Fluoride: Fact vs. Fiction

Fluoridating the public water supply has been common practice for nearly 80 years in the U. S. It's an acclaimed public health intervention that helps prevent cavities. For just as long, some have raised concerns about the practice that can veer from evidence-based to unsubstantiated conspiracy. An analysis by government researchers, published Monday in JAMA Pediatrics https://jamanetwork.com/journals/jamapediatrics/fullarticle/2828425, is adding to the debate. The research found that exposing babies and kids to high levels of fluoride might be associated with neurodevelopmental harm. Frankly, it's a lot to digest — so we invited health correspondent Pien Huang https://www.npr.org/people/729920828/pien-huang onto the show to wade through the debate. Questions, story ideas or want us to dig into another public health debate? Email us at [email protected] mailto:[email protected] — we'd love to hear from you! Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Emily Kwong?

  This message comes from NPR sponsor Viori with the Halo Essential Wide-Like Pant. Receive 20% off your first purchase at viori.com/NPR on any US orders over $75 and free returns. Exclusions apply. Visit the website for full terms and conditions. You're listening to Short Wave from NPR. Hey, Shortwavers. Emily Kwong here. I'm back again with Ping Kwong.

• 0:26Speaker 01

  Hello, hello.

• 0:27Emily Kwong?

  To look at what is in our drinking water, this time fluoride.

• 0:31Speaker 01

  Yep, we're talking fluoride, which is a topic that NPR has covered in drinking water around the US for literally decades. Fluoride is a very common mineral that occurs naturally in almost all soil, in water, even in many rocks.

• 0:45Emily Kwong?

  I didn't know that. Fluoride's hanging out in the rocks. OK.

• 0:48Speaker 01

  And most people in the US get fluoridated drinking water. It's added to the water to prevent tooth decay and cavities. The current US Public Health Service recommendation is 0.7 parts per million optimally, which is three drops in a 55-gallon barrel.

• 1:03Emily Kwong?

  OK, not higher, not lower, just 0.7 parts per million.

• 1:06Speaker 01

  Right, Emily. And it used to be a range, but in 2015, it was revised down to the standard minimum, 0.7 parts per million, because there were concerns that at levels higher than that, it could be causing dental fluorosis, which is streaking or modeling on kids' teeth.

• 1:20Emily Kwong?

  Yeah, I mean, growing up, fluoride was always kind of unquestioned. It was considered one of the greatest public health achievements of the 20th century.

• 1:29Speaker 01

  And it still is, Emily. But a debate is evolving over whether the risks and the benefits of fluoride have changed. So back in August 2024, part of the National Institutes of Health, called the National Toxicology Program, released a big report. It was over 300 pages long, and it linked high levels of fluoride exposure with a slight decline in children's IQ. At the time, I spoke with Ashley Mollin, who's an outside researcher. She studies toxic exposures at the University of Florida. And she called it "the most comprehensive and rigorously conducted report of its kind and so important for our understanding of..."

• 2:08Speaker 02

  Impacts of fluoride exposure on child IQ.

• 2:12Speaker 01

  And there were experts, especially within the dental community, that raised concerns about the report immediately. I mean, they were worried that people would misconstrue it to mean that any fluoridation in drinking water is a problem when the amount of fluoride being discussed was twice what's added to the public drinking water.

• 2:28Emily Kwong?

  OK, and there's a new turn in this debate. Monday, government researchers published the analysis behind that report in the medical journal JAMA Pediatrics. What did that say?

• 2:38Speaker 01

  Yeah, yeah, so it gave us some more details about how they'd done their research. For this analysis, they had looked at dozens of studies, mostly from China and India. And they used this to conclude that some babies and kids exposed to high levels of fluoride may experience some amount of neurodevelopmental harm. Now, these results are controversial, but the analysis has spurred opponents of fluoridation to call for a new assessment of its benefits and its risks.

• 3:04Emily Kwong?

  Today on the show, we wade into the fluoride debate to separate the science and truth from fear and fiction. You're listening to Short Wave, the science podcast from NPR.

• 3:20Speaker 03

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• 3:24Emily Kwong?

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• 4:09Emily Kwong?

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• 4:31Emily Kwong?

  All right, Ping, I think, oh, where to begin? We don't have time for a complete exhaustive history of fluoride in drinking water. But what are the major beats? How did this all start?

• 4:43Speaker 01

  Okay, so this story starts at the turn of the 20th century, early 1900s, when dentists in the US start noticing that people who live in certain areas have lower rates of tooth decay. And they don't know why until a few decades later, the 1930s, when they realize that in these areas, there's actually a higher-than-normal amount of fluoride in the water.

