By Camille Powell, S26 Environmental Clinic student
The U.S. Environmental Protection Agency (EPA) is revisiting standards for fluoride in drinking water—a step that, if handled responsibly, could be a win for public health. But tumult surrounding fluoride has already had potentially dangerous consequences: a wave of state and local bans driven by misinformation and politics rather than science. Proponents of these bans say they promote individual autonomy, while critics worry they will strip away a critical public health protection from the very populations that need it the most.
Many environmental regulations were originally undertaken as public health initiatives to manage disease, including water sanitation, purification, and yes, fluoridation. Since the 1950’s most U.S. cities have been adding fluoride to drinking water for its benefits in preventing dental disease.
In a joint action with the U.S. Health and Human Services Department (HHS), the EPA announced an expeditious review of the new science on fluoride in drinking water as part of the Trump administration’s initiative to address childhood disease. A federal judge in California had also ordered the agency to strengthen regulations for fluoride in drinking water in 2024.
The source of concern comes from a series of studies linking high levels of fluoride and lower IQ in children. While the credibility of these studies is not disputed, the body of data observing this correlation was primarily gathered on non-U.S. populations exposed to naturally occurring levels of fluoride that far exceed those aimed at through supplemental fluoridation.
Health experts continue to promote the safety of water fluoridation and its importance as a health safety net for people, especially children, with barriers to dental care. Dental professionals, who were strong opponents of expanding Medicare to include dental benefits, are among those most concerned with the potential harms of removing this public health guardrail.
EPA action could bring positive change if it lowers its standards to meet the decade-old public health recommended level. In 2015, HHS recommended decreasing fluoride levels to 0.7 mg/L to achieve an optimal balance of dental protection and minimization of adverse effects. This included both water supplies with naturally occurring and supplemental fluoride.
At that time, EPA regulations were set at a maximum contaminant level goal (MCLG) and maximum contaminant level (MCL) of 4.0 mg/L to protect against “crippling” skeletal fluorosis, and a secondary maximum contaminant level of 2.0 mg/L to protect against dental fluorosis. Even supporters of fluoridation are increasingly recognizing potential health risks above 2.0 mg/L. But after review, the agency decided to leave their levels as is.
It is hard to say what the result of EPA’s current review will be. According to EPA assistant administrator for the Office of Water, the agency’s review will only focus on potential harmful effects and not consider benefits. A standard change would primarily affect communities with high levels of naturally occurring fluoride, in terms of both financial costs and health benefits. In its prior review, the EPA found that most cities that added fluoride had already lowered levels to 0.7 mg/L. So, why the big fuss about supplemental water fluoridation?
Statements that refer to fluoride as a “neurotoxin” that causes “profound IQ loss” in children in the U.S. where we are experiencing an “epidemic” of childhood disease far worse than the COVID-19 pandemic, are fuel for populist policies. This rhetoric has emboldened state and local officials to ban water fluoridation, and to do it quickly. Within one month of the EPA and HHS joint announcement, Utah and Florida became the first states to legislate a ban. Since then, 19 other states have introduced similar bills. Some city councils have voted to end water fluoridation with minimal opportunity for public comment.
Leaders banning or ending water fluoridation emphasize the right of people to choose what they consume. If only they had the same energy about industrial contaminants as they do for public health “contaminants.”
The populations with the highest health risks from hazardous pollution are the same ones that will be most harmed by defluoridation. In that sense, EPA’s involvement is ideologically aligned with its other actions, like its closure of environmental justice programs. These efforts also follow a larger trend currently seen in federal health agencies to emphasize individual health for those who can afford and access it, while taking away critical public health protections for those who cannot.
References
Anna Clark, After Sowing Distrust in Fluoridated Water, Kennedy and Skeptics Turn to Obstructing Other Fluoride Sources, ProPublica (Jan. 14, 2026) https://www.propublica.org/article/fluoride-supplements-fda-rfk-jr-ken-paxton-restrictions
Audrey Boucher, Grayling City Council votes to remove fluoride from water systems, UpNorthLive News, May 14, 2025. https://upnorthlive.com/news/local/grayling-city-council-votes-to-remove-fluoride-from-water-systems.
EPA Will Expeditiously Review New Science on Fluoride in Drinking Water (Apr. 7, 2025) https://www.epa.gov/newsreleases/epa-will-expeditiously-review-new-science-fluoride-drinking-water.
National Primary Drinking Water Regulations: Announcement of the Results of EPA’s Review of Existing Drinking Water Standards and Request for Public Comment and/or Information on Related Issues, (Jan. 11, 2017) https://www.regulations.gov/document/EPA-HQ-OW-2016-0627-0001
Valerie Volcovici and Leah Douglas, US EPA moves to take action on review of fluoride in drinking water (Jan. 28, 2026) https://www.reuters.com/legal/litigation/us-epa-moves-take-action-review-fluoride-drinking-water-2026-01-28/.
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