The Environmental Protection Agency released its Protocol for Developing the Fluoride Human Health Toxicity Assessment, marking the next step in an accelerated review of public health risks linked to fluoride in drinking water, on Aug. 3.
The protocol release follows an August 2024 federal court ruling directing EPA to assess fluoride’s potential developmental neurotoxicity risks under the Toxic Substances Control Act, according to the agency. The court ruling compelled EPA to act after a lawsuit by advocacy groups.
Approximately 73% of Americans served by public water systems receive fluoridated water, a public health practice that has been in place since the 1940s. The Centers for Disease Control and Prevention has called community water fluoridation one of the 10 great public health achievements of the 20th century for its role in reducing tooth decay.
The review is occurring against the backdrop of HHS Secretary Robert F. Kennedy Jr.’s longstanding criticism of water fluoridation, elevating political attention to the scientific assessment process.
The toxicity assessment, once complete, could inform regulatory action on maximum contaminant levels for fluoride in drinking water. Any changes to fluoride standards would affect water treatment operations in thousands of communities across the country.
For the roughly 200 million Americans who drink fluoridated water, the review’s outcome has direct personal health implications. Proponents of fluoridation cite decades of evidence that community water fluoridation reduces cavities, while critics point to emerging research suggesting possible associations with neurodevelopmental effects at certain exposure levels.
The American Dental Association and the American Academy of Pediatrics continue to support community water fluoridation at currently recommended levels.