• 5:03Emily Kwong?

  Oh, like naturally?

• 5:05Speaker 01

  Yeah, naturally. And it's also in the 1930s that a team of scientists at the University of Pittsburgh proposed in a paper to add a controlled amount of fluoride to the drinking water to prevent tooth decay.

• 5:16Emily Kwong?

  Okay, so that is the genesis of this idea.

• 5:19Speaker 01

  Right, yeah. And then, in the 1940s, cities started experimenting with adding fluoride to the water. So it starts with Grand Rapids, Michigan in 1945. By the end of the decade, dental examiners are reporting markedly lower cavities. And so, hearing this, you know, other towns in Michigan, Texas, and Wisconsin start their own programs. And that doubles the number of Americans who get fluoridated water to over a million.

• 5:45Emily Kwong?

  Wow.

• 5:45Speaker 01

  So then if you fast forward to 1962, federal drinking water standards are updated to give fluoride guidelines. And then, over the subsequent decades, more and more Americans get access to fluoridated water to protect against tooth decay. That figure is up to around 70% in the US today.

• 6:02Emily Kwong?

  And there's even more fluoride that abounds. There's fluoride in toothpaste.

• 6:06Speaker 01

  Yeah, it's been the case for decades now. I mean, basically, every toothpaste I've used throughout my entire life has had it in it. Plus, it's in mouth rinses, it's in dental floss.

• 6:16Emily Kwong?

  It also naturally occurs in all kinds of foods, like spinach, and seafood, and tea, and fruit. You'll find fluoride there.

• 6:23Speaker 01

  The science is clear, Emily. Fluoridating water lowers the numbers of cavities in people, which it does by restoring minerals to teeth that are lost when bacteria grow inside the mouth, especially after, like, say, drinking sugary drinks. And this is especially useful for lower-income families who might not have access to fluoride products like toothpastes and mouth rinses. There's a study by the Colorado School of Public Health, which found that adding fluoride to the water saved around $6.8 billion in dental expenses in one year alone.

• 6:55Emily Kwong?

  So this has been the story of fluoride for most of our lifetimes. It's a very rosy public health story. But it sounds like there's always been a little bit of pushback. Tell me about that.

• 7:05Speaker 01

  Yeah, so ever since it started, there's been this debate over fluoridating water. Our colleagues Jeff Brumfield and Selena Simmons-Duffin have reported about conspiracy theories surrounding fluoride in drinking water. There was this time in the 1960s when the John Birch Society, this far-right group, alleged that it was part of a communist plot. And there are lots of other theories around it as well, different versions that reflected the concerns of their times. But meanwhile, the scientific understanding is also evolving, which brings us to this latest research in JAMA Pediatrics. It was done by government scientists at the National Toxicology Program.

• 7:41Emily Kwong?

  That's the part of the NIH that you mentioned earlier.

• 7:43Speaker 01

  Uh huh, with that August report, that's the one. And like we were saying, they just published a study in JAMA Pediatrics that looks at a few dozen studies that other people have conducted. And it finds this link between high levels of fluoride and a small decrease in children's IQ. Now, it's not totally definitive. This is something that they're saying with moderate confidence.

• 8:04Emily Kwong?

  OK, we could have a whole aside about IQ tests and what they measure.

• 8:07Speaker 01

  We could, yeah.

• 8:08Emily Kwong?

  Sticking with the study, what does moderate confidence mean?

• 8:12Speaker 01

  So moderate confidence is basically like a grade that they put on the quality of evidence that's available to them. It's not low quality, it's not high quality. It's enough to say something with moderate confidence. Does that make sense?

• 8:25Emily Kwong?

  Yeah, OK. Moderate confidence that high levels, again, much higher than what's added to our drinking water, is associated with a small decrease in IQ.

• 8:32Speaker 01

  Yeah, could be associated.

• 8:34Emily Kwong?

  Could be associated.

• 8:35Speaker 01

  Yeah.

• 8:36Emily Kwong?

  Science, so many words, yeah.

• 8:40Speaker 01

  And while this conclusion is not new, this research has already been quite influential in the debate over fluoride and drinking water. It was accompanied by two op-eds in the paper that was published on Monday. One questioned its methods, disagreed with its conclusions, and the other fully supported it. I spoke with Dr. Bruce Lanfer. He's at Simon Fager University, and he co-authored that supportive piece.

