Once hailed as a triumph of public health, water fluoridation is now under intense attack in the US.

Despite decades of data proving its efficacy at protecting teeth from decay—particularly children’s teeth—two states have now banned the use of fluoride in public water, and communities around the country have followed suit or are considering doing the same. The current US health secretary, Robert F. Kennedy Jr., who is known for his anti-vaccine advocacy and for peddling conspiracy theories, has pledged to remove fluoride from US water.

Now, a pair of researchers at Harvard—Sung Eun Choi and Lisa Simon—have modeled exactly what will happen in the US if Kennedy follows through on his pledge: The number of cavities and decayed teeth in American children and teens (ages 0–19) will increase by an estimated 7.5 percentage points over the first five years. That means there will be 25.4 million more rotten teeth in the mouths of children and teenagers. The dental bills for the added decay will total at least $9.8 billion in that time. Other costs, such as loss of work among parents, were not included, making the financial estimate conservative. But children will also be more miserable, with an estimated loss of 2.9 million quality-adjusted life years.

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