More regulations on fluoride in drinking water may be coming due to the new court order last week, experts say.
Fluoride, commonly added to drinking water to prevent cavities, has come under scrutiny.
Several cities have now stopped adding fluoride to their drinking water. But whether the whole landscape will change depends on what the Environmental Protection Agency (EPA) will do next.
How Much Fluoride in Water Might Be Safe?
On Sept. 24, U.S. Federal Judge Edward Chen ordered the EPA to strengthen its rules around fluoride in drinking water.
The decision was made in light of The National Toxicology Program’s (NTP) report in August, which found that 1.5 milligrams of fluoride in drinking water is sufficient to pose neurodevelopmental risks in children.
The EPA calculates a margin of exposure to determine a safety buffer between the exposure and hazard levels. For fluoride, the exposure rate should be one-tenth of the hazard level, lawyer Michael Connett said.
Since the NTP’s report found 1.5 milligrams per liter to be potentially risky, exposure risks could start from 0.15 milligrams per liter, Connett added.
Americans’ current exposure level of 0.7 milligram per liter—"the level presently considered “optimal” in the United States – poses an unreasonable risk of reduced IQ in children,” Chen wrote in his ruling.
Currently, the EPA sets the maximum level for fluoride at 4 milligrams per liter, significantly higher than the risk level cited in the recent study.
What Might the EPA Do?
The EPA can either appeal the judge’s decision or take action to regulate fluoride, Connett, the lawyer representing the plaintiffs, told The Epoch Times. The EPA has 60 days to appeal the judge’s decision.
The agency is in the process of reviewing the judge’s decision, Jeffrey Landis, a media representative for the EPA, told The Epoch Times. He referenced the court’s opinion, which did not conclude “with certainty that fluoridated water is injurious to public health.”
Should the EPA accept the judge’s orders, the agency would need to start a rulemaking process, John Strait Applegate, a law professor at Indiana University, told The Epoch Times.
“[This would] mean that it necessarily will issue a rule,” Applegate said. “It could go through a thorough analysis and decide that the federal judge was wrong and there is not enough reasonable risk.”
The lawsuit focused on a fairly narrow risk of fluoride exposure and developmental problems; however, the EPA would need to consider all risks and benefits such as the dental benefits of adding fluoride, he noted.
The agency may also find other risks related to fluoride and decide to issue warnings on fluoridated water consumption.
Connett hopes that the EPA may issue a rule to ban the addition of fluoride to water.
Towns Going Off Fluoride
Some towns may choose to stop adding fluoride. This is legal since states and cities just need to make sure that they do not exceed the EPA’s fluoride limits.
In the wake of the ruling, at least three towns have stopped adding fluoride to their drinking water.
Somers and Yorktown in New York, and the City of Abilene in Texas, are among the first U.S. towns to halt fluoridation after the judge’s ruling.
“I would not be surprised if cities on their own made that decision,” Amy Hardberger, director at the Center for Water Law and Policy at the Texas Tech University, told The Epoch Times. “Cities that make that decision, maybe were already leaning in that direction,” she added.
Yorktown in recent years stopped fluoridating due to needing to upgrade its water system. The town resumed fluoridating in August 2024.
Resuming fluoridation prompted the town’s supervisor to closely follow the EPA court case. “I said about two weeks ago, there is this case. We have been following it,” Ed Lachterman, Yorktown’s supervisor, told The Epoch Times.
“So when the ruling came out, someone had sent it to me. I sent it to our town attorney to look at. We both read it through. We both [were] kind of shocked, because when you look at the judge’s ruling it’s quite decisive.”
“I was pretty ambivalent to all this before, but when I’m hearing it’s an unreasonable risk to our children, that really gives me a pause,” Lachterman said.
Somers gets water downstream from Yorktown so stopping fluoridation in Yorktown would also do the same to Somers.
“I spoke with their supervisor when I was contemplating the decision, and he felt wholeheartedly that that we should be doing this for his residents as well, meaning, stop it for their safety. So we were on the same page there,” he added.
State-Level Considerations
These considerations may be less applicable to other cities that heavily rely on fluoride to help control dental problems in their population.
For example, the city of San Antonio did not add fluoride to their drinking system until 2002. Since most in the city were of low socioeconomic background, fluoride was added to the drinking water to ensure a dental safety net, Hardberger said.
Some states like California and Illinois have state mandates to add fluoride to their drinking water. For these states, cities would not be able to stop adding fluoride without overturning prior regulations.
States can set their own limits on fluoride, provided it is lower than the requirements of the EPA.
More Research to Come
This new order will likely prompt more public attention and research on the topic, Hardberger said.
Looking at the NTP report, which only found an association between fluoride exposure and neurological risks, the exact level at which fluoride becomes risky is still unclear, she said.
“The challenge with anything like this is all about quantity. Almost anything is toxic in too high quantities,” Hardberger said.
An Oct. 4 Cochrane review, considered the gold standard in evidence-based health care, found that the addition of fluoride to drinking water may have fewer health benefits as compared to before.
Their review of recent studies suggests that fluoride in water was linked to a slight reduction in tooth decay in children’s baby teeth and a marginal increase in children without tooth decay.
The review also found that the dental health benefits of adding fluoride to drinking water may be smaller now than before fluoride toothpaste was widely available.