• 9:07Speaker 04

  The people who are proposing fluoridation need to now prove it's safe. That's what this study does. It shifts the burden of proof, or it should.

• 9:17Speaker 01

  So he's arguing that there's enough evidence to prompt this reassessment of the risks and the benefits of fluoride in the water system. Now, on the other hand, you've got a dentist like Stephen Levy. He's a public health dentist at the University of Iowa. He wrote the other op-ed that argues for staying the course. And he says that using this data for that debate is a stretch.

• 9:40Speaker 05

  The major problem is that the science is not as strong as it is presented by these authors.

• 9:47Speaker 01

  So he says that they didn't fully consider some other recent research that cast doubt on the links between fluoride exposure and IQ. And he also makes the point that, you know, because water fluoridation is so common, we take its benefits for granted. You know, there are problems definitely associated with getting cavities, too. It can be painful. You can get infections. You can have to go to the dentist and get expensive fillings, or you can miss school for it. Like, there are all these problems that are also associated with getting cavities.

• 10:16Emily Kwong?

  Yeah, I can see why there's so much pushback, certainly among dentists, but among fluoride's critics. What are their main questions?

• 10:24Speaker 01

  Yeah, so there are a couple that are being raised right now. One of them is about whether, you know, because people get fluoride, not just from their drinking water, but also from the food that they eat, the toothpaste and mouthwash they use, whether that total cumulative fluoride might be pushing, you know, some vulnerable people, again, that's pregnant people and young children, whether that's pushing their fluoride levels to levels that... Might be harmful. And another question is really on the benefit side of it. There is recent analysis that showed that fluoride in the drinking water definitely prevents cavities, but it's not to the same extent that it was back in the 40s, 50s, 60s, before fluoridated toothpaste became a regular thing. So some are saying that it's time to reweigh the risks and the benefits,

• 11:09Speaker 01

  given how society has changed.

• 11:11Emily Kwong?

  As a science reporter, what do you make of these questions and that they're being raised right now?

• 11:16Speaker 01

  I think they're interesting. I think that like it's useful to have a real scientific debate about these questions. You know, as a science reporter, you're like, OK, great. These are the questions. Let's get more evidence. But my concern is that even in the lack of evidence, you know, there's this huge public debate that's swirling and political and sort of happening regardless of whether the evidence becomes clear or not.

• 11:39Emily Kwong?

  Right. Science will always move slower than politics. OK, so where does that leave us? Like, what are you watching for next?

• 11:45Speaker 01

  Yeah, so there's a couple of things that are coming up. The Environmental Protection Agency has this deadline coming up in the next two weeks over whether they want to appeal this recent court decision that told them to tighten their fluoride regulations. That could have bearing on the debate. And then there's Robert F. Kennedy Jr. He's President-elect Donald Trump's nominee for Health Secretary. And he told NPR that one of his priorities is to get the country to stop fluoridating the water. So we'll have to see what happens there. And finally, there's also what's happening on the local level. So there are some communities that are going through transitions with their drinking water. For example, NPR has reported that Calgary in Canada removed fluoride from its water supply.

• 12:28Speaker 01

  And then after data came back showing that dental cavities rose significantly, they're now reintroducing it. On the other hand, you've got Florida's Surgeon General, Joseph Lattipoe, who made headlines recently for advising local governments in Florida to stop adding fluoride to their water supplies. So yeah, there's a lot happening with fluoride right now. It's going to be interesting to track those decisions and what the public health outcomes are. So we will see what happens.

• 12:56Emily Kwong?

  Ping Huang, thank you for summarizing what is a sprawling and complicated conversation.

• 13:02Emily Kwong?

  Right now. I admire it and I appreciate it.

• 13:04Speaker 01

  You're welcome. Thanks for having me on. And I'm sure we're going to talk much more about Florida in the future.

• 13:09Emily Kwong?

  We recently had Ping on our show as part of a big roundup of health stories from 2024 that will flow over into 2025. You can check out that episode at the link in our notes. We'll be tracking developments in drinking water, bird flu, and more.

• 13:24Emily Kwong?

  If you like this episode, follow us. Whichever podcast app you're using, click Follow right now and you can stay up to date with all the latest science news. This episode was produced by Hannah Chin. It was edited by our showrunner, Rebecca Ramirez. Rebecca, Ping, and Tyler Jones checked the facts. Kwasi Lee was the audio engineer. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. Thank you for listening to Short Wave from NPR.

• 13:54Emily Kwong?

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