along the Guadalupe River.

While there were no campers in residence, Jane Ragsdale died. The camp said: “We at the camp are stunned and deeply saddened by Jane’s death.

“She embodied the spirit of Heart O’ the Hills and was exactly the type of strong, joyful woman that the camp aimed to develop with the girls entrusted to us each summer.”

Julian Ryan, 27

Relatives of Mr Ryan told local news broadcaster KHOU 11 that he died saving his family from floodwaters in Texas Hill County.

They described how he tried to smash a window to help them escape the rising water, but it cut his arm and he bled out before help could arrive.

Who is still missing?

Penny, Emlyn, and Madelyn ‘Emmy’ Jeffrey, 11

Christin Jeffrey Jones posted on Facebook that her parents Penny and Emlyn Jeffrey are missing, as well her niece Madelyn ‘Emmy’ Jeffrey.

She said her family were in Hunt, Texas, and “were spending the night at their cabin on the river at Casa Bonita which is now completely gone”.

“We ask for continued prayers and miracles,” she said. “Please share the word.”

Charlene and Mike Harber, 74 and 76

RJ Harber also told CNN that his parents, Charlene and Mike Harber, are still missing.

He believes the couple have died.

US

Deadly Texas floods: What were the warnings?

Published

4 hours ago

July 6, 2025

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Deadly Texas floods: What were the warnings?

Questions have been raised over extreme weather warnings in Texas, after heavy rain caused fatal flash floods along the Guadalupe River.

At least 51 people have died from the flooding in Texas, with an unknown number of people – including 27 girls from Camp Mystic in Kerr County – still missing.

As rescue teams continue to search for the missing, local and federal officials have come under fire over their flood preparations and about why those along the river weren’t warned of the risks sooner.

What happened?

As much as 10ins (25cm) of heavy rain fell in just a few hours overnight in central Kerr County on Friday, causing the banks of the Guadalupe River to burst at around 4am local time.

Homes and vehicles were swept away by the downpour – equivalent to months’ worth of rain – while 27 girls staying at Camp Mystic, a Christian summer camp along the river, went missing when the fast-rising floodwaters hit.

The death toll stands at:
• At least 43 people, including 15 children and 28 adults, in Kerr County,
• One person in Kendall County,
• At least four people in Travis County,
• At least two in Burnet County,
• And one person in the city of San Angelo.

What flood warnings were there?

Private forecasting company AccuWeather said it and the National Weather Service (NWS) sent warnings about potential flash flooding hours before it began, urging people to move to higher ground and evacuate flood-prone areas.

The NWS also issued flash flood emergencies – a rare alert notifying of imminent danger – at 4.23am local time.

In a statement, AccuWeather said that “these warnings should have provided officials with ample time to evacuate camps such as Camp Mystic and get people to safety”.

It also called Texas Hill County one of the most flash-flood-prone areas of the US because of its terrain and many water crossings.

However, chief of the Texas Division of Emergency Management Nim Kidd said that one NWS forecast earlier in the week had called for up to six inches of rain.

“It did not predict the amount of rain that we saw,” he said.

Were they enough?

Locals have told various news agencies that while there had been phone alerts late into the night, forecasts headed into Friday evening did not predict the extreme conditions.

Christopher Flowers, who was staying at a friend’s house along the river when the flooding started, told the Reuters news agency: “What they need is some kind of external system, like a tornado warning that tells people to get out now.”

Kerrville resident Darryl Huffman told Sky’s US partner network NBC News that he did not believe the storm would pose such danger before its arrival.

“I looked out the window and it was barely sprinkling outside,” he said, “so I had no indication that the river was going to be right outside my driveway”.

Jonathan Porter, chief meteorologist at AccuWeather, said it appeared evacuations and other proactive measures could have been undertaken to reduce the risk of fatalities.

He said in a statement: “People, businesses, and governments should take action based on Flash Flood Warnings that are issued, regardless of the rainfall amounts that have occurred or are forecast.”

Separately, the NWS’s union told NBC News the agency’s offices in central Texas were well-staffed and had issued timely warnings, “giving preliminary lead times of more than three hours before warning criteria were met”.

What have officials said?

Local and federal officials have said they had not expected such an intense downpour of rain and insisted that no one saw the flood potential coming.

Kerr County Judge Rob Kelly, the county’s top elected official, said: “We know we get rain. We know the river rises. But nobody saw this coming.”

“We have floods all the time. This is the most dangerous river valley in the United States,” he said, adding: “We had no reason to believe this was going to be anything like what’s happened here. None whatsoever.”

