• Secretary of Health and Human Services Robert F. Kennedy Jr. has advocated for prohibiting fluoridated water across U.S. localities.
  • Recent research indicates potential health risks and neurotoxic impacts on children, yet experts urge caution due to the preliminary nature of these studies.
  • There is a call for more comprehensive research into the effects of fluoridated water on American health.
  • Health organizations continue to endorse the use of fluoride in drinking water at controlled levels (0.7 mg/L in the U.S.) to enhance dental health.

The controversy regarding fluoride’s safety in drinking water has been reignited this month by a proposal from the Secretary of Health and Human Services, Robert F. Kennedy Jr., to eliminate fluoridated water in U.S. communities.

Concurrent with the secretary’s proposal, the Environmental Protection Agency (EPA) disclosed at a press event in Salt Lake City on April 7 that it would evaluate “new scientific data” on the alleged health risks linked to fluoridated water.

The EPA sets the fluoride limits in public drinking water, which currently stands at 0.7 milligrams per liter (mg/L) as per the Centers for Disease Control and Prevention (CDC).

This announcement followed closely after a recent prohibition in Utah, making it the first state to outlaw fluoride in drinking water.

In an interview with The Associated Press, Kennedy revealed his plans to form a task force to review the issue and create updated guidelines concerning fluoridated water.

Although Kennedy lacks the authority to ban fluoridation nationwide, he can direct the CDC to amend its recommendations and collaborate with the EPA to adjust the fluoride thresholds in drinking water.

Fluoride, a naturally occurring mineral, started being added to U.S. community water supplies in the mid-1940s as a measure to prevent dental issues, especially in regions where dental care was scarce.

The long-term health impacts of fluoride exposure are still not fully understood. However, organizations like the American Academy of Pediatrics, the American Dental Association, the World Health Organization (WHO), and the CDC continue to endorse fluoridated water for dental health.

These agencies assert that the existing fluoride levels in drinking water are safe and that fluoride toothpaste and supplements are appropriate for use in age-specific quantities.

“When public figures like Secretary Kennedy support misleading information and challenge peer-reviewed studies, it endangers public health,” stated Brett Kessler, DDS, president of the American Dental Association. “We need to halt the rhetoric and thoroughly investigate fluoride at the optimal level once and for all,” he added.

The current research on fluoride’s effects is ongoing but limited. A significant issue with existing studies is the lack of solid evidence that confirms the purported health risks to the U.S. population, particularly the potential neurotoxic effects on children.

Compounding the issue, fluoride levels are considerably higher in many countries outside the United States, where fluoride research is more prevalent. Moreover, most European countries and some Canadian provinces do not fluoridate their drinking water at all.

Despite advancements in dental care and the uncertainties regarding health impacts, the rationale for continued fluoride use in drinking water is questioned by many.

“Over the past two decades, there’s growing evidence suggesting that fluoride exposure, particularly in developing children, is neurotoxic,” explained Bruce Lanphear, MD, MPH, a professor of health sciences at Simon Fraser University in British Columbia, Canada. “This is evidenced by reduced IQ scores, similar to what we’ve observed with lead exposure in children. We shouldn’t expect universal agreement; even with lead, consensus is more substantial, yet still not unanimous,” Lanphear told Healthline.

Potential Health Concerns Linked to Fluoride

In 2015, the CDC reduced the recommended fluoride concentration in water from 1.2 mg/L to 0.7 mg/L, following a rise in fluorosis cases among children.

See also  Iconic 'Top Gun' Star Val Kilmer Passes Away Following Throat Cancer Battle: Dies from Pneumonia

The prevalence of dental fluorosis, which causes discoloration and spots on teeth, has almost doubled among U.S. adolescents, according to data from PubMed Central.

“It appears to have stabilized, but there has been a significant increase, and it’s solely because kids are receiving too much fluoride,” Lanphear commented.

Kennedy’s stance on fluoride might be influenced by a new global study released in January by JAMA Pediatrics. The research suggested that children with higher fluoride exposure in water exhibited lower IQ scores, sparking debate among health professionals.

Supporters of fluoride caution that these findings are based on data from children in countries like China and India, where fluoride levels are substantially higher. The American Dental Association has urged the public to interpret these results cautiously.

