For decades, drinking water fluoridation opponents were often portrayed as a fringe element and conspiracy theorists, but a federal ruling in the US may put an end to the practice and marks a pivotal point in their campaign to convince the public and policymakers of the substance’s dangers for infants’ developing brains.
Armed with a growing body of scientific evidence pointing toward fluoride’s neurotoxicity, public health advocates say the legal win shows they are overcoming “institutional inertia” and the unwillingness of federal public health agencies to admit they may have been wrong.
The order last week requiring the US Environmental Protection Agency (EPA) to begin the process of strengthening fluoride regulations represents a “landmark” legal win that has long been in the making, said Stuart Cooper, director of the Fluoridation Action Network advocacy group.
“After many years of them ignoring us and defending fluoridation, we had an opportunity to get a fair and balanced adjudication in courts,” Cooper said.
The Obama-appointed US judge Edward Chen found fluoridation could cause developmental damage and lower IQ in children at levels to which the public is generally exposed in drinking water. Though the ruling did not state the level at which fluoridation would damage brains, the levels in US water present an unreasonable risk, the court found.
The EPA now must perform a risk assessment that is among the first steps in setting new limits under the Toxic Substances Control Act.
US water has been fluoridated since 1945, though the recommended levels have since been lowered over health risks. Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the US Centers for Disease Control and Prevention, and dentistry groups say it protects young children’s gums and developing teeth.
It is added to drinking water for more than 200 million Americans, or about 75% of the population, at recommended levels of 0.7 milligrams of fluoride per liter of water.
Though those opposed to fluoridation can point to credible evidence to back their case, anti-fluoridation history has included conspiracy theories that the process was a post-second world war communist plot, or, later, a coordinated effort to sap US society of intelligence.
But there has always been evidence of the risks, and the practice is rare in most other countries, including those in Europe. The last 15 years have seen an “uptick” in high-quality scientific research demonstrated the risks, said Michael Connett, a Food and Water Watch lead attorney on the case.
The EPA had been “a good soldier” and toed the federal government’s line, but that required it to ignore evidence and abandon its statutorily required duties, Connett said.
“You have agencies that have aggressively promoted fluoridation for decades in a very un-nuanced, sledgehammer way, so it’s quite a departure from that party line to say, ‘Oh, oops, looks it might actually be damaging the brain,” Connett said. “There’s an institutional credibility and inertia issue.”
Still, even after the ruling, many fluoridation supporters are not backing down. Much of the medical establishment supports the process. In a statement last week, the American Dental Association, which supports fluoridation, said: “The key takeaway for the public and public health community from this ruling is that it does not conclude with any certainty that fluoridated water is injurious to public health.’”
Cooper pointed to a statement made by an American Pediatric Association official during the court case in which she said she would not oppose fluoridation even if it reduced five IQ points for up to 10% of the population.
Cooper said the fight over fluoridation over the last several decades had been with the medical establishment and regulatory agencies, while everyday residents generally agreed that the practice should end.
“The vast majority of the public was always on our side, there was never a citizen who said, ‘Yes, please give us fluoridated water,’” Cooper said.
The shift in part picked up momentum as scientists like Linda Birnbaum, a former head of the EPA’s toxic chemicals program, came out in support of ending fluoridation, and some government agencies over the last several years found unreasonable risk.
“When do we know enough to revise long-held beliefs? We are reminded of the discovery of neurotoxic effects of lead that led to the successful banning of lead in gasoline and paint,” Birnbaum said in a 2020 op-ed.
In the ruling’s wake, four water systems, including that which provides water to Salt Lake City, have stopped or suspended fluoridation.
Despite the win, Connett said he did not expect support for fluoridation to immediately vanish.
“There’s a scientific paradigm and deep beliefs that exist that say fluoridation is safe and effective, and that doesn’t just go away overnight,” he added.