Mr Kelly separately noted that while the county considered a flood warning system along the river that would have functioned like a tornado warning siren about six or seven years ago, “the public reeled at the cost”.

At a news conference with the Texas governor, Homeland Security secretary Kristi Noem said on Saturday that “everybody knows that the weather is extremely difficult to predict” before saying “we have all wanted more time and more warning and more alerts and more notification” from the NWS.

She said a “moderate” flood watch issued on Thursday by the NWS had not accurately predicted the extreme rainfall and said the Trump administration was working to upgrade their technology.

Will forecasting get better?

While Ms Noem said technology for the NWS would be upgraded, the White House has previously been criticised after Donald Trump‘s administration ordered 800 job cuts at the National Oceanic and Atmospheric Administration (NOAA) – the parent organisation of the NWS.

A 30% cut to its budget is also in the pipeline, subject to approval by Congress.

Professor Costa Samaras, who worked on energy policy at the White House under President Joe Biden, said NOAA had been in the middle of developing new flood maps for neighbourhoods and that cuts to NOAA were “devastating”.

US

At least 51 people killed in Texas flooding as authorities face scrutiny over response

Published

13 hours ago

July 6, 2025

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At least 51 people killed in Texas flooding as authorities face scrutiny over response

At least 51 people have died after heavy rain caused flash flooding, with water bursting from the banks of the Guadalupe River in Texas.

The overflowing water began sweeping into Kerr County and other areas around 4am local time on Friday, killing at least 43 people in the county.

This includes at least 15 children and 28 adults, with five children and 12 adults pending identification, Kerr County Sheriff Larry Leitha said at a news conference.

In nearby Kendall County, one person has died. At least four people were killed in Travis County, while at least two people died in Burnet County. Another person has died in the city of San Angelo in Tom Green County.

An unknown number of people remain missing, including 27 girls from Camp Mystic in Kerr County, a Christian summer camp along the Guadalupe River.

Rescuers have already saved hundreds of people and would work around the clock to find those still unaccounted for, Texas governor Greg Abbott said.

But as rescue teams are searching for the missing, Texas officials are facing scrutiny over their preparations and why residents and summer camps for children that are dotted along the river were not alerted sooner or told to evacuate.

AccuWeather said the private forecasting company and the National Weather Service (NWS) sent warnings about potential flash flooding hours before the devastation, urging people to move to higher ground and evacuate flood-prone areas.

The NWS later issued flash flood emergencies – a rare alert notifying of imminent danger.

“These warnings should have provided officials with ample time to evacuate camps such as Camp Mystic and get people to safety,” AccuWeather said in a statement that called Texas Hill County one of the most flash-flood-prone areas of the US because of its terrain and many water crossings.

But one NWS forecast earlier in the week had called for up to six inches of rain, said Nim Kidd, chief of the Texas Division of Emergency Management.”It did not predict the amount of rain that we saw,” he said.

Officials said they had not expected such an intense downpour of rain, equivalent to months’ worth in a few short hours, insisting that no one saw the flood potential coming.

One river near Camp Mystic rose 22ft in two hours, according to Bob Fogarty, meteorologist with the NWS’s Austin/San Antonio office. The gauge failed after recording a level of 29.5ft.

“People, businesses, and governments should take action based on Flash Flood Warnings that are issued, regardless of the rainfall amounts that have occurred or are forecast,” Jonathan Porter, chief meteorologist at AccuWeather, said in a statement.

“We know we get rain. We know the river rises,” said Kerr County Judge Rob Kelly, the county’s top elected official. “But nobody saw this coming.”

Judge Kelly said the county considered a flood warning system along the Guadalupe River that would have functioned like a tornado warning siren about six or seven years ago, before he was elected, but that the idea never got off the ground because “the public reeled at the cost”.

Homeland Security Secretary Kristi Noem was asked during a news conference on Saturday whether the flash flood warnings came through quickly enough: “We know that everyone wants more warning time, and that is why we are working to upgrade the technologies that have been neglected for far too long.”

Presidential cuts to climate and weather organisations have also been criticised in the wake of the floods after Donald Trump‘s administration ordered 800 job cuts at the science and climate organisation NOAA, the parent organisation of the NWS, which predicts and warns about extreme weather like the Texas floods.

A 30% cut to its budget is also in the pipeline, subject to approval by Congress.

“Accurate weather forecasts matter. FEMA and NOAA matter. Because little girls’ lives matter,” said Frank Figliuzzi, a national security and intelligence analyst at Sky’s US partner organisation NBC News.