The American Fluoridation Society is raising concerns about recent federal actions related to fluoride, warning that steps taken by agencies this week could reduce access to a substance the group says is proven to prevent tooth decay.
According to the American Fluoridation Society, tooth decay is the most common chronic disease among children and adults in the United States. The organization says fluoride is a naturally occurring mineral in lakes, rivers, and groundwater, and that when used at recommended levels, it strengthens tooth enamel and reduces cavities. Communities without adequate natural levels of fluoride often adjust their water supply to reach what the society describes as the optimal level for reducing decay.
“Nearly 12 million U.S. residents have enough natural fluoride in their drinking water to prevent decay,” the society stated. “Other communities adjust their fluoride level to the optimal level, which reduces decay by at least 25% for adults and children over their lifetimes.”
The Environmental Protection Agency (EPA) announced this week that it will conduct a scientific review of fluoride “in coordination with Secretary Kennedy and HHS.” According to the American Fluoridation Society, this development raises questions of impartiality because Health and Human Services Secretary Robert F. Kennedy Jr. has publicly called for the end of water fluoridation.
“Given that Kennedy has called for the end of water fluoridation, can the EPA conduct a review jointly with him that will truly be impartial?” the society stated. “It’s a reasonable question to ask.”
The society said federal actions on fluoride are based on what it calls a misrepresentation of scientific evidence. One example cited is the Make America Healthy Again (MAHA) report, which raised safety concerns by referencing “74 high-quality studies” reviewed by the National Toxicology Program (NTP). According to the American Fluoridation Society, the NTP reported that 70 percent of those studies were “rated as low quality (high risk of bias).”
The society also pointed to NTP’s own conclusions, stating that no link was found between fluoride at concentrations used in community water systems and lower IQ scores. “The only link to IQs that the NTP reported — and with only ‘moderate confidence’ — was to fluoride levels above 1.5 milligrams per liter,” the group said. “That level is more than double the level used for water fluoridation.”
The society noted that the NTP report failed to pass peer review by the National Academies of Sciences on two occasions. According to the society, the National Academies concluded that the NTP had not provided “clear and convincing” evidence to support its conclusions, and also urged clarification that the findings did not question the safety of water fluoridation in the United States.
After these peer review outcomes, the NTP ended its collaboration with the National Academies and selected a new set of peer reviewers, the society stated.
The American Fluoridation Society also criticized the methods used in some of the NTP’s referenced studies, particularly regarding how fluoride exposure during pregnancy was measured.
“An expectant mother typically urinates more than 1,400 times during pregnancy,” said Dr. Johnny Johnson, president of the American Fluoridation Society. “To take only one to three urine samples out of 1,400 is not a reliable way to measure someone’s fluoride exposure. When it comes to research, this approach is an example of garbage in, garbage out.”
The group also expressed concern over a proposed move by the Food and Drug Administration (FDA) to ban fluoride supplements. These supplements are commonly prescribed for children in communities where the water supply lacks sufficient fluoride, and are designed to deliver an equivalent amount of fluoride as fluoridated water.
At a July FDA hearing, opponents of fluoride cited the NTP report while, according to the society, ignoring its flaws. The society also disputed claims made at the hearing that fluoride is only effective when applied topically. Citing a 2003 study, the society said developing teeth benefit from fluoride exposure even before they emerge.
The society pointed to the U.S. Preventive Services Task Force’s 2021 recommendation supporting the use of fluoride supplements. The Task Force noted that tooth decay in early childhood is associated with multiple adverse outcomes, including pain, tooth loss, impaired growth, poor school performance, and future dental problems.
According to the society, the FDA official at the hearing referenced a 2011 Cochrane review but only partially quoted its findings — stating that no benefit was found for primary teeth, but not mentioning the review’s finding of a 24 percent reduction in decay in permanent teeth.
The society also addressed concerns raised by the FDA Commissioner that fluoride could harm intestinal bacteria important to a child’s health. According to the society, microbiologists have dismissed these concerns. Gary Moran, a microbiologist at Trinity College Dublin, stated during the July hearing that “there is no convincing evidence to support a stance that fluoride use in childhood has a detrimental effect on microbiome development.”
Despite assurances that decisions would be made based on scientific data, the society pointed to a quote from Kennedy in the FDA’s announcement of the proposed ban: “Ending the use of ingestible fluoride is long overdue.” The group cited this as evidence that the decision may be politically driven rather than science-based.
According to researchers cited by the society, ending water fluoridation across the United States could result in 25 million additional decayed teeth over five years. The society also pointed to Calgary, Alberta, where tooth decay rates increased significantly after fluoridation was discontinued. Following the rise in cases requiring general anesthesia for dental treatment, Calgary recently decided to resume fluoridation.
“Behind every statistic is a story. Behind every number is a name,” the society stated. “So much is at stake for people’s health if Kennedy’s opinions prevail over the evidence.”
More information is available at www.AmericanFluoridationSociety.org.
