Residents of Birmingham, Alabama, were abruptly informed earlier this month that their water utility had decided to stop adding fluoride to city water. Then, days later, they learned that the utility had actually stopped adding fluoride years ago.
On March 20, Central Alabama Water (CAW) made an announcement that it had discontinued water fluoridation. The announcement cited “aging equipment” and “increasing maintenance and component replacement” as justifications for the removal of fluoride, which it indicated had already occurred. But the water utility also highlighted unsubstantiated health concerns and noted that people can buy toothpaste and mouthwash that contain fluoride to protect their teeth.
Emphasizing that there are “questions about the long‑term health effects,” CAW said, “ending drinking water fluoridation allows customers and their health care providers to make more individualized decisions about fluoride use.”
Days later, a CAW spokesperson revealed that three of its water treatment plants had abandoned fluoride years ago—in January 2023, August 2023, and March 2024, respectively.
“It’s important to realize that pretty much no one in Birmingham has had any fluoride in their water for two years,” a CAW spokesperson told local WBRC news on March 24. The removal occurred before a 2025 law that restructured the water board, the spokesperson explained, adding that there was “no public notification” of the change. The spokesperson said this lack of notice meant residents weren’t able to “consult with their dentists.”
City response
Birmingham Mayor Randall Woodfin blasted CAW’s revelations in a series of Facebook posts, noting that some of the water utility’s current leaders are the same as those prior to the restructuring. Thus, the current board should have been well aware that plants had previously stopped fluoridating water and known that the public was not duly notified. Among the overlapping leaders is the current CEO Jeffrey F. Thompson, who previously worked as assistant general manager of operations and technical services for the utility’s previous board, Birmingham Water Works Board.
In a subsequent post, Woodfin suggested that the CAW broke a state law that requires the utility to provide a 90-day written notice of such a change, including the reasons for the change and the communities affected.
“This is the same board that promised transparency. The same leadership that said they would run this utility the right way. And now they can’t even follow a basic notification statute before stripping a public health measure from hundreds of thousands of people’s drinking water,” Woodfin wrote.
Late last week, the City of Birmingham filed a lawsuit against CAW, claiming that the CAW failed to provide notice of the change and requesting an emergency court order for fluoridation to resume, according to local WVTM13 news. The city claimed in its filing that removing fluoride from the water threatened residents’ dental health, including low-income residents and children who lack access to dental care.
When reached by Ars Technica, the City of Birmingham declined to comment on the lawsuit. CAW told reporters that it does not comment on pending litigation.
Fluoride recommendations
The American Dental Association (ADA) and the American Academy of Pediatrics recommend fluoridating community water to prevent tooth decay, particularly in children. In areas where fluoridated water is unavailable, medical experts advise prescribing fluoride supplements for children.
Water fluoridation is considered one of the top 10 public health achievements. Still, since its introduction in the US in 1945, unfounded fears and conspiracy theories have swirled about the practice. Such concerns have been stirred up again in recent years by anti-vaccine Health Secretary Robert F. Kennedy Jr. Although he has no background in medicine, public health, or science, Kennedy has bucked scientific evidence on fluoridation and made strong, unsubstantiated claims that fluoridated water is unsafe. As health secretary, he has pledged to remove it from US water. A modeling study by Harvard University researchers last year found that if Kennedy follows through on that pledge, it would lead to 25 million more decayed teeth in children and teens in the first five years.
Health experts have also specifically pushed back on the idea that fluoridation is no longer necessary due to the availability of fluoride-containing toothpaste and mouthwash. In comments to NBC News, Scott Tomar, head of the department of population oral health at the University of Illinois Chicago, said: “It certainly is true that fluoride-containing toothpaste is effective at preventing decay, but it’s not true that that alone justifies removing fluoride from our drinking water.” Tomar said CAW’s move to remove fluoride will put residents at risk of more cavities. “It has probably put youngest children at the greatest risk, because that’s usually where we see it show up first when fluoridation stops,” he said.
