On September 26, 2024, California Federal District Court Judge Edward Chen ruled in favor of environmental groups in Food & Water Watch, Inc., et al. v. EPA. In his ruling, the judge stated, “Plaintiffs have proven, by a preponderance of the evidence, that water fluoridation at the level of 0.7 mg/L – the prescribed optimal level of fluoridation in the United States – presents an ‘unreasonable risk of injury to health or the environment, without consideration of costs or other non-risk factors, including an unreasonable risk to a potentially exposed or susceptible subpopulation under the conditions of use.’”

 

The judge’s ruling calls for the EPA to review regulations for fluoride in drinking water.

“While District Court Judge Edward Chen was careful to note his decision ‘does not conclude with certainty that fluoridated water is injurious to public health,’ he added that evidence of its potential risk was now enough that the EPA has to do something,” according to magazine U.S. News.

"In all, there is substantial and scientifically credible evidence establishing that fluoride poses a risk to human health; it is associated with a reduction in the IQ of children and is hazardous at dosages that are far too close to fluoride levels in the drinking water of the United States," Chen stated in his ruling.

To fluorinate or not?

Chen cited a recent study performed by “the National Institutes of Health's toxicology program that concluded ‘higher levels’ of fluoride are linked to lowered IQ in children,” the U.S. News article adds.

Anti-fluoride groups have been fighting the EPA in courts across the country for almost a decade.

The U.S. government began adding fluoride to drinking water in 1945 when it was thought to have the benefit of reducing cavities.

“Hailed as a major public health accomplishment of the 21st century, community water fluoridation has led to significantly less tooth cavities. Thanks to fluoridated products like toothpaste and mouthwash, we’ve also seen similar reductions in countries that don’t fluoridate drinking water,” according to Food & Water Watch. “The benefits of fluoride in preventing tooth decay are well documented, but it’s time to revisit community water fluoridation in light of new research.”

Research findings on adding fluoride to water are mixed, further fueling the debate.

The American Association of Pediatrics (AAP) questioned the validity of the National Institutes of Health’s review.

“While additional research to better understand the association and potential biologic mechanisms would be important, there’s nothing about the research that makes me concerned [about] … low levels of fluoride through use of toothpaste and drinking fluoridated water,” said Charlotte W. Lewis, MD, MPH, FAAP, a member of the AAP Section on Oral Health, according to AAP News.

“The National Toxicology Program released a 324-page systematic review of published literature showing that 18 of 19 studies it deemed ‘high-quality’ found higher levels of fluoride linked to lower IQ in children. Authors said they have ‘moderate confidence’ in the association.”

One of the limitations of the report is that high fluoride was defined at a minimum of 1.5 milligrams per liter of water—double the concentration the EPA recommends in community water.

“Also, the studies included for analysis were geographically heterogeneous, with different study populations. Socioeconomic, physical, familial, cultural, genetic, nutritional, and environmental confounders affect IQ. It is unclear whether data on children’s IQ extracted from a variety of different studies are accurate, comparable, or generalizable,” according to AAP experts.

“The review was designed to evaluate the literature on exposure to fluoride and possible associations with IQ. It was not intended to determine if it is biologically plausible for fluoride to impact IQ or to demonstrate cause and effect. AAP experts said comparing the results of IQ tests that were not performed or assessed under similarly controlled conditions does not yield reliable conclusions,” AAP News continues.

The Centers for Disease Control and Prevention (CDC) continues to recommend that fluoride be added to community drinking water.

“While the NIH report did say that more research was needed to assess the potential dangers of the lower levels of fluoride typically found in U.S. drinking water, Chen ruled ‘there is not enough of a margin’ of safety at those levels,” U.S. News notes. “He pointed to studies of pregnant moms that found their fluoride exposure could be even higher. EPA experts had told the court those higher levels could be due to exposure to fluoride in food, toothpaste and other dental products.”

"Not only is there an insufficient margin between the hazard level and these exposure levels, for many, the exposure levels exceed the hazard level," Chen’s ruling adds.

“Specifically, the Court finds that fluoridation of water at 0.7 milligrams per liter (‘mg/L’) – the level presently considered ‘optimal’ in the U.S. – poses an unreasonable risk of reduced IQ in children. … as required by the Amended TSCA, the Court finds there is an unreasonable risk of such injury, a risk sufficient to require the EPA to engage with a regulatory response. This order does not dictate precisely what that response must be. Amended TSCA leaves that decision in the first instance to the EPA.”

The EPA currently has the ruling under review, Reuters says.
Actions open to the Agency include adding warning labels about the risks of ingesting fluoride at the current allowed thresholds or creating more stringent regulations regarding its addition to drinking water.

“One thing the EPA cannot do, however, in the face of this Court’s finding, is to ignore that risk,” Chen added.