EPA Fluoride Review Faces Scrutiny Over Science & Political Influence

The U.S. Environmental Protection Agency’s (EPA) reevaluation of the potential health risks of fluoride in drinking water is drawing scrutiny from dental organizations and public health advocates, who fear the agency may prioritize studies aligning with a predetermined outcome rather than adhering to standard scientific practices. The review, announced in January 2026, comes amid broader regulatory uncertainty and a shift in public health policy under the current administration.

The EPA’s assessment plan, released in January, focuses specifically on the potential harmful health effects of fluoride exposure, explicitly excluding consideration of its beneficial effects, such as the prevention of dental caries. This approach has raised concerns among those who champion water fluoridation as a cornerstone of public health.

“The EPA is assessing the toxicity of fluoride in drinking water and recently announced they are using a Gold Standard Science approach and had a call for public comment,” explained Tim Wright, professor in pediatric dentistry at the UNC Chapel Hill Adams School of Dentistry and editor in chief of the Journal of the American Dental Association. “The toxicity review appears to have already been completed and does not include the most recent studies related to this topic, calling into question the scientific validity of any conclusions from the EPA review.”

The reevaluation was announced alongside U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., a figure whose views on public health have sparked considerable debate. Kennedy has overseen changes to federal childhood vaccine recommendations and personnel shifts within key public health agencies like the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA).

The current review unfolds against a backdrop of increasing debate over the safety and efficacy of water fluoridation, a practice initiated in the United States in 1945. The CDC has historically lauded water fluoridation as one of the ten great public health achievements of the 20th century, citing its significant role in reducing tooth decay. A study following the implementation of fluoridation in Grand Rapids, Michigan, in 1945, demonstrated a greater than 60 percent reduction in tooth decay rates among children born after the introduction of fluoridated water by 1956.

Currently, approximately 63 percent of the U.S. Population receives fluoridated water. In North Carolina, that figure stands at roughly 88 percent as of 2022.

However, recent research, including an August 2024 monograph from the National Toxicology Program (NTP), has fueled renewed concerns. The NTP report concluded, with “moderate confidence,” that higher fluoride exposure – specifically 1.5 milligrams per liter and above – is associated with lower IQ scores in children. It’s important to note that this level exceeds the optimal concentration of 0.7 milligrams per liter recommended for U.S. Community water fluoridation.

Critics of the NTP monograph point out that the majority of studies included in the analysis (17 out of 19) were conducted in China, Mexico, India, and Iran, where fluoride levels in water sources often differ significantly from those in the United States.

The American Dental Association (ADA) has urged the EPA to base its review on “peer-reviewed, scientifically tested evidence.” Richard Rosato, president of the ADA, stated in a February press release, “We urge Administrator Zeldin and his team to implement an objective, evidence-based process utilizing all the latest peer-reviewed, valid and reproducible research…to reach an objective conclusion.” The ADA also expressed concern over the exclusion of recent studies, including one demonstrating a link between typical U.S. Fluoride exposure levels and improved cognitive performance in adolescents.

The ADA and the North Carolina Dental Society have both encouraged their members to contact the EPA during the public comment period, which closes on February 27, 2026. The North Carolina Dental Society also recommends that the EPA enlist the National Academies of Science, Engineering, and Medicine to peer review its assessment plan and systemic review to ensure objectivity and scientific rigor.

EPA Administrator Lee Zeldin has stated that the agency is committed to using “sound science” to protect human health and the environment, working in collaboration with Secretary Kennedy to uphold the Safe Drinking Water Act. “Every American should be able to count on safe, healthy drinking water when they pour a glass to drink or use it to cook a meal, especially for a child,” Zeldin said on January 22nd.

The outcome of the EPA’s review could have significant legal, operational, and public health implications for communities across the country, potentially altering long-standing practices and sparking further debate over the role of fluoride in public health.