More than 20 million gallons of water are treated at the Murphree Water Treatment Facility in Gainesville every day. It serves drinking water to 200,000 people. Jodi Gilbert is the plant manager.
“So this is the very non-exciting fluoride tank” he chuckles, standing in front of a tank that’s holding 7,500 gallons of an acid containing fluoride.
“It’s in a liquid form that contains a certain amount of those fluoride ions. And as it’s added to water, it basically dissolves,” he explained.
This facility is one of 104 utilities in Florida that actively adds fluoride to drinking water, according to the Florida Department of Health.
“This is our laboratory,” Gilbert said, as an operator gradually added tiny amounts of fluoride to the city’s drinking water.
Fluoride is naturally present in most water systems, but usually at levels too low to help prevent cavities, according to the Centers for Disease Control and Prevention. That’s why the CDC recommends utilities add more fluoride with the goal of reaching 0.7 parts per million, or milligrams per liter, of fluoride.
Experts liken it to one penny in a jar that’s holding $14,000. It’s small but effective. Studies from the CDC show it can reduce cavities in adults and children by 25%.
But data from the CDC shows 31 utilities in Florida had annual average fluoride levels that were approximately half the CDC’s recommended level or less for at least a year.
Experts say these levels are so low, it’s likely the utilities weren’t adding any additional fluoride to meet the CDC’s recommendation, leaving communities with sub-optimal levels of fluoride to fight tooth decay and cavities.
“They either had problems securing fluoride product to add or, I don’t know. But clearly those levels are significantly below the optimum level that they should be,” said Dr. Scott Tomar, professor and associate dean for prevention and public health sciences at the University of Illinois, Chicago.
The utilities span the entire state of Florida, from Gainesville in the north to Naples in the south. The data comes from the CDC’s My Water’s Fluoride state fluoridation reports, which date from 2015 to 2023.
According to the data, 13 of the utilities had low fluoride levels for one year, before bouncing back to levels closer to the CDC’s recommended level. Eighteen utilities had low fluoride levels for two or more years. The longest duration was seven years in Palm Bay, which had an annual average of 0.26 parts per million of fluoride from 2017 to 2023.
Some of the lowest levels were recorded in Boynton Beach, which had an average fluoride level of 0.15 parts per million from 2015 to 2020.
While there is still some natural fluoride in the water, it’s not enough to help prevent cavities, according to Tomar.
”For most places, anything below 0.6 parts per million really is not considered fluoridated. And almost by definition, we would not expect the full preventive effect,” said Tomar. “There’s some fluoride, but not sufficient to prevent tooth decay.”
Dr. Johnny Johnson, president of the American Fluoridation Society, calls the fluoride gaps a health issue.
“We’re fluoridating water for people’s health and safety and for their entire body and we’re supposed to be doing it and we’re not doing it,” said Johnson. “ For a utility or elected officials to not be fiscally responsible and maintain this as it should be when the community leaders and citizens think that it’s being done?”
WUFT reached out to all 31 utilities. Representatives from Manatee County, Gainesville, Boynton Beach, Delray Beach, DeLand, and Cocoa confirmed they stopped adding fluoride for one or more years. The majority said equipment issues were to blame.
In Manatee County, residents have been without fluoridated water since mid-2021 “due to equipment failures, corrosion and safety concerns,” wrote Bill Logan, the county’s information outreach manager, in an email.
According to Logan, Deputy County Administrator Evan Pilachowski offered two options to bring the equipment back online: one year to replace the system at its current location, which would cost $2 million, or three years to add a new fluoride system, which would cost $1.5 million.
Logan said commissioners voted to write a new ordinance that would eliminate fluoride from the county’s drinking water.
In Brevard County, residents in Cocoa haven’t had fluoridated water in over a year, “simply because our equipment for adding it has been broken and is still broken,” wrote Donald Downs, a public relations officer for Cocoa Utilities Department in an email.
Back at the Murphree Water Treatment Facility in Gainesville, plant manager Jody Gilbert said they’ve also had equipment issues. “We have had pump issues with the feed system. It’s equipment that we had to get ordered and replaced. And so we were not feeding fluoride during those times,” said Gilbert.
Data from the CDC shows the utility had an annual average fluoride level of 0.31 parts per million for 2019 and 0.36 parts per million in 2021.
Since fluoride is not federally mandated, utilities aren’t required to give public notice when they stop adding fluoride. That means residents who think they’re getting fluoridated water, may not be.
“It’s not required for us to report on a regular basis to the community what the levels are,” said Jennifer McElroy, supervising environmental engineer at Gainesville Regional Utilities, which runs the Murphree Water Treatment Facility in Gainesville. “If the public was interested, then they can always ask,” said McElroy.
In an interview with the Florida Today newspaper, Deputy Mayor Mike Jaffe of Palm Bay said most residents, himself included, had no idea the city had been without fluoridated water since 2017. Jaffe said he didn’t learn of the issue until he was elected to the city council in November 2024.
The city voted to stop adding fluoride in January 2025. Palm Bay joins other areas listed in the CDC data that have voted to stop adding fluoride in the past year, including Collier County, Melbourne, Naples, and Tavares.
A new bill filed in the legislature means non-fluoridated water could become permanent in Florida. The bill, filed by Sen. Keith Truenow (R-Tavares), seeks in part to ban the addition of fluoride to all water systems in the state.
If that happens, experts said they expect to see a rise in tooth decay and cavities. Dr. Erica Caffrey, a pediatric dentist and professor at the University of Maryland, points to a study in Calgary, Canada, where the city voted to stop adding fluoride in 2011.
Researchers found the number of second graders with cavities rose from 56% to 64% from 2013-2014 to 2018-2019. In the nearby city of Edmonton, which continued to fluoridate its water, the number of second graders with cavities decreased from 58% to 55%.
“ I have certainly heard from my colleagues who work in non-fluoridated communities where the dental decay rates are absolutely quite high,” said Caffrey.
She said pain from cavities can affect more than just a person’s dental hygiene, causing sleepless nights, trouble focusing, and increased visits to emergency rooms and urgent care centers. In children, she said cavities can affect everything from what they can eat to how they see themselves.
“A child’s nutrition can suffer. Their speech can suffer if they have to have teeth pulled. And their self-esteem, self-image are absolutely affected by dental decay and the way that looks in the mouth,” said Caffrey.
The legislature will discuss the possible ban on fluoride during the next legislative session, which starts March 4.