iv l © 2025 American Dental Association
Table of Contents
14. What are salt and milk fluoridation and where are they used?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
15. Can the consistent use of bottled water result in individuals missing the benefits
of optimally fluoridated water?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
16. Do home water treatment systems such as water filters, reverse osmosis, and
water softeners remove fluoride from drinking water?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Section 2: Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
17. Does fluoride in the water supply, at the levels recommended for the prevention
of tooth decay, adversely affect human health?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
18. Are additional studies being conducted to determine the effects of fluorides on humans?. . . . . . . . 37
19. Why did the USPHS issue a report in 2015 recommending 0.7 mg/L as the optimal level
for fluoride in drinking water for all temperature zones in the United States?. . . . . . . . . . . . . . . . . . . 39
20. What is the recommendation for the maximum level of naturally occurring fluoride
in drinking water contained in the 2016 EPA 6-Year Review 3? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
21. What is the Secondary Maximum Contaminant Level (SMCL) for naturally occurring
fluoride in drinking water established by the EPA?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
22. Does the total intake of fluoride from air, water, food, and beverages in the community
in the United States with drinking water fluoridated at the recommended level pose
significant health risks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
23. How much fluoride is recommended to maximize the tooth decay prevention
benefits of fluoride?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
24. Is there a need for prenatal dietary fluoride supplementation?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
25. When fluoride is ingested, where does it go? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
26. Will drinking water that is fluoridated at the recommended level adversely affect bone health?. . . . . 49
27. What is dental fluorosis or enamel fluorosis?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
28. Is it safe to use fluoridated water to reconstitute infant formula? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
29. What can be done to reduce the occurrence of dental fluorosis in the United States?. . . . . . . . . . . . 56
30. Why is there a warning label on a tube of fluoride toothpaste?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
31. Is fluoride, as provided by community water fluoridation, a toxic substance? . . . . . . . . . . . . . . . . . . . 59
32. Does drinking water fluoridated at the recommended levels cause or accelerate
the growth of cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
33. Does fluoridated water cause osteosarcoma?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
34. Does fluoride, as provided by community water fluoridation, inhibit the activity
of enzymes in humans?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
35. Does the ingestion of fluoridated water at recommended levels adversely
affect the thyroid gland or its function?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
36. Does fluoride affect the function of the pineal gland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Table of Contents
14. What are salt and milk fluoridation and where are they used?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
15. Can the consistent use of bottled water result in individuals missing the benefits
of optimally fluoridated water?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
16. Do home water treatment systems such as water filters, reverse osmosis, and
water softeners remove fluoride from drinking water?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Section 2: Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
17. Does fluoride in the water supply, at the levels recommended for the prevention
of tooth decay, adversely affect human health?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
18. Are additional studies being conducted to determine the effects of fluorides on humans?. . . . . . . . 37
19. Why did the USPHS issue a report in 2015 recommending 0.7 mg/L as the optimal level
for fluoride in drinking water for all temperature zones in the United States?. . . . . . . . . . . . . . . . . . . 39
20. What is the recommendation for the maximum level of naturally occurring fluoride
in drinking water contained in the 2016 EPA 6-Year Review 3? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
21. What is the Secondary Maximum Contaminant Level (SMCL) for naturally occurring
fluoride in drinking water established by the EPA?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
22. Does the total intake of fluoride from air, water, food, and beverages in the community
in the United States with drinking water fluoridated at the recommended level pose
significant health risks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
23. How much fluoride is recommended to maximize the tooth decay prevention
benefits of fluoride?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
24. Is there a need for prenatal dietary fluoride supplementation?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
25. When fluoride is ingested, where does it go? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
26. Will drinking water that is fluoridated at the recommended level adversely affect bone health?. . . . . 49
27. What is dental fluorosis or enamel fluorosis?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
28. Is it safe to use fluoridated water to reconstitute infant formula? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
29. What can be done to reduce the occurrence of dental fluorosis in the United States?. . . . . . . . . . . . 56
30. Why is there a warning label on a tube of fluoride toothpaste?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
31. Is fluoride, as provided by community water fluoridation, a toxic substance? . . . . . . . . . . . . . . . . . . . 59
32. Does drinking water fluoridated at the recommended levels cause or accelerate
the growth of cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
33. Does fluoridated water cause osteosarcoma?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