A new federal court ruling does not change recommendations from the AAP and American Dental Association (ADA) to use optimally fluoridated water to prevent dental caries.
U.S. District Judge Edward Chen in the Northern District of California ruled on a lawsuit this week regarding potential risks associated with fluoridation of drinking water. In his ruling, he said that while he “does not conclude with certainty that fluoridated water is injurious to public health,” there still is an “unreasonable risk” of harm. He did not ban fluoridated water but said the Environmental Protection Agency must take regulatory action to address the optimal level of fluoridation in drinking water in the U.S.
The AAP and other experts have questioned the validity of the research on which Chen relied heavily in his ruling.
“There is nothing about the current decision that changes my confidence in the safety of optimally fluoridated water in the U.S.,” said Charlotte W. Lewis, M.D., M.P.H., FAAP, a member of the AAP Section on Oral Health. “Water fluoridation is a public health policy based on a solid foundation of evidence. When new research is published, health experts scrutinize it to make sure it meets high standards for public safety.”
Dental caries is one of the most common chronic diseases in children and can have lifelong consequences. It disproportionately impacts children who are racial minorities, come from low-income families or have special needs. Decades of research support the safety and effectiveness of fluoride to prevent caries.
In his court ruling, Chen repeatedly cited the National Toxicology Program’s (NTP’s) systematic review of published literature released last month that found higher levels of fluoride were linked to lower IQ in children. Authors said they have “moderate confidence” in the association.
The NTP report has important limitations. High fluoride exposure was defined as at least 1.5 milligrams per liter of water, which is double the concentration U.S. officials recommend in community water. The review also was not intended to demonstrate cause and effect.
Numerous factors impact IQ, and it is unclear whether IQ data from different studies are accurate, comparable or generalizable, according to AAP experts. Other studies have found no link between fluoride and IQ, and the National Academies of Sciences, Engineering and Medicine twice rejected previous drafts of the NTP report.
Community water fluoridation started in the 1940s and has been recognized as one of the 10 great public health interventions of the 20th century by the Centers for Disease Control and Prevention (CDC). Communities that have stopped fluoridating water have seen dental caries increase.
The AAP continues to recommend children use age-appropriate amounts of fluoride toothpaste and drink optimally fluoridated water to protect their teeth. Children living in communities without fluoridated water should supplement with dietary fluoride. Fluoride varnish should be applied to children’s teeth as recommended by the U.S. Preventive Services Task Force.
Following the court ruling, the ADA also said it “remains staunchly in support of community water fluoridation at optimal levels to help prevent tooth decay.”
“Oral health should not be a luxury; it’s essential. Optimally fluoridated water is accessible to communities regardless of socioeconomic status, education or other social variables,” ADA President Linda J. Edgar, D.D.S., said in a statement. “Even in an era with widespread availability of fluoride from various sources, studies show that community water fluoridation prevents at least 25% of tooth decay in children and adults throughout their life span. The scientific weight of sound evidence around the benefit of community water fluoridation is clear and compelling.”
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