Having been selected by President-elect Donald Trump to spearhead the Department of Health and Human Services, Robert F. Kennedy Jr. hinted at the possibility of a push to eliminate fluoride from potable water. Throughout his campaign for Trump, Kennedy criticised fluoride, calling it a ‘manufacturing by-product’ and suggested its links to cancer, as well as a variety of other illnesses and disorders. He revealed on November 2 that the incoming Trump administration might suggest the removal of fluoride from public water sources on the 20th of January, deeming it a contributor to diseases such as arthritis, bone fractures, bone cancer, IQ loss, developmental disorders and thyroid disease.
He corroborated his claim by referencing a video from a lawyer who recently won a lawsuit against the Environmental Protection Agency (EPA), demanding further action on regulating fluoride in water. Regardless of the outcome of Trump’s bid for presidency, Kennedy, a vocal proponent against water fluoridation, persisted in his endeavors. Prior to the election, when questioned about his administration’s stance on fluoride removal, Trump expressed potential congruence with Kennedy’s views although he noted that he had not yet discussed it.
Despite Kennedy’s claim, continuous research attests to the safety and effectiveness of adding fluoride to drinking water in the United States as a method to enhance children’s oral health. As of 2015, the recommended concentration in US drinking water is determined to be 0.7 milligrams per liter. Various health organizations, such as the American Dental Association, American Academy of Pediatrics and the Centers for Disease Control and Prevention are in support of this practice.
However, recent studies have shed light on a possible connection between fluoride and certain health concerns such as bone disorders and children’s IQ, particularly when the fluoride concentration surpasses the United States’ recommended levels. David Bellinger, a professor of neurology at Harvard Medical School and a professor in the Environmental Health Department of Harvard School of Public Health, emphasized the need for a thorough risk-benefit analysis of fluoride addition.
Speaking to the nuances of toxicology, Bellinger pointed out that ‘the dose makes the poison’, highlighting that allegations linking fluoride to diseases require specification of the responsible dose. What qualifies as fluoride, and what merits does it hold? As a naturally occurring resource in soil, water, and certain foods, fluoride serves a critical function in preventing tooth decay and cavities by fortifying tooth enamel against damage from bacteria, plaque, and sugar.
Water fluoridation, which might seem like a modern procedure, actually has a history dating back to 1945 in the United States. The federal Public Health Service first advocated the addition of fluoride to tap water in 1962, although the final decision is made at the state and local levels. According to a 2022 report from the CDC, approximately 72% of the U.S. population or 209 million people have access to fluoridated water.
Furthermore, fluoride is a common additive in oral care products such as toothpaste and mouthwash. In 2015, following the health officials’ decision in the U.S. to reduce the recommended fluoride concentration in drinking water to 0.7 milligrams per liter, they claimed that the lower levels still adequately protect teeth without causing staining, and alternative fluoride sources made previously higher levels less necessary.
Fluoride application through toothpaste and rinses is subsumed beneficial by pediatric dentists, yet emphasize that its absorption through water intake is equally, if not more important, particularly for younger children who still have their primary teeth. The infused fluoride can support the development of permanent teeth. Supporting this, the American Dental Association affirms that studies prove the effectiveness of fluoride in communal water systems, reducing tooth decay in both children and adults by a minimum of 25%.
In recent events, a federal judge directed the Environmental Protection Agency to intensify regulations regarding fluoride levels in drinking water due to concerns about potential impacts on children’s intellectual growth. Judge Edward Chen of the U.S. District Court clarified that the court hadn’t conclusively declared water with added fluoride to be harmful to public health as it remained ambiguous whether the common fluoride amounts caused a reduction of children’s IQ.
Nevertheless, Judge Chen expressed that there was sufficient cause to further scrutinize the matter, mandating the EPA to set stricter regulations. However, the judgement was not explicit about the regulatory measures the agency should take, and the EPA is now reviewing the decision. Following the court’s ruling, the American Association of Pediatrics asserted that fluoride in potable water is safe for children.
While dental fluorosis remains a minor adverse effect of fluoride, experts caution that prolonged exposure to fluoride above the recommended levels in the U.S. could lead to skeletal fluorosis. This infrequent condition weakens bones and can cause stiffness and joint pain. The Public Health Service recommends a fluoride concentration of 0.7 milligrams per liter for community water systems.
However, under the Safe Drinking Water Act, it’s the EPA’s responsibility to enforce drinking water quality standards. Presently, in order to prevent skeletal fluorosis, the EPA mandates that the fluoride concentration does not exceed 4 milligrams per liter in water systems.