Washington Post's medical columnist, Dr. Leana Wen, has come out in favor of removing fluoride from water supplies due to the research presented above as well as additional studies cited below. Little to no benefit in cavity reduction for people who use fluoride toothpaste, too much of a risk of cognitive damage from drinking fluoridated water, particularly to fetuses in prenatal exposure. I've removed the partisan political bits at the beginning and end to focus on the science talk, can see in full at the links if desired.
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By
Leana S. Wen
November 12, 2024 at 6:30 a.m. EST
Fluoride is a naturally occurring mineral that has long been known to prevent tooth decay. Bacteria in the mouth produce acid that dissolves the tooth’s surface, eventually leading to cavities. Fluoride replenishes lost minerals from wear and tear and strengthens dental enamel.
Since 1962, the U.S. Public Health Service
has recommended adding fluoride to public drinking water. The Centers for Disease Control and Prevention reports that this practice has reduced cavities by about
25 percent and hails it as one of the 20th century’s
10 greatest public health achievements.
Over the years, research has shown that fluoride is not harmless. Higher levels can lead to problems such as
tooth discoloration,
bone deformities and
thyroid diseases. In recognition of these risks, as well as the fact that most people are now getting fluoride through toothpaste, the
Public Health Service lowered the recommended fluoride concentration in drinking water in 2015. In 2019, the CDC urged parents to
supervise young children’s use of toothpaste to guard against excessive fluoride ingestion.
Multiple studies also show that neonatal fluoride exposure might interfere with brain development. A
JAMA Pediatrics study concluded that Canadian women who drank fluoridated water during pregnancy had children with lower IQ scores at ages 3 to 4 years old. There was no statistically significant effect on girls, but IQ scores of boys born to women with higher fluoride consumption were nearly 4.5 points lower.
Another Canadian study found that exposed girls were impacted, with worse cognitive flexibility and executive function. Three studies from Mexico found a link between fluoride intake during pregnancy and a
significant drop in IQ,
attention-deficit/hyperactivity symptoms and
cognitive development problems.
A U.S. study published this year in
JAMA Network Open found that prenatal fluoride exposure was associated with children developing neurobehavioral problems. Researchers followed 229 women in the Los Angeles area from pregnancy through about the third year of their child’s life and linked higher amounts of fluoride by the expectant mothers to nearly double the odds of the child having problems such as anxiety and emotional instability.
This study, which was funded in part by the National Institutes of Health and the Environmental Protection Agency, generated significant controversy. Anti-fluoridation groups seized upon it to justify their crusade, while organizations such as the
American Dental Association issued statements doubling down on the benefits of water fluoridation.
Both sides have legitimate points. The safety of low-level fluoridation has been demonstrated by decades of research, though emerging studies suggest it could be a risk to pregnant women. Moreover, although the data are clear that community fluoridation dramatically reduced cavities before fluoride toothpaste became available, the current benefit is much smaller. Indeed, a
2024 Cochrane review — considered the gold standard of medical reviews — concluded that fluoridating water today “may” lead to “slightly less” decay in kids’ teeth. “However, these results also included the possibility of little or no difference in tooth decay,” the authors wrote.
Currently, about
72 percent of Americans receive fluoridated water. At least
a dozen states have laws mandating fluoridation. One — Hawaii —
has banned it. Most others leave it to individual localities. Municipalities that don’t add fluoride to drinking water include
Portland, Oregon, and
Wichita, where voters have repeatedly rejected fluoridation proposals. Other localities have been joining them; since 2023, towns in
North Carolina,
Florida,
Pennsylvania and
Texas have decided to stop the practice.
Interestingly,
most Western European countries, including Denmark, France, Germany, Italy, the Netherlands, Norway and Sweden, have ended public water fluoridation. If Kennedy succeeds in persuading Trump to recommend against fluoridation, he would actually be aligning the United States with peer countries. That could result in a slight increase in tooth decay, but it could also benefit Americans by reducing prenatal exposure.
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