Florida Surgeon General Dr. Joseph Ladapo has officially recommended against community water fluoridation for all local governments across the state due to “neuropsychiatric risk.” This recommendation follows the National Toxicology Report findings that fluoride reduces IQ in a subset of children at certain levels and the landmark court ruling against the EPA that deemed community water fluoridation an “unreasonable risk.” Dr. Ladapo provided five studies as evidence before concluding, “Due to the neuropsychiatric risk associated with fluoride exposure, particularly in pregnant women and children, and the wide availability of alternative sources of fluoride for dental health, the State Surgeon General recommends against community water fluoridation.”

While Robert F. Kennedy Jr., expected to serve in the Trump administration as HHS Secretary, has signaled plans to recommend halting water fluoridation nationwide, many dental health organizations continue to advocate for the practice. These groups cite decades of research supporting the safety and effectiveness of fluoridation in preventing tooth decay, particularly in underserved populations.

The HighWire reported on the pushback from dental associations and the mainstream media after the EPA lost the landmark 7-year court case. NPR reported “[Ladapo] called it “public health malpractice” despite widespread consensus among public health experts that fluoridation has dramatically improved dental health in the U.S., saved billions in dental costs, and prevented millions of childhood cavities.”

The Fluoride Action Network has raised concerns about NPR’s reporting on the recent court ruling, citing “journalistic malpractice.” Judge Edward Chen’s decision stated, “This finding does not conclude with certainty that fluoridated water is injurious to public health.” NPR, however, quoted the ruling as saying it “does not conclude with any certainty,” prompting criticism over a perceived misrepresentation about the court’s stance on fluoride risks.

The lead attorney on the case, Michael Connett, said, “It’s bad enough that NPR misquoted the Court’s ruling on fluoridation. But a more fundamental issue here, which NPR completely ignores (as does most media), is that “certainty” of harm is NOT required to find a risk, and indeed EPA has never once required “certainty” of harm to find unreasonable risk for other toxic chemicals under TSCA. If certainty of harm was required to find a risk, virtually every regulation protecting the public from toxic chemicals would disappear overnight.”

Dr. Ladapo’s recommendation is not based on the efficacy of fluoride for dental health but on the safety of consuming fluoride, specifically in children. Instead, Dr. Ladapo refers to the studies that connect fluoride consumption to reduced IQ, ADHD, decreased child inhibitory control and cognitive flexibility, and increased child neurobehavioral problems.

The American Dental Association (ADA) endorses hundreds of dental products containing fluoride, many developed by major pharmaceutical companies such as Colgate, GlaxoSmithKline, Johnson & Johnson, Procter & Gamble, and Pfizer. These companies pay the ADA $14,500 per product to secure its “seal of approval,” along with a $3,500 annual maintenance fee. While critics of fluoridation see this relationship as a potential conflict of interest, the ADA maintains that its recommendations are based on rigorous scientific evidence.

The CDC listed community water fluoridation as one of the top 10 “public health advancements of the 20th century.” The CDC receives millions of dollars in industry funding from pharmaceutical companies through the CDC Foundation. The EPA and CDC have yet to change any content on their pages to reflect the recent court decision or any mention of the NTP report that links fluoride consumption to lower IQs in children.

Dr. Ladapo’s guidance mentions that “evidence shows fluoride strengthens teeth, making them more decay-resistant. However, additional research is being conducted to review the impacts of overall fluoride exposure in the population.” He said fluoride is available from multiple sources, including toothpaste and mouthwash. Connett said there is some evidence that topical fluoride has modest benefits for dental health, but there is no reason for people to consume fluoride systemically.

Connett, in an appearance on The HighWire, said Europe has the same dental health outcomes, if not better, despite not having fluoride in the water supply. “If you look at the cavity rates in Europe according to WHO data, they’re generally lower and often just as low as the United States,” Connett said. “They’ve seen the same dramatic declines in tooth decay over the past 50-60 years that we’ve seen here in the United States. Dentists here in the United States, many of them, claim it is a result of adding fluoride to the water.”

The U.S. is the most fluoridated country in the world and is lagging behind other countries that decided to discontinue the practice. While dental association groups continue to claim that the evidence shows community water fluoridation is safe and effective, Connett said they do not have a single study to prove consumption of fluoride is safe for the brain. Connett asked the EPA, FDA, CDC, and other proponents for a study proving the chemical is neurologically safe.

“I asked all of them, can you point me to any study that shows that adding fluoridation chemicals to drinking water is safe for the brain,” Connett said. “Just one. I wasn’t asking for hundreds. I was just asking for one. And every one of those organizations came back and said we are not aware of any safety data on that point.”

Connett added that advocates for community water fluoridation often state there are thousands of safety studies, but nobody could provide a single study under the penalty of perjury.

Ladapo wrote, “While there is insufficient data to determine if the lower level of 0.7 milligrams per liter, currently recommended for U.S. community water systems, has a negative impact on children’s IQ, the report concludes that there is moderate confidence in the scientific evidence that points to an association between higher levels of fluoride consumption and lower IQ in children.”

The NTP study that concluded there is an association between water fluoridation and IQ loss in children involved water supplies with a level of 1.5 ppm, just over twice the recommended amount for U.S. water systems. Connett said Americans consume fluoride not only from tap water but also from processed foods and beverages. “It doesn’t just stay in the water,” Connett said. “It’s contaminating our processed foods. It’s contaminating our processed beverages. Let us keep in mind the water supply that feeds into the food supply.”

Dr. Ladapo has challenged federal agencies’ public health guidance multiple times as the Florida Surgeon General. Dr. Ladapo appeared on The HighWire last December to raise his concerns about DNA integration with the mRNA COVID-19 vaccines. Weeks later, Ladapo called for the mRNA shots to be taken off the market when the FDA did not alleviate his concerns.