Birmingham, Alabama, residents got some confusing news last month. On March 20, Central Alabama Water (CAW) announced it was stopping water fluoridation. The reason, they said, was aging equipment. Reasonable enough. Except a few days later, a CAW spokesperson casually dropped that the utility had actually stopped fluoridating water years ago. Two years, to be precise. And nobody told anyone.
This isn’t just a PR disaster, though it absolutely is one. It’s a textbook example of how quickly public health protections can erode when the right people aren’t paying attention, or worse, when institutional knowledge gets muddled in leadership shuffles.
The Timeline Nobody Knew About
According to reporting by Ars Technica, three water treatment plants had quietly stopped fluoridating water at different points: January 2023, August 2023, and March 2024. When a CAW spokesperson spoke to local WBRC news on March 24, they made this stunning admission: “It’s important to realize that pretty much no one in Birmingham has had any fluoride in their water for two years.”
The spokesperson explained that the removals happened before a 2025 law restructured the water board, and crucially, there was “no public notification” at any point. This meant residents never got to consult with their dentists about alternatives or adjustments to their oral health routines.
That’s a problem. A big one.
The Law They Apparently Forgot
Birmingham Mayor Randall Woodfin didn’t waste time with diplomatic language. In a series of Facebook posts, he pointed out that some of CAW’s current leadership had worked for the previous water board. These folks should have known that fluoride had been removed and that the public was left in the dark. Among them is current CEO Jeffrey F. Thompson, who previously served as assistant general manager of operations and technical services.
Woodfin suggested that CAW broke state law requiring a 90-day written notice before making such changes, including explanations and affected communities. “This is the same board that promised transparency. The same leadership that said they would run this utility the right way,” Woodfin wrote. “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.”
The City of Birmingham filed a lawsuit against CAW, seeking an emergency court order to resume fluoridation and claiming the removal threatened residents’ dental health, particularly low-income families and children without access to dental care.
The Unsubstantiated Fears Behind It
Here’s where things get messier. When CAW made its March announcement, it didn’t just cite equipment problems. The utility also highlighted “questions about the long-term health effects” of fluoridation and suggested people could simply buy fluoride toothpaste instead.
This framing matters because it legitimizes doubts that have been circling for decades. Water fluoridation, introduced in the US in 1945, has been targeted by unfounded fears and conspiracy theories ever since. Those concerns have gotten fresh momentum in recent years thanks to anti-vaccine Health Secretary Robert F. Kennedy Jr., who has made strong claims that fluoridated water is unsafe despite having no background in medicine, public health, or science. As health secretary, he’s pledged to remove fluoride from US water entirely.
The technology of public health recommendations is pretty clear, though. The American Dental Association and the American Academy of Pediatrics both recommend water fluoridation to prevent tooth decay, especially in children. A Harvard modeling study found that if Kennedy follows through on removing fluoride, it would result in 25 million more decayed teeth in children and teens in just the first five years.
Why Toothpaste Isn’t the Answer
Scott Tomar, head of the department of population oral health at the University of Illinois Chicago, pushed back hard on the idea that fluoride-containing toothpaste eliminates the need for water fluoridation. According to comments he gave to NBC News, “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 warned that CAW’s move puts 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.
That’s the real issue here. Water fluoridation is considered one of the top 10 public health achievements. It’s not sexy. It doesn’t make headlines until something goes wrong. But it works, especially for people who can’t afford regular dental care or who live far from dental offices.
The Accountability Question
What happened in Birmingham raises uncomfortable questions about business accountability in utilities serving the public. CAW didn’t just make a technical decision and fail to communicate it. The utility actively cited questionable health concerns in its announcement, effectively validating misinformation that’s been debunked by medical professionals. Whether intentional or not, that’s a form of narrative malpractice.
The fact that current leadership didn’t know (or claim not to have known) that fluoride had been removed for two years is equally troubling. How does a major public health measure get quietly discontinued without institutional awareness? Either the news wasn’t tracked properly, or it was forgotten in reorganization, or someone decided it wasn’t worth mentioning. None of those scenarios are reassuring.
Birmingham’s lawsuit might force the utility’s hand, or it might not. Either way, this is a reminder that public health protections require constant vigilance. They’re not permanent. They can disappear quietly, justified by equipment issues or outdated fears, until someone wakes up and asks why their kids’ teeth are rotting.
