Florida’s top health official last week advised governments across the state to stop adding fluoride to their water, citing the neuropsychiatric risk — particularly for pregnant women and children — associated with the practice.
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Florida’s top health official on Friday advised governments across the state to stop adding fluoride to their water, citing the neuropsychiatric risks — particularly for pregnant women and children — associated with the practice.
“It is public health malpractice, with the information we have now, to continue adding fluoride to water,” Surgeon General Joseph A. Ladapo said.
Ladapo made the announcement last week during a press conference. His office also issued written guidance detailing the latest research showing that exposure to fluoridated water can lead to neurodevelopmental issues in children, including lower IQ.
Given that risk, along with the wide availability of toothpaste, mouthwash and other alternative sources of fluoride, Ladapo recommended against community water fluoridation.
Florida’s new written guidance includes a tool for communities to determine if their local government fluoridates their water so they can contact local officials to discuss.
Ladapo said that as a physician, he previously supported water fluoridation because he learned in medical school that it was an important public health intervention. However, the landmark ruling in September by a California federal judge prompted him to review the science.
In that ruling, Judge Edward Chen concluded water fluoridation at current U.S. levels poses an “unreasonable risk” to children’s health. He ordered the U.S. Environmental Protection Agency (EPA) to take regulatory action in light of recent scientific findings.
Ladapo said that once he better understood the science, “I was appalled, frankly,” because scientists have been publishing high-quality studies demonstrating these neurotoxic effects for years yet the public has been largely unaware of those findings.
Stuart Cooper, executive director of the Fluoride Action Network (FAN) — a plaintiff in the lawsuit against the EPA — told The Defender, “Dr. Ladapo’s response is exactly how leaders ought to be reacting to this urgent public health crisis affecting over 200 million Americans, including 2 million pregnant women and over 300,000 exclusively bottle-fed infants who rely on fluoridated tap water for most of their nutrition.
Cooper added:
“He’s not alone. Municipal and state officials from around the country are now beginning to respond, by suspending or ending fluoridation locally …
“Citizens need to realize that politicians are voluntarily authorizing the addition of this neurotoxin to the water. The harm is needlessly self-inflicted, but that also means the solution is simple: ban the use of fluoridation chemicals.”
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Recent science suggests risks outweigh benefits
Ashley Malin, Ph.D., assistant professor in the University of Florida’s Department of Epidemiology joined Ladapo at the press conference. She is the lead author of a recent study of women and children in Los Angeles that found children born to women exposed during pregnancy to fluoridated drinking water were more likely to have neurobehavioural problems.
Malin said in the last seven years there have been several “high quality, rigorously conducted, prospective pregnancy and birth cohort studies in North America.” These studies showed that chronic, relatively low prenatal fluoride exposure levels are associated with poorer neurodevelopmental outcomes — including reduced IQ, more symptoms of ADHD (attention-deficit/hyperactivity disorder) and declines in executive functioning.
The National Toxicology Program (NTP), a division of the U.S. Department of Health and Human Services, published a report in August that found with moderate confidence that fluoride exposure is associated with lowered child IQ at levels of 1.5 milligrams per liter (mg/L) — only twice the currently recommended 0.7 mg/L level of water fluoridation in the U.S.
The NTP said there was uncertainty about exposure at lower levels — a finding that pro-fluoride organizations such as the American Dental Association (ADA) cite to justify their pro-fluoridation position.
However, in his ruling, Chen said there is not a sufficient margin of safety between the level at which fluoride is known to be toxic, or the hazard level, and the currently recommended exposure level.
For most chemicals regulated by the EPA, there must be at least a factor of 10 between the hazard level and the exposure level in order to protect people, because real exposure levels can vary and people have different sensitivities.
Malin said that to comply with EPA’s regulatory rule of thumb, fluoride levels in drinking water would need to be set to .15 mg/L or lower.
Ladapo’s new guidance also cited several other recent key peer-reviewed studies linking water fluoridation to neurodevelopmental issues.
These include a 2017 study in Mexico that linked prenatal fluoride exposure with lower IQ in children ages 6 to 12, a 2019 Canadian study that found an association between exposure to fluoridated water and ADHD among children and adolescents between ages 6 and 17, and several other studies.
Does water fluoridation prevent cavities?
ADA President Brett Kessler said it was “disheartening to hear Dr. Ladapo’s misinformed and dangerous comments regarding community water fluoridation.”
The ADA said that “according to the CDC,” water fluoridation reduces cavities by 25%. This number was repeated in coverage of Ladapo’s statement by NPR and The Washington Post.
To make this claim, in its May 2024 statement on water fluoridation, the CDC cited studies from 15 to 34 years ago, from 1990, 1999, 2002 and 2007. On a different water fluoridation webpage, the CDC also cites a Cochrane review from 2015.
However, the authors of that Cochrane study published an updated version of their review in October of this year, concluding that adding fluoride to drinking water provides very limited dental benefits, especially compared with 50 years ago.
The authors of the Cochrane study found that more contemporary evidence shows community water fluoridation may lead to a very small reduction in cavities in children’s baby teeth over time. Fluoride in water reduced tooth decay only by about one-quarter of one tooth, they found.
“These results also included the possibility of little or no difference in tooth decay,” they said.
One 2021 study in Calgary, Canada, found that stopping water fluoridation led to an increase in cavities. However other recent major observational studies, including the LOTUS Study, found only a 2% reduction in cavities among people living in fluoridated areas in England.
Since 2023, towns in North Carolina, Florida, Pennsylvania and Texas have decided to stop the practice. And most Western European countries have ended the practice.
Fluoride is ‘an equal-opportunity neurotoxicant’
Water fluoridation made the news earlier this month when Robert F. Kennedy Jr., —- Children’s Health Defense founder and President-elect Donald J. Trump’s nominee to lead HHS — publicly backed the idea.
Kennedy’s position led to attempts by mainstream media to discredit the idea as conspiracy theory or to cast the move as a “Republican push.”
However, Rick North, FAN board member, told The Defender:
“Fluoridation isn’t a partisan issue, although too often the mainstream media has tried to make it one. Fluoride doesn’t care if the mothers and children it harms are Democrats, Republicans or anyone else. It’s an equal-opportunity neurotoxicant.”
North said recently the mainstream media has attempted to paint ending water fluoridation as an issue supported exclusively by conservatives.
However, places like North’s former home of Portland, Oregon, a Democratic city, is the largest city in the country to have ended water fluoridation in a landslide vote.
Even CNN medical analyst Dr. Leana S. Wen conceded in a recent Washington Post op-ed that she had planned to write an article that would debunk claims that water fluoridation was dangerous.
However, when she actually read the science, Wen said she “was shocked.” “The data clearly indicates that conventional wisdom needs to be revisited.”
Wen cautioned the medical and scientific community “against knee-jerk reactions.”
Malin also said she thought the issue had become unnecessarily politicized. “I really don’t view this as a political issue, I view this as a human rights issue and a public health issue.”
Brenda Baletti, Ph.D., is a senior reporter for The Defender. She wrote and taught about capitalism and politics for 10 years in the writing program at Duke University. She holds a Ph.D. in human geography from the University of North Carolina at Chapel Hill and a master's from the University of Texas at Austin.
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