Milwaukee Water Works has temporarily cut in half the amount of fluoride it adds to drinking water as nationwide supply chain issues are causing a shortage.
Fluoride, a naturally occurring mineral, is added to many public water supplies in the U.S. to tackle tooth decay, which was a pervasive and damaging public health issue during the first half of the 20th century. Beginning July 31, the water utility reduced fluoride levels from about 0.6 or 0.7 milligrams per liter to 0.3 milligrams per liter.
The reduction in fluoride has not affected how the utility treats its water, which is still safe to drink, said Milwaukee Water Works Superintendent Patrick Pauly. But he said he’s “very concerned” about finding a stable supply. What’s left will last three to four months.
The utility provides water to more than 866,000 people in the city of Milwaukee and in more than a dozen suburbs, including Wauwatosa, Menomonee Falls, West Allis, Greenfield and Waukesha.
“We hope there is a shift in the market conditions,” Pauly told the Journal Sentinel.
Fluoride shortage once linked to Iran war, now domestic supply issues
Milwaukee Water Works was nearing the end of a one-year contract with Pencco, a Texas-based supplier of water treatment chemicals, to provide 20 approximately 45,000-pound shipments of fluoride for about $225,000.
In April, fluoride shortages in the U.S. were a far-reaching ripple effect of war in the Middle East. Israel is one of the world’s top exporters of fluorosilicic acid, which is used to fluoridate drinking water. At the time, Dan Hartnett, chief policy officer at the Association of Metropolitan Water Agencies, told NPR that one of Israel’s main suppliers lost many of its employees because they were called to Israeli military service.
Pauly said Pencco told Milwaukee Water Works that month it would slightly reduce shipment volumes because of the conflict in the Middle East.
In early June, Pauly said, Pencco staff informed him they would not be requesting an extension of the contract because supply shortages were making it difficult to serve new customers. He said there was no mention of the Middle East situation.
Pencco spokesperson Emily Horne said the company is having trouble sourcing any additional fluoride supply that would allow it to enter into new contracts – and any extension in Milwaukee would be considered new.
“We’re doing the best we can to fulfill all of our existing contractual obligations,” Horne said, “but it’s been tough.”
Hartnett told the Journal Sentinel he learned in an Aug. 4 call with members of his association that a number of water utilities in the Midwest and northeast also have had their fluoride deliveries reduced by suppliers. It seemed that domestic supply chain challenges, not the situation in the Middle East, were causing these issues, although utilities did not know exactly what was happening to the domestic market, he said.
“The bottom line is that Milwaukee is not alone, and several other large communities are also taking steps to stretch their fluoride supplies in the face of shortages,” Hartnett said.
Pauly said upon receiving Pencco’s notice, the utility “immediately” worked with the city’s purchasing division to procure a new supplier. But when the procurement process closed on July 27, no bids were received.
“We had done outreach during that bidding process … and unfortunately were given the indication that it was a very challenging market. It’s not just Pencco,” Pauly said.
Water utility staff are looking for shipments of fluoride to purchase on the open market “on an emergency basis,” Pauly said. He said he hopes to be able to issue a formal contract by the end of the year.
A spokesperson for the Wisconsin Department of Natural Resources said the agency is not aware of other Wisconsin water utilities having the same kind of trouble.
Fluoride in drinking water has faced growing opposition
The fluoride shortage happens as the risks and benefits of water fluoridation are being debated nationwide.
In Wisconsin, 85 municipalities have chosen to stop adding fluoride to their water supply, according to data provided earlier this year to the Journal Sentinel by the DNR. In DeForest, a Madison suburb, village officials voted to remove fluoride in February 2025 and, following an election which changed the makeup of the village board, voted to bring it back a few months later.
The U.S. Centers for Disease Control and Prevention has called community water fluoridation one of the top public health achievements of the 20th century, correcting course from a time where about 50% of older adults had lost all their natural teeth.
Although fluoride comes from other sources like toothpaste, and can also naturally occur in groundwater, public health experts say adding it to drinking water can especially help protect children and adults who can’t see a dentist regularly.
Anti-fluoride activists have long argued it is toxic, a view that has gained momentum under U.S. Health and Human Services Secretary Robert F. Kennedy Jr. Under President Donald Trump, the U.S. Environmental Protection Agency is fast-tracking a review of public health risks from fluoride in drinking water.
Fluoride at higher doses has well-documented consequences. Dental fluorosis, or staining of the tooth enamel, can occur when young children take in too much fluoride. Skeletal fluorosis, which is rare in the U.S. but more common in other parts of the world, causes bone and joint problems.
The U.S. Public Health Service in 2015 lowered its recommended fluoride concentration for community water systems from 1.2 mg/L to 0.7 mg/L to provide “the best balance of protection from dental (cavities) while limiting the risk of dental fluorosis.”
Milwaukee has fluoridated its drinking water since 1953.
Madeline Heim covers health and the environment for the Milwaukee Journal Sentinel. Contact her at 920-996-7266 or mheim@usatodayco.com.
This article originally appeared on Milwaukee Journal Sentinel: Fluoride in Milwaukee drinking water halved due to supply shortage
Reporting by Madeline Heim, Milwaukee Journal Sentinel / Milwaukee Journal Sentinel
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By Madeline Heim, Milwaukee Journal Sentinel | USA TODAY Network