“I believe RFK Jr. and his colleagues have instilled a lot of fear,” said Danelle Fisher, MD, FAAP, a board-certified pediatrician at Providence Saint John’s Health Center in Santa Monica, CA. “We need to reassure people that they are safe and that we have effective means to maintain their children’s health and safety. In terms of dental health, properly fluoridated water and toothpaste have proven beneficial,” she told Healthline.

The JAMA Pediatrics study coincided with a comprehensive report from the National Toxicology Program released in August 2024 by the National Institutes of Health. This report similarly linked high fluoride levels in children to slight reductions in IQ, leading opponents to reconsider the current fluoride standards in U.S. water supplies.

However, the report acknowledged flaws in its methodology, noting insufficient data to conclude whether the current fluoride level of 0.7 mg/L in U.S. community water systems adversely affects children’s IQ.

“We have mounting evidence that fluoride is neurotoxic because kids are ingesting too much fluoride, as indicated by rising rates of fluorosis, and because recent studies suggest that fluoride is ineffective when added to water for preventing tooth decay,” Lanphear added.

Lanphear, who authored an editorial accompanying the JAMA Pediatrics study, referenced a 1995 animal study that associated fluoride with behavioral deficits in rats.

“Many of the earlier studies were cross-sectional and not of high quality. And that has been a major critique of this new evidence – but it really shouldn’t be, as that’s how most science progresses,” Lanphear explained.

Indeed, many studies on fluoride toxicity have been limited in scope, conducted on animals and in vitro. However, researchers continue to express concerns over potential fluoride-related health risks. Some have highlighted dental fluorosis as a complication, while others have noted more severe effects.

A 2022 literature review suggests that exposure to fluoride levels significantly above the current 0.7 mg/L in the U.S. or the 1.5 mg/L threshold set by the WHO could lead to various health issues, including:

  • skeletal fluorosis
  • arthritis
  • bone damage
  • osteoporosis
  • muscle damage
  • fatigue
  • joint-related problems
  • chronic health conditions
  • organ damage
  • endocrine or thyroid disruptions

Yet, as with other fluoride studies, these findings are limited and can be easily misinterpreted. For instance, the fluoride levels examined in the 2022 review exceeded both U.S. and international standards for water fluoride content. Additionally, results from animal studies do not necessarily apply to humans.

Due to the limited scope of fluoride research, health experts and scientists remain divided on whether fluoride should continue to be added to public drinking water or be removed altogether.

Inderpal S. Randhawa, MD, a board-certified internist, immunologist, pediatrician, pediatric pulmonologist, and medical director of the Children’s Pulmonary Institute at MemorialCare Miller Children’s & Women’s Hospital Long Beach in Long Beach, CA, noted that the risk of tooth decay and poor dental hygiene still exists in some parts of the U.S.

See also  Kenan Thompson: Strategies for Managing GERD Post-Diagnosis Revealed

He told Healthline that Kennedy’s proposed ban on fluoridated water might be reasonable in communities with widespread access to dental care and fluoride-based toothpaste. In areas with poor dental health, however, fluoride levels should remain as low as possible, he advised.

“The concerns are real,” Randhawa stated. “Long-term, systemic fluoride exposures can result in an excess amount of fluoride in the body. This can impact the bones, thyroid, and other organ systems. Reducing this risk in the context of today’s advanced dental care is something to consider.”

Fisher emphasized that the current fluoride levels are safe but called for more research involving U.S. children to better understand the potential risks.

“It’s always important to consider new research and base our recommendations on what we believe is in the best interest of the children who need this fluoride for optimal dental health — but obviously, we never want to cause harm,” Fisher remarked.

“So, if compelling evidence emerges that the fluoride levels in U.S. water are too high, leading to a reduction in IQ and potentially cognitive decline, that is crucial information to know. The challenge with drawing conclusions from the [JAMA Pediatrics] study is that it might be misleading,” she added.

Fisher noted that the JAMA Pediatrics findings are based on data from countries with almost double the fluoride levels found in U.S. water supplies.

“There’s no information in there that studied children in the U.S., but since this is being cited as evidence, it is important not to create panic among families. If we’re going to research the direct correlation between IQ scores and fluoride exposure in the U.S., let’s conduct that study,” she suggested.

“Historically, we’ve recognized the importance of having fluoride in our water supply. Adding fluoride to the water in an appropriate amount was crucial to improving dental health. This has definitely been proven, especially here in the U.S.,” Fisher emphasized.

Fluoride Levels Deemed Safe for Intermittent Use

Many health professionals agree that occasional fluoride use appears safe and effective.

“Compared to drinking fluoridated water, where exposure is systemic, topical application with products like toothpaste results in significantly lower exposure,” Randhawa explained. “Similarly, treatments received at the dentist involve minimal exposure.”

Fisher highlighted that before the introduction of fluoride to drinking water, dental and related health issues were prevalent in areas lacking access to fluoride and adequate dental care.

“Before we had fluoride in the water, we observed significantly more dental problems and subsequent issues stemming from those,” she stated.

“The amount of dental decay and disease was widespread, and it remains so in parts of the world where children lack access to fluoride. Dental issues don’t just affect the teeth; they impact the entire child. We’re talking about kids who could potentially develop brain problems, brain abscesses that spread from dental decay,” Fisher explained.

Lanphear offered a different viewpoint, suggesting that the risks associated with water fluoridation might outweigh the potential benefits.

“The evidence supporting the effectiveness of water fluoridation or systemic fluoride has never been robust,” he asserted, citing a comprehensive systematic review published in 2024 in the Cochrane Review.

The review evaluated evidence dating back to 1975 on whether water fluoridation effectively reduces tooth decay. It concluded that fluoridated water had little to no benefit in preventing cavities, perhaps a 3% to 4% reduction, Lanphear noted, which he described as not statistically significant. This finding, he argued, calls into question the benefits of fluoridation.

See also  Groundbreaking Research Reveals: Cannabis Use May Significantly Increase Heart Attack Risk

Lanphear also advised caution regarding fluoride-based toothpaste for young children, which contradicts current pediatric recommendations. “Children aged 1 to 4 years might be ingesting 80% of their fluoride from swallowing toothpaste,” he estimated.

Nevertheless, fluoridated water remains at very low levels in U.S. communities for now, and pediatric dentists continue to recommend fluoride-based toothpaste.

Pediatricians like Fisher advise that children under 6 years old use a pea-sized amount of fluoridated toothpaste twice daily. Fisher stated that pediatricians and dentists consider this a safe quantity to ingest if swallowed, since most young children do not yet know how to spit.

“Are we swallowing too much toothpaste? There’s no evidence to indicate that we are. However, if future studies demonstrate this, we will adjust our recommendation accordingly, but currently, there’s no need for concern,” she said.

Need for Further Research on Fluoride Exposure

Fisher reiterated that the fluoride levels in U.S. water systems are adequate but urged further study of the potential effects.

“Let’s examine how we as a society, as Americans, can best supply an optimal amount of fluoride to our children so that their teeth and brains are healthy,” she proposed.

“It would be beneficial to conduct a prospective study of American children, meaning we start by observing them and then follow their development over time, measuring IQ, if desired,” she suggested.

Fisher noted that there are alternative methods to assess cognitive development that don’t rely on IQ scores.

“Such studies would be intriguing and important, and potentially, if we discover that the amount of fluoride in our water is either too much or insufficient, we can adjust it accordingly,” she said.

Lanphear concurred that more research on fluoride is necessary, but he opposed fluoridated water.

“At a minimum, it’s time to convene an independent scientific panel to review the evidence on the safety and purported benefits of water fluoridation,” he stated.

“Fluoride toothpaste has proven effective, based on rigorous, randomized, controlled trials. Drinking it or taking it as a supplement, however, does not appear to be effective. So given all of that, if you ask me, and I had to make that decision as an individual, I’d say, absolutely remove it from the water,” Lanphear said.

Fisher, however, remained optimistic about the low levels of fluoride in water and reassured the public about current best practices for dental health.

If there’s one consensus among most, if not all, experts, it’s that more research on the effects of fluoride exposure is essential.

“Scientists are here to ensure good health for ourselves and our children. Nothing is more important,” Fisher stated. “We do need fluoride. We need a suitable amount, and we should not panic about this.”