The American Dental Association (ADA) has long been a leading voice in promoting fluoride as a cornerstone of public dental health policy. However, in light of recent scientific developments, the organization’s unyielding stance on fluoride is raising serious concerns. This is especially true regarding the ADA’s disregard for decades of scientific studies presented during the federal lawsuit against the Environmental Protection Agency (EPA) concerning fluoride added to community drinking water.

This negligence by the ADA has led to significant consequences for public health, particularly among vulnerable populations, while also undermining the concept of informed consent. Moreover, by ignoring the precautionary principle—which advocates for preventive action in the face of potential harm—the ADA has failed to advocate for the protection of the public from risks that could have been minimized or avoided through a more cautious, informed approach.

 

The Federal Lawsuit and Ignored Evidence

In a landmark case that reached federal courts, research was presented challenging the safety of community water fluoridation, particularly its neurotoxic effects on developing brains. A wealth of studies, published in peer-reviewed journals from across the world, suggest that fluoride exposure from community water supplies, especially during critical periods of brain development, could have harmful consequences for children.

The United States District Court for the Northern District of California ruled that fluoridation at 0.7 mg/L — the level endorsed by the EPA — presents an unreasonable risk of reduced IQ in children. The findings included evidence that exposure to fluoride added to the water can lead to lower IQ levels in children and other developmental issues.

The ruling did not outline the exact actions the EPA must take, but under the Toxic Substances Control Act (TSCA), once a court determines that a chemical presents an unreasonable risk, the EPA is legally required to mitigate or eliminate that risk. Judge Chen cautioned: “What the EPA cannot do, given this Court’s finding, is ignore the risk.”

Despite the mounting evidence, the ADA remains resolute in its historical endorsement of water fluoridation, disregarding credible research. This stance is echoed by several prominent organizations closely linked to the ADA, including the American Association for Dental, Oral and Craniofacial Research (AADOCR), the American Water Works Association (AWWA), the American Fluoridation Society (AFS), and most surprisingly, the American Academy of Pediatrics (AAP), all of which continue to parrot the ADA’s talking points and promote fluoride as universally safe.

The ADA has responded to the court’s decision, saying the ruling: “Provides no scientific basis for the ADA to change its endorsement of community water fluoridation as safe and beneficial to oral health.”

The Precautionary Principle

However, given the emerging data on fluoride’s possible neurotoxic effects, particularly for infants, pregnant women, and individuals with kidney issues, these organizations’ reluctance to adopt a precautionary stance contravenes public health principles. The precautionary principle suggests that credible evidence of potential harm, especially to vulnerable populations, warrants protective action, even without full scientific consensus. By ignoring this principle, these organizations risk prioritizing long-standing policy over evolving science signaling possible developmental risks.

Harm to Susceptible Populations

Research shows that certain groups are more vulnerable to fluoride’s toxic effects:

  • Infants and Young Children: Developing brains are especially susceptible to fluoride’s neurotoxic effects. Studies have linked prenatal fluoride exposure to lower IQ scores in children, raising concerns about long-term cognitive development.
  • Pregnant Women: Fluoride crosses the placenta, exposing developing fetuses directly, with potential risks to fetal brain development emphasized in the lawsuit.
  • People with Kidney Disease: Those with impaired kidney function retain higher systemic fluoride levels, leading to adverse health effects, including bone and cognitive problems.

Despite well-documented risks to these vulnerable populations, the ADA refuses to alter its recommendations, posing both public health and ethical concerns.

Fluoride’s Efficacy in Serious Question: The Cochrane Review

The 2024 Cochrane fluoride review critically evaluated studies on communities with and without fluoridated water supplies, finding insufficient evidence that fluoride prevents cavities in modern populations. Much of the research supporting community fluoridation is outdated or of poor quality, with studies showing cavity reduction primarily from older data. The review also indicates minimal benefit in today’s context, where dental care and oral hygiene products are widely accessible.

 

Linda J. Edgar, DDS., past president of the American Dental Association has stated.”…community water fluoridation prevents at least 25% of tooth decay in children and adults throughout their lifespan.” But according to the results of the Cochrane review, this estimate is wildly overblown compared to what is found in the scientific literature.

The large decline in fluoridation’s effectiveness over the past 50 years found in the Cochrane review is illustrated by two graphs created by FAN’s Science Director, Chris Neurath, from the report’s data. The first graph is for deciduous (baby) teeth, and the second for permanent teeth:

 

Figure 1. Studies plotted by year of publication, show that over the last 50 years, the effectiveness of fluoridated water appeared to decline substantially in baby teeth. Courtesy of Fluoride Action Network using data from the 2024 Cochrane Review.

 

Figure 2. Studies plotted by year of publication, show that over the last 50 years, the effectiveness of fluoridated water appeared to decline substantially in permanent teeth. Courtesy of Fluoride Action Network using data from the 2024 Cochrane Review.

Despite all this, the ADA continues to support fluoridation without acknowledging that fluoride’s effectiveness is no longer as clear-cut as once believed. This stance undermines public confidence and raises questions about the ADA’s motives for maintaining an outdated, potentially harmful policy.

Informed Consent and Public Trust

Central to public health is the principle of informed consent, where people have the right to understand the risks and benefits of treatments. However, the ADA’s unwavering endorsement of water fluoridation denies the public this right. Many Americans are unaware of fluoride’s potential harms, especially for vulnerable groups, and consume fluoridated water under the assumption that it is universally safe. This lack of transparency erodes public trust in the ADA and public health agencies.

The ADA’s endorsement of fluoridation also removes the option for informed consent. Unlike voluntary treatments, community water fluoridation is imposed largely without consent, and avoiding fluoridated water entirely can be financially burdensome and logistically challenging.

Conclusion: Public health policies must evolve with science

The ADA’s steadfast support for water fluoridation, despite mounting evidence of harm and ineffectiveness, raises questions about the organization’s commitment to science and public health. Ignoring credible research and the concerns of susceptible populations risks the health of vulnerable individuals and undermines public trust. The ADA has a responsibility to prioritize science and transparency, ensuring that all Americans, especially high-risk groups, are informed of the true benefits and risks of fluoridated water.

Rather than uphold outdated practices, public health policies must evolve with science. As a commitment to protecting public health and informed choice, the ADA and supporting organizations must embrace the precautionary principle, particularly when children, pregnant women, and other susceptible groups are at risk.

Until the ADA adopts a precautionary approach and evolves its policy positions to consider the scientific evidence, it will continue to jeopardize both public health and confidence in our healthcare systems. The IAOMT endorses banning water fluoridation so we can restore the publics’ trust and safeguard future generations’ health.