Central Alabama Water announced Friday that it will no longer treat drinking water with fluoride, citing safety, financial and infrastructure concerns.
“While we acknowledge there are strong opinions about fluoride in drinking water, this decision is based on our operational, safety and financial needs,” CAW CEO Jeffrey Thompson said in a statement. “This change reduces chemical handling risks for our employees, eliminates the use of aging equipment and allows us to focus resources on delivering safe, reliable and exceptionally high-quality drinking water.”
Fluoridation of drinking water involves the handling, storage and metering of a hazardous and highly corrosive industrial-grade chemical. Officials claim ending the addition of fluoride reduces potential chemical exposure for employees and reduces the likelihood of accidental chemical spills.
Adding fluoride to water has been optional for water companies. Neither the U.S. Environmental Protection Agency nor the Alabama Department of Environmental Management require utilities to add fluoride. EPA just sets a maximum level of fluoride in drinking water.
CAW said in its statement that it has notified ADEM regarding the change in fluoridation practices. But it did not notify the public before Friday’s press release. Mountain Brook Mayor Graham Smith, for one, said she did not receive advance notice of the change.
CAW said in the statement that fluoridation systems at its water treatment plants are near the end of their useful life cycles and eventually would require replacement at a cost of nearly $4 million. Recurring maintenance costs have been more than $250,000 per year.
The costs for Central Alabama residents could be far greater.
Dr. Stephen Mitchell, co-director of the Civitan-Sparks Clinic at UAB and associate professor in UAB’s Department of Pediatric Dentistry, is a strong proponent of fluoridation. The negative health and financial outcomes of defluoridation, he said, would be ravaging for the 750,000 people served by CAW.
According to CDC reports on oral health, for every $1 invested in community water fluoridation, about $20 is saved in dental treatment costs. Mitchell said local data reflects this impact: in Jefferson County, where roughly 98% of residents have fluoridated water, about 34% of kindergarten and third-grade students experience tooth decay, compared to 57% in nearby Blount County, which has only 18% fluoridation.
Mitchell acknowledges this data does not definitively establish causation. But fluoride is known to repair and prevent damage to teeth caused by bacteria, according to the CDC. And, statewide, counties with more than 90% fluoridation in water report about 14% lower tooth decay rates than those with little or none, Mitchell said.
CAW’s decision would increase the financial burden on Central Alabama residents, Mitchell said, especially those in rural or low-income areas. Based on 2024 Alabama Medicaid data, this 14% difference translates to roughly $11 million in additional diagnostic and treatment costs across the state. Costs would rise by an estimated $750 million over five years if fluoridation were eliminated.
In its statement, CAW acknowledged that concerns have arisen in some groups about lifetime fluoride consumption, and it said many people get fluoride through toothpaste and mouthwash. But it said the decision to stop adding fluoride to the water did not indicate it was taking a position in the scientific debate but rather was made for financial and operational reasons.