Victory! Court Requires EPA to Strengthen Regulations on Fluoride in Drinking Water

Published Sep 26, 2024

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Clean Water

Research shows that adding fluoride to drinking water may pose an unreasonable risk to public health. Our lawsuit now compels the EPA to address this threat.

Research shows that adding fluoride to drinking water may pose an unreasonable risk to public health. Our lawsuit now compels the EPA to address this threat.

For decades, local governments have followed federal recommendations to add fluoride to drinking water. Public water systems provide fluoridated drinking water to over 207 million people in the U.S., with the intent of promoting dental health. But mounting scientific evidence demonstrates fluoride at high enough levels has harmful neurotoxic effects on children. And now, due to a lawsuit Food & Water Watch filed with allies, the Environmental Protection Agency (EPA) must consider these risks and revise its regulations on fluoride in drinking water.

When Food & Water Watch began learning of these risks, we knew we had to act. The EPA, which regulates toxics in our drinking water, has the responsibility to review new research and respond to protect communities. But the agency had long prescribed a level of fluoridation based on dental and skeletal benefits, without considering neurological risks. 

So in 2016, we joined allies to file a petition asking the EPA to limit or ban fluoridation and then sued the agency when it denied our petition. This September, after considering extensive scientific evidence, a federal court ruled in our favor.

As the Court wrote, we have proven “that water fluoridation at the level of 0.7 mg/L — the prescribed optimal level of fluoridation in the United States — presents an ‘unreasonable risk of injury to health or the environment, without consideration of costs or other non-risk factors.’” As a result, the EPA can no longer ignore the risk and must strengthen its regulations.

Fluoride Poses Neurotoxic Risks to Children

Fluoridating (adding fluoride to) drinking water has been linked to ADHD, a decrease in average IQ in children, and cognitive impairments in older populations. The neurotoxic effects are especially prevalent among formula-fed infants, African Americans, and undernourished people.

These risks have been found in the overwhelming majority of credible studies from across the globe. Recent studies in Canada and Mexico, for example, found associations between fluoride concentrations in pregnant women and health problems for their children. Those problems include lower IQ and greater risk of ADHD and inattention.

Another Canadian study found formula-fed infants in regions with fluoridated drinking water had lower non-verbal intelligence scores compared to those living in non-fluoridated regions. Because formula-fed infants consume more water than breastfed infants and therefore more fluoride when living in fluoridated areas, they tend to be at greater risk of higher fluoride exposure.

This has justice implications, as often low-income families and families of color are more likely to use formula. One study, for example, found that lower-income Hispanic immigrant women are significantly more likely to be early formula users. 

The EPA currently limits fluoridation to 4 milligrams per liter, but scientists have observed average IQ reductions at levels below that limit. Even at the Public Health Service’s recommended “optimal” concentration — 0.7 mg/L — we could see adverse IQ outcomes in formula-fed infants. 

We Need a Precautionary Approach to Fluoride in Drinking Water

Outside of the United States, fluoridation is nowhere near as common. In Western Europe, 97% of the population drinks non-fluoridated water. Western countries without fluoridation have seen the same reductions in tooth decay as the United States. 

That’s because most of the benefit of fluoride comes from topical usage (for instance, in toothpaste). Studies show that drinking fluoridated water has much less benefit to dental health.

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Fluoridation became common decades ago when scientists believed the opposite to be true. However, the science has come a long way since then. We now know that along with providing little dental benefit, drinking fluoride poses major risks to our health.

Under the Toxic Substances Control Act (the bedrock law regulating toxic substances in the U.S.), the EPA has the authority to regulate certain usess of chemicals if they present an “unreasonable risk” to the general public or a “susceptible subpopulation.” This refers to groups of people who could be more vulnerable to adverse health impacts from exposure to dangerous chemicals, including the elderly, pregnant people, and babies.

As the court itself pointed out, over two million women and babies are impacted by fluoridation — “a number far exceeding population size the EPA has looked to in determining whether regulatory action was warranted in other risk evaluations (i.e, 500 people or less).” 

The EPA’s Duty is Clear — It Must Consider Risk and Update Fluoride Regulations

When in doubt, the agency should err on the side of not adding chemicals to our water that could have devastating impacts on public health. And the Toxic Substances Control Act says the same — if the science shows that a risk to health or the environment is unreasonable, the EPA must act.

In response to our lawsuit, the court found that the risks of adding fluoridation are unreasonable and, therefore, “sufficient to require the EPA to engage with a regulatory response.” As a result, it ruled that the agency must act to strengthen these regulations. 

Its ruling represents an important acknowledgment of a large and growing body of science indicating serious human health risks associated with fluoridated drinking water. This court looked at the science and acted accordingly. Now, the EPA must respond by implementing new regulations that protect everyone in the U.S. — especially our most vulnerable infants and children — from this known health threat.

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