Yet, from its beginning, fluoride research has also served as a vector for competing ideological beliefs, political drama, legal challenges and controversy in public debate over science, public health and policymaking.
In the 1960s the John Birch Society linked fluoridation concerns with anti-Communist paranoia. This point of view was infamously captured in the character General Jack Ripper (Sterling Hayden) in Stanley Kubrick’s 1964 film Dr. Strangelove, who declared, “I can no longer sit back and allow Communist infiltration, Communist indoctrination, Communist subversion and the International Communist Conspiracy to sap and impurify all of our precious bodily fluids.”
Fast forward to April 7, Secretary of Health and Human Services Robert F. Kennedy, Jr. visited Utah, where a ban on fluoridation of water was set to take effect the following month. “It makes no sense to have it in our water supply,” Kennedy told reporters. “I’m very, very proud of this state for being the first state to ban it, and I hope many more will come.”
Kenedy was accompanied by Lee Zeldin, the administrator of the Environmental Protection Agency (EPA), who on the same day announced that the EPA would “expeditiously review new scientific information on potential health risks of fluoride in drinking water.” (Weeks later, Zeldin would go on to announce that the EPA was rolling back Biden-era protections on PFAS, or “forever chemicals,” in drinking water.)
Fluoridation of water undoubtedly keeps teeth healthy. In 1999, the Centers for Disease Control and Prevention (CDC) listed “fluoridation of drinking water” as one of the 10 “Great Public Health Achievements” of the 20th century. According to the CDC fluoridation has reduced tooth decay in children by 40%-70%, while tooth loss has declined by 40%-60% in adults. Recent federal research studies, however, raise legitimate concerns about adverse health effects of fluoride exposure on fetuses and infants.
In August 2024, scientists at the National Institutes of Health’s National Toxicology Program (NTP) published a systematic review of 72 studies that examine the evidence linking fluoride exposure and its effects on the cognitive or neurological development in children. Of those 72 studies, 19 were deemed to be “high quality,” and 18 of those “reported an inverse association between estimated fluoride exposure and IQ in children.” Of the remaining 53 low-quality studies, 46 found a similar inverse association. None of the studies examined took place in the United States but were conducted in six different countries—China, India, Iran, Mexico, Canada and New Zealand. The researchers survey found little evidence that “fluoride exposure is associated with adverse effects on adult cognition,” their review however found:
[W]ith moderate confidence, that higher estimated fluoride exposures … are consistently associated with lower IQ in children. More studies are needed to fully understand the potential for lower fluoride exposure to affect children’s IQ.
This NTP researched was a central piece of evidence used in trial in a suit brought by consumer groups against the federal government. (Food & Water Watch et al. v US Environmental Protection Agency). In his ruling on September 24, 2024, U.S. District Judge Edward Chen determined that the EPA must more strictly regulate the amount of fluoride in drinking water. The judge, who was nominated by President Barack Obama to serve on the San Francisco U.S. District Court, wrote:
Plaintiffs have proven, by a preponderance of the evidence, that water fluoridation at the level of 0.7 mg/L [or 7 parts per million]—the prescribed optimal level of fluoridation in the United States—presents an unreasonable risk of injury to health of the public … and poses an unreasonable risk of reduced IQ in children. … Simply put, the risk to health at exposure levels in United States drinking water is sufficiently high to trigger regulatory response by the EPA.
Following the court ruling, the American Dental Association and the American Academy of Pediatrics both announced that there was no evidence that fluoride was harmful and that their support for fluoridation of public water supplies was unchanged.
In January, the online journal JAMA (Journal of the American Medical Association) Pediatrics published “Fluoride Exposure and Children’s IQ Scores: A Systematic Review and Meta-Analysis.” Authored by scientists from the National Institute of Environmental Health Sciences, the review found that “across the multi-country epidemiological literature” there was an inverse association “between fluoride exposure and a children’s I.Q.” In other words, the higher the exposure to fluoride, the lower the I.Q. However, the authors note that such an inverse association was less certain “when fluoride exposure was estimated by drinking water alone at concentrations less than 1.5 mg/L [or 1.5 parts per million].” Due to that uncertainty, the scientists called for further research.
It is estimated that 11 million Americans drink water from municipal water supplies or wells where the levels of fluoride exceed the standard 7 mg/L or 0.7 parts per million, and of those 3 million drink water from municipal water supplies or well where the levels of fluoride exceed 1.5 mg/l or 1.5 parts per million.
According to CNN, there are 36,767 water systems in 36 states with publicly available information on the CDC’s website. As of 2023, just over a third of those water systems included in the data add fluoride to water. Water fluoridation is not mandatory, and the CDC’s recommended fluoride concentration in drinking water (0.7 milligrams per liter) is not an enforceable standard. The decision to fluoridate the water is taken at a local level and depends on how much fluoride is naturally present.
European countries like Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, Netherlands, Norway, and Sweden don’t fluoridate their water, but rather control cavities in their populations by administering fluoride through fluoridated salt, fluoride toothpaste or fluoride dental treatments for children and young adults.
An April 15 article in the American Journal of Public Health, “Fluoride Teeth, and Developing Brains: Dental Health in Tension With Environmental Health, Millions Affected,” advocated for “new methods of fluoride application [that] could potentially be developed that further minimize the risk of ingesting fluoride, especially in young children, while maximizing the benefit of fluoride for caries prevention.”
The American Journal of Public Health’s authors examined the two studies mentioned above and other recent research findings that raise questions about whether excessive fluoride damages the brains of fetuses and babies. They concluded:
Clearly, more research is needed. … In the meantime, however, we believe that the time has come for dental, medical, public health, environmental health, health policy, epidemiology, and risk assessment professionals to come together, weigh the evidence, and arrive at a consensus on policy recommendations and steps. As a first step, given that neither prenatal nor infant exposures to fluoride contributes toward the reduction of cavities in permanent teeth, whereas the major anticaries benefits of fluoride are from topical contact with post-erupted teeth, it may be prudent to consider recommendations that minimize prenatal and infant fluoride exposure. We owe our young ones and future generations nothing less.
Howard Hu and Linda Birnbaum, the two authors of the American Journal of Public Health article, are independent public health researchers, well respected in their fields, and have a track record of putting people first.
Hu, the journal article’s lead author, is an M.D. with a Ph.D. in epidemiology from Harvard, and is Professor of Population and Public Health Sciences at the Keck School of Medicine at the University of Southern California.
He served as a nonretained scientific expert witness (i.e. a voluntary, unpaid witness) in the above-mentioned Food & Water Watch suit against the EPA.
Birnbaum, a co-author of the study, holds a Ph.D. in microbiology from the University of Illinois and is adjunct professor at the University of North Carolina at Chapel Hill School of Public Health and a member of the editorial board of Environment International.
Birnbaum, an expert on endocrine disruptors, served through both Obama administrations and into the first Trump administration, as the director of both the National Institute for Environmental Health Sciences and the National Toxicology Program.
In January, in the wake of the JAMA Pediatrics article linking fluoride exposure in infants to lower I.Q. scores, Linda Birnbaum was quoted in the New York Times. “My recommendation is that pregnant women and infants shouldn’t be exposed to excess fluoride,” she said. “The more we study a lot of chemicals, especially the chemicals that affect I.Q., like lead—there’s really no safe level.”
Joel Bleifuss is Barn Raiser Editor & Publisher and Board President of Barn Raising Media Inc. He is a descendent of German and Scottish farmers who immigrated to Wisconsin and South Dakota in the 19th Century. Bleifuss was born and raised in Fulton, Mo., a town on the edge of the Ozarks. He graduated from the University of Missouri in 1978 and got his start in journalism in 1983 at his hometown daily, the Fulton Sun. Bleifuss joined the staff of In These Times magazine in October 1986, stepping down as Editor & Publisher in April 2022, to join his fellow barn raisers in getting Barn Raiser off the ground.
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