The city of Jackson may soon pause adding fluoride to its drinking water, after city staff told the Board of Aldermen that the city’s supply of the chemical it adds to help prevent tooth decay will only last through the week.
During a study session on Nov. 2, water utilities foreman Brad Noel told the aldermen that supply interruptions tied to the war in the Middle East will force the city to temporarily cut fluoride from its water system, according to reporting by the Southeast Missourian. The fluoride treatment item appeared on the agenda of that study session.
Noel described the shortage as a long-term problem, saying it stems partly from the Middle East conflict and partly from reduced production as some water systems drop fluoride altogether. Noel said the city’s distributor — one of the largest in the country, with roughly nine or 10 distribution centers — can still deliver, but orders will need to be placed about a month in advance instead of two to three weeks, and the supplier has notified the city it cannot guarantee future deliveries.
A national shortage tied to the war in Iran
Jackson is far from alone. Water utilities across the U.S. have reported shortfalls of fluorosilicic acid, the chemical used to fluoridate drinking water, as the conflict involving Iran disrupts global supply chains, according to NPR and The Associated Press.
Israel is one of the world’s top exporters of the chemical, according to EPA data cited by AP. The Hill, citing a 2022 EPA risk assessment, reported Israel is the second-top exporter of inorganic acids including fluorosilicic acid, estimated at the time at about 40 million kilograms. At least one major Israeli supplier cut production after employees were called up into Israeli military service, Dan Hartnett, chief policy officer at the Association of Metropolitan Water Agencies, told NPR.
“There’s concern that if this conflict in Iran goes on for longer and the supply chain continues to be disrupted, a growing number of systems may start to face those similar types of challenges,” Hartnett said.
The chemical is made primarily overseas and shipped to the U.S. in 5,000-gallon tanker trucks, NPR reported. “We don’t manufacture it, we don’t produce it. All of our chemicals are purchased, and they rely on the supply chain in order to get to our plants,” Matthew Garbark, director of the Baltimore City Department of Public Works, told NPR.
Other systems already cutting back
Baltimore’s water system and WSSC Water, which serves 1.9 million customers in the Maryland suburbs of Washington, D.C., reduced fluoride levels from the recommended 0.7 milligrams per liter to 0.4 mg/L this spring, NPR and AP reported. Two Pennsylvania boroughs, Lititz and Hanover, reported supply shortages in March and briefly halted or considered halting fluoridation. By September, Central Arkansas Water, which serves about 500,000 customers, ran out of the chemical entirely, Newsweek reported.
Utilities that have reduced fluoride levels say their water remains safe to drink, NPR and AP reported.
Why utilities add fluoride, and what researchers found
The Centers for Disease Control and Prevention says utilities add fluoride to help prevent cavities. The U.S. Public Health Service recommends a concentration of 0.7 milligrams per liter for community water fluoridation.
Fluoride can be toxic at high doses, according to the Agency for Toxic Substances and Disease Registry. In a 2024 review, the National Toxicology Program concluded with moderate confidence that higher fluoride exposure, such as drinking water containing more than 1.5 milligrams per liter, was associated with lower IQ scores in children. The review found too little evidence to determine whether fluoride in drinking water at the recommended 0.7 milligrams per liter affects children’s IQ.
In Jackson, city documents presented to the board indicated the chemical’s supply is also linked to phosphate and fertilizer manufacturing, which depends on sulfur and sulfuric acid from the Middle East, the Southeast Missourian reported. The city’s own water comes from groundwater wells; fluoride levels in Jackson’s water are tracked in the city’s annual water quality report.
It remains unclear how long Jackson may go without fluoridated water. The war’s disruption of shipping, including at the Strait of Hormuz, continues to affect imports, and Hartnett of the water agencies association has warned that more systems could face shortages if the conflict drags on.