Iran War Triggers Fluoride Shortage at US Water Utilities

Multiple US water utilities have lowered or suspended fluoride additions to drinking water following supply chain disruptions triggered by the ongoing war between the United States and Iran. The Association of Metropolitan Water Agencies confirmed that several utilities have reported disrupted shipments over recent weeks, with shortages stemming from decreased production at key Israeli suppliers.

Fluorosilicic acid, also known as hydrofluorosilicic acid, is the primary chemical used by American water systems to fluoridate drinking water as a public health measure to prevent tooth decay. Israel ranks among the world's top exporters of fluorosilicic acid, and the United States sits among the top five global importers of the product, according to US Environmental Protection Agency data. Nearly two-thirds of the American population receives fluoridated drinking water through municipal systems, based on Centers for Disease Control and Prevention figures.

The current shortage is driven in large part by workforce mobilization at Israeli chemical plants. At least one major Israeli supplier has faced significant staffing gaps as employees have been called into active military service amid the conflict, according to Dan Hartnett, chief policy officer for the Association of Metropolitan Water Agencies. The resulting production slowdown has cascaded through international supply networks, reducing volumes reaching American water treatment facilities and forcing utilities to ration remaining inventories.

Among the affected utilities, WSSC Water, the eighth largest water and wastewater utility in the United States serving roughly 1.9 million customers across Maryland, announced on April 7 that it was reducing fluoride concentrations from the recommended 0.7 milligrams per liter to 0.4 milligrams per liter. A spokesperson for the utility indicated officials were uncertain how long the shortage would persist, but expressed confidence the operator could maintain service at the reduced level for several more months.

The Baltimore City Department of Public Works followed on April 13 with a similar reduction from 0.7 to 0.4 milligrams per liter, covering approximately 1.8 million residents in and around the city. Department officials described the move as a temporary adjustment driven solely by supply availability and reaffirmed their commitment to providing safe, high-quality drinking water. In Pennsylvania, the borough of Lititz informed its water customers in March that it had been forced to halt fluoridation entirely for roughly two weeks due to supply issues.

Industry observers warn that as the conflict continues, additional stressors are expected to weigh on the supply chain, potentially leading to shortages in more communities across the country. Water utilities add fluoride voluntarily to improve community oral health outcomes, and reduced concentrations do not affect drinking water safety. However, research from jurisdictions that have ceased water fluoridation, including Calgary, Juneau, and parts of Israel, indicates that prolonged low exposure can produce measurable dental health impacts over a span of years. Younger children are typically the first population to experience increased rates of tooth decay, because fluoride strengthens developing tooth enamel.

Public health experts recommend that residents in affected service areas brush twice daily with fluoridated toothpaste and maintain regular dental appointments to compensate for temporarily reduced water fluoridation levels. Those concerned about insufficient fluoride exposure should consult their dentist before pursuing supplements or alternative treatments.

The shortage highlights a broader vulnerability in the United States' specialty chemicals supply chain. While domestic fluorosilicic acid is produced as a byproduct of phosphate fertilizer manufacturing, most notably at Mosaic Company facilities in Bartow, Florida and other Bone Valley operations, US water utilities rely heavily on imports to meet aggregate demand. Redirecting domestic output to fill the gap left by reduced Israeli shipments will take time, and spot market prices for fluoridation chemicals have risen as utilities compete for available volumes.

Utility industry groups are pressing suppliers and federal agencies for clearer visibility into supply timelines. Officials at the affected utilities have stressed that fluoride levels will be restored to optimal concentrations as soon as supply conditions stabilize, though no firm timeline has been offered. As of mid-April, the conflict in the Middle East continues to weigh on shipping lanes and production schedules for a range of specialty chemicals, and fluoridation materials are expected to remain constrained for at least several weeks.