EPA Expedites Fluoride Review, Despite Appealing “Unreasonable Harm” Ruling From 2024

EPA Administrator Lee Zeldin announced a “fast-track effort” to review fluoride while “adhering to gold-standard scientific methods and radical transparency.” This comes as part of the Make America Healthy Again (MAHA) agenda, in which HHS Secretary Robert F. Kennedy Jr. announced before taking office that the Trump administration would call for water systems to stop adding fluoride. However, the EPA has received pushback from MAHA advocates for contradictory actions as the agency continues to appeal the landmark court case in which the Fluoride Action Network (FAN) and Attorney Michael Connett successfully defeated the agency, for which Judge Edward Chen ruled action must be taken.

Administrator Zeldin said the new action will use data sharing, peer review, and interagency collaboration to address public concerns about fluoride, with an emphasis on outcomes related to childhood development and maternal and infant health. The review will be conducted under the Safe Drinking Water Act (SDWA), and there is currently a 30-day comment period on regulations.gov. The agency is also holding an information webinar regarding the actions on January 28 at 1pm EST.

“Science is always evolving, and our policies should too,” said Secretary Kennedy. “A growing body of evidence indicates that ingesting fluoride can cause neurological harm and other adverse effects. By contrast, fluoride’s benefits to teeth come almost entirely from topical contact, not from ingestion. Most of Europe has already moved away from water fluoridation in favor of topical products such as toothpaste, and it may well be time for the U.S. to follow suit.”

“EPA wants the MAHA movement to be focused on this press release,” Connett said on Friday. “But simultaneous to issuing this press release yesterday, EPA also filed a legal brief to further challenge a federal court order requiring EPA to take action to protect the public from fluoridation’s ‘unreasonable risk’ to health. The time has come for action to reduce the public’s exposure to fluoride, not just another government review. That is what the court ordered EPA to do, and what the MAHA movement should insist upon – especially since EPA’s review will likely take 2 or more years to complete.”

It has now been 16 months since Judge Chen issued his ruling that adding fluoride to the water supply poses an “unreasonable risk” to the health of children, particularly noted by the National Toxicology Program (NTP) report that found an association with reduced IQ in children at higher exposure levels. The EPA is required to take action to eliminate the threat, but there is no set timetable for doing so under the ruling. The agency’s appeal of the case is using taxpayer dollars to delay action on the issue, while Administrator Zeldin said they are moving forward with an expedited review process under the SDWA.

“While I am glad the EPA is addressing the harms of fluoride in the water, let’s remember that they lost a lawsuit in 2024 and were ordered by Judge Chen to ‘take regulatory action,’ said Zen Honeycutt, founder of Moms Across America. “Opening a public comment period and reviewing fluoride is NOT taking regulatory action – it is delaying regulatory action.”

Last March, Utah became the first state to ban the practice of public water fluoridation, which prompted a visit from Secretary Kennedy and Administrator Zeldin. Zeldin said at the time that upon his nomination to become EPA Administrator, Kennedy reached out to discuss issues of concern, with the number one issue being fluoride. Florida became the second state to ban the practice in May.

While studies have shown fluoride can protect teeth by preventing tooth decay, the benefit is “predominantly” topical. Fluoride is included in toothpastes and mouthwash made by the largest manufacturers and is readily available for children and adults to use. These products contain warning labels not to ingest the product.

The FDA has been removing ingestible fluoride supplements from the market that have never been FDA-approved. A ProPublica article earlier this month includes quotes from dentists who insist that ingestible fluoride supplements should be available in Utah and Florida, where fluoridated water has now been banned. The dentists do not address the safety concerns regarding fluoride as a neurotoxin that has been linked to reduced IQ in children, nor the availability of fluoridated toothpaste that provides the topical benefit for which fluoride has been shown to provide.

About two-thirds of people in the United States live in areas with fluoridated water systems, but have worse dental health outcomes compared to peer nations that artificially fluoridate the water. A Decayed, Missing, and Filled Teeth (DMFT) index from 2017 shows Denmark, Germany, and Finland as having the best dental health outcomes in this regard, despite having no artificial water fluoridation. The number is an average across the population for which an individual would have a decayed, missing, or filled tooth. Denmark scored a 0.4, while the United States was 300% of Denmark’s score with a 1.2.

Dental fluorosis has nearly doubled in the US since 1987, with it affecting about 41% of adolescents and 23% of the entire population. From 1986-1987 to 1999-2004, moderate and severe dental fluorosis increased from 1.3% to 3.6% among children aged 12-15.

With mixed messaging from the EPA, MAHA supporters are unsure what will come from the upcoming expedited review that is occurring alongside the EPA’s appeal against the court ruling that mandates they take action to protect children from the “unreasonable risk” posed by water fluoridation.

“While we would have preferred fluoride regulation under TSCA, a rigorous review under SWDA will go a long way towards updating fluoride standards in the U.S., paving the way for a national phase-out of water fluoridation,” the Fluoride Action Network wrote on X in response to EPA Administrator Zeldin’s announcement.