Health Care

Iran war throttles global fluoride supply, impacting US waterworks

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by Joseph Choi - 04/25/26 5:00 PM ET

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by Joseph Choi - 04/25/26 5:00 PM ET

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Fluoride is becoming harder to source as the war in Iran places more strain on global supply chains, leading some local governments to reduce their own use of the widely used cavity-fighting agent.

Two major water supply systems in Maryland, which serve the Baltimore and suburban D.C. areas, announced this month they would be temporarily reducing the concentration of fluoride, citing the conflict in the Middle East as the cause of a wider national shortage. A Pennsylvania town halted fluoridation for at least a few weeks, also citing the war.

According to chemical suppliers and trade groups, the shortage was brought on by a confluence of supply chain disruptions as well as higher transportation costs resulting from the conflict in the Middle East.

“Some of the suppliers around the nation have either taken their supply offline or severely shortened it, or it’s gone into other streams, like not to municipal streams. And there’s only a few fluoride manufacturers in the nation,” said Emily Horne, a spokesperson for Pencco, which has supplied the Baltimore-area waterworks.

Lowering the concentration from the federally recommended 0.7 mg/L to 0.4 mg/L, the city’s Department of Public Works said this decision was brought on by “broader national supply chain disruptions, driven in part by ongoing conflict in the Middle East.”

The war in Iran and the associated standoff in the Strait of Hormuz have impacted U.S. fluoride levels, as Israel is one of the major global suppliers of the chemical used in water systems, fluorosilicic acid.

A 2022 risk assessment by the Environmental Protection Agency (EPA) found that Israel is the second top exporter of inorganic acids, including fluorosilicic acid, estimated at the time to be sending out 40 million kilograms. China is the top exporter, trailed by Poland, Germany and Malaysia.

The U.S. was among the top five importers of fluorosilicic acid, ranking fourth.

Eric R. Byer, president and CEO of Alliance for Chemical Distribution (ACD), blamed the delays and shortages on rising shipping surcharges.

“Unpredictable and rising transportation costs threaten the delivery of essential chemical products that countless U.S. industries and municipal systems use every day,” Byer said in a statement. “With ocean carriers imposing unjustified and unclear surcharges, ACD encourages regulators to continue to use their authority to protect American shippers, ensuring our members can continue to effectively deliver the chemical products Americans rely on for the health and safety.”

“Recent concerns about fluoride availability are a reminder of what we learned during COVID,” the Society of Chemical Manufacturers and Affiliates said in a statement. “Global supply chains can be disrupted quickly, and domestic manufacturing is essential to ensuring reliable access to critical materials that support public health and key industries.”

It remains unclear whether fluoride-containing products will also be affected by the current shortage. Colgate-Palmolive and Procter & Gamble, which control the vast majority of the toothpaste market, did not respond when reached for comment by The Hill.

Steve Via, director of federal relations for the American Water Works Association, noted that the supplier in Israel is a “very small player” in the grand scheme of fluoride supply. But even then, its gradual withdrawal from the market over the past few months has made a noticeable impact in the U.S.

The U.S. is the ninth top exporter of fluoride, according to the EPA’s 2022 estimates, and it has a “significant amount of capacity” to produce the chemical, said Via. But since 2022, manufacturers of fluoride, a byproduct of the phosphate fertilizer industry, have looked to sell their product in more “reliable markets” with “reliable margins.”

Roughly 70 percent of the U.S. population lives in communities serviced by fluoridated water. There is no federal requirement that water systems use fluoride, which occurs naturally in waterways, though the U.S. Public Health Service issues recommendations on how much to add.

Some states have recently moved to effectively ban fluoride from being added to water systems, including Florida and Utah. Florida Gov. Ron DeSantis (R) called water fluoridation “basically forced medication on people.” Health and Human Services Secretary Robert F. Kennedy Jr. said last year that he intended to direct federal agencies to stop recommending fluoride.

“What it comes down to is the supply. The suppliers we have here in the states, with that U.S. supply are taking steps to get the supply that they ha