President-elect Donald Trump and his U.S. Department of Health and Human Services secretary nominee, Robert F. Kennedy Jr., have signaled they may recommend removing fluoride from drinking water, putting the spotlight on a decades-long public health practice.
But "recommend" is the key word when considering how Kennedy and Trump could affect Maine. No federal law mandates fluoride in water systems to help prevent tooth decay and cavities, and Maine is not among the more than a dozen states with fluoridation mandates.
Instead, local bodies make those decisions, while the Trump administration could make recommendations on fluoride's use and its concentration levels.
Still, the rhetoric from Kennedy, who has also promoted anti-vaccine conspiracies but recently said he is "all for" the polio vaccine, has resulted in renewed discussions over fluoride. About seven in 10 Americans have access to fluoride in their water as part of what the U.S. Centers for Disease Control and Prevention has called one of the top public health achievements of the 20th century.
Maine has 65 community water systems that fluoridate, and they provide drinking water to 133 communities and more than 520,000 residents, according to state data. The Oxford County town of Norway became the first Maine municipality with a fluoridated water supply in 1952, after Grand Rapids, Michigan, was the first U.S. city to add the mineral in 1945.
Other Maine municipalities added fluoride over the next few decades, such as the state's largest city of Portland starting fluoridation in 1997, and the most recent group of cities such as Wells and Kennebunk starting it in 2004, according to the state.
Maine water systems that do not fluoridate may still contain some naturally occurring fluoride from the erosion of deposits in bedrock, and it can also enter drinking water when groundwater is affected by discharge from fertilizer and aluminum factories.
Under a 1983 law, voters in a Maine water district or municipality must sign off on adding fluoride to the water supply, unless less than half of the annual water supply comes from another public water source that is already authorized to fluoridate.
In Maine, the target level of concentration for fluoride in order to provide dental benefits is 0.7 milligrams per liter, which is the same limit the U.S. Public Health Service recommends. The federal enforceable limit of 4.0 milligrams per liter, which the government can penalize water systems for exceeding, could change after a federal judge appointed by former President Barack Obama ordered the Environmental Protection Agency in September to strengthen regulations after finding fluoride potentially hurts children's IQ.
Maine's Division of Environmental and Community Health notes exposure to "excessive consumption of fluoride over a lifetime may lead to increased likelihood of bone fractures in adults" along with bone effects "leading to pain and tenderness." The state also says children 8 years old and younger who are exposed to excessive fluoride amounts have an "increased chance of developing pits in the tooth enamel, along with a range of cosmetic effects to teeth."
Maine and its local governments will continue to handle fluoridation rules for now, but Kennedy and Trump could tinker with recommendations and limits in ways that affect all states. The American Dental Association has otherwise reiterated its support of fluoridation in community water systems to help prevent tooth decay.