It's been almost a year since Utah banned supplemental fluoride from drinking water.
Roughly 43% of Utahns went from drinking fluoridated water to not. Lawmakers said residents should be able to choose whether they wanted to take fluoride and cited research that high levels of fluoride can hurt people's health. Dental experts decried the ban.
It's too soon to see the effects, said Dr. James Bekker, a pediatric dentist and former president of the Utah Dental Association. Instead, he expects to see a difference in five to seven years, especially among kids whose adult teeth will come in a few years.
Researchers at the University of Utah, where he teaches, will be paying attention, he said.
"If you have had fluoride in the water, they come in stronger, harder enamel. If you don't have fluoride, the enamel is softer, and so then you get the cavities."
Juneau, Alaska, could be an example of Utah's future. Cavity-related procedures there were more common after fluoride was removed from the water, especially among children born post-fluoridation, according to a study from the University of Alaska Anchorage.
In the meantime, though, Bekker said there's been a silver lining: more fluoride awareness in Utah.
That's been driven in part by the Utah Oral Health Coalition's Your Smile Matters education campaign, which launched in late 2025. Director Lorna Koci isn't shy about their ultimate goal.
"We want fluoride back, and we're not going to get fluoride back unless we do this work," she said.
Funded by a grant from the nonprofit CareQuest Institute for Oral Health, much of the campaign's work happens in schools. The group teaches classes for young children on the basics of brushing their teeth and offers information and free toothbrushes at resource fairs. At some events, dental hygiene students from Weber State University and Fortis College provide topical fluoride varnish and oral health screenings while meeting families.
"We have some wonderful photographs of children's mouths that are healthy mouths and very unhealthy mouths," Koci said. "So we, it's like the driver ed class with the accidents."
Educational pamphlets are in English and Spanish, and Koci said a Spanish-speaking hygiene student has attended at least half of their events so far.
The campaign also encourages more schools to work with Big Smiles Dental, which provides dental hygiene and basic treatment for kids. They plan to seek funding so Big Smiles can treat more uninsured children, Koci said, but the program also benefits those with insurance.
"We try not to take patients from a home dentist, but many, we know many children who have dental coverage don't get taken to the dentist," she said.
Outside of school districts, Koci said the Your Smile Matters campaign is in talks with health departments, including Summit County, which didn't have fluoride in the water even before Utah's outright ban.
"We should have been working more with them in the first place, but this has really raised the awareness," she said.
Bekker's a fan of the campaign, but he doesn't see it as a magic solution.
"Is it enough? Who knows. We just need to keep working at it and keep doing everything we can."
From his vantage point as a dentist and delegate to the American Dental Association, he said reactions to fluoride varnish, a treatment painted on the teeth with a tiny brush, have changed.
"Some people are saying, 'No, I'm fine,' because there's that worry that's been put in people's minds," he said.
So dental professionals are phrasing things differently.
"Now we're not so much asking, 'Do you want a fluoride treatment?'" he said. "It's, 'I'd like to just explain a little bit to you about how we go forward in Utah now that we don't have fluoride in the water, and here are the facts.'"
Without added fluoride in drinking water, the only other way to get systemic fluoride, which supports teeth as they develop, is through supplements, Bekker said. Republican Rep. Stephanie Gricius, who sponsored the bill that banned added fluoride from public drinking water, said people would still be able to access fluoride through supplements, which the law allows pharmacists to prescribe.
But some pharmacies aren't participating, Bekker said.
"Some pharmacies have said, 'No, we're not going to do that, because we have to train the pharmacy, we have to do all the studies on the dose, the correct dosage, for the certain area and the certain ages.'"
Utah's Department of Health and Human Services does not track the sale of fluoride supplements, so it's hard to know whether they have become more popular since fluoride was removed from the water.
Macy Lipkin is a Report for America corps member who reports for KUER in northern Utah.
Editor's note: KUER is a licensee of the University of Utah but operates as an editorially independent news organization.
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