Is fluoride in tap water safe? Florida officials raise concerns. Here’s what the science says

Fluoride – it’s added to the water systems of more than two thirds of Americans. It’s in dental products from toothpaste to mouthwash. It’s been the subject of long-running conspiracy theories.

Throughout Florida, cities have temporarily removed fluoride from their drinking water because of Florida Surgeon General Dr. Joseph Ladapo’s concerns about the health risks.

And now that Donald Trump was elected to another term, Robert F. Kennedy Jr. says he could try to take it out of water supplies nationwide.

“On January 20, the Trump White House will advise all U.S​. water systems to remove fluoride from public water,” Kennedy said in a Saturday, Jan. 18, post to X. “Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”

U.S. health experts strongly disagree.

Florida policies are changing:Is there fluoride in the water in Florida? Some communities are removing it. Here’s why

The Centers for Disease Control calls the practice of adding fluoride to tap water systems one of the 10 greatest public health achievements of the last century. Major medical groups, such as the American Dental Association and the American Academy of Pediatrics, have also endorsed water fluoridation at recommended levels as a way to boost oral health.

But what does the science really show about adding fluoride to tap water? Here’s what we know.

What is fluoride?

Fluoride is a natural mineral. It is found in soil, air, food and water sources across the planet, although in different amounts depending on the place, according to the National Institute of Dental and Craniofacial Research.

Fluoride strengthens teeth by hardening their outer surface, or enamel. It’s a common ingredient in oral health and teeth cleaning products such as toothpastes, mouth rinses and varnishes used by dentists.

Why is fluoride added to drinking water? What are the benefits?

The American Dental Association says adding fluoride to water streams is a “safe, beneficial, and cost-effective” public health measure, citing studies that it cuts cavities in children and adults by 25%.

“Decades of research and practical experience indicate that fluoride is safe and beneficial to oral health,” Linda Edgar, president of the American Dental Association, said in a statement released in August 2024.

The American Association of Pediatrics also maintains that fluoride in drinking water and toothpaste is a safe means of boosting children’s oral health.

Charlotte W. Lewis, a member of the AAP’s oral health section, said in a statement in September 2024 that she is confident in the “safety of optimally fluoridated water in the U.S.”

“Water fluoridation is a public health policy based on a solid foundation of evidence,” she said.

Is fluoride dangerous? Is there any risk?

Several studies published over the last year have raised concerns about the effects of fluoride in large quantities and given ammunition to groups who are pushing to ban public water fluoridation in some communities.

A report released in August 2024 by the U.S. Department of Health and Human Services found that drinking water containing more than 1.5 milligrams per liter was “consistently associated with lower IQ in children.” The current recommended level in the U.S. is 0.7 milligrams of fluoride per liter of water.

But the report, which evaluated studies conducted in Canada, China, India, Iran, Pakistan and Mexico, noted that the fluoride levels found to cause such risks were more than twice as high as the amount U.S. officials recommend be added to public water systems. Fluoride levels that high are mostly found in other countries and a tiny minority of U.S. communities.

The report also did not specify how much IQ levels dipped or whether adults could also be affected.

A study released in May 2024 also found that children in the womb in “optimally fluoridated” areas in the U.S. could increase the risk of neurobehavioral issues after birth.

The Department of Health and Human Services said the data was “insufficient” to determine whether the current recommended level of 0.7 milligrams of fluoride per liter of water also had an effect on IQ, and that “more research is needed” to understand whether lower levels also have health effects.

What did Florida surgeon general Dr. Joseph Ladapo say about tap water?

In November 2024, Florida Surgeon General Dr. Joseph Ladapo called fluoridated water a “health malpractice.”

According to the Florida Department of Health’s statement that corresponded with Ladapo’s announcement, there is a neuropsychiatric risk associated with too much exposure to fluoride through ingestion, particularly in pregnant women and children. The statement said that “the wide availability of alternative sources of fluoride for dental health,” eliminated the need for community water fluoridation.

“It is clear more research is necessary to address safety and efficacy concerns regarding community water fluoridation,” Ladapo said. 

“The previously considered benefit of community water fluoridation does not outweigh the current known risks, especially for special populations like pregnant women and children.”