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There are two ways to prevent tooth decay. First is the easy way which is to put fluoride in the drinking water. It's easy and protects everyone, but particularly the poorer segments of the population that might struggle with things like preventative dentist appointments.
The second way is the hard way which is to modify your diet to avoid foods high in sugars and carbs and to prefer more proteins and fiber. This is the approach some European countries take.
If you do neither you will get significantly increased rates of tooth decay.
Actually lots of areas in Europe tested fluoride in water locally at some point. But they never found convincing evidence of this being preferably to getting fluoride the "classic way" (personalized in small doses already included in toothpaste).
Are USians not brushing their teeth? Or have they changed the toothpaste formulas to exclude fluoride, too, now?
It is possible to get fluoride-free toothpaste but it’s a bit of a niche/specialty item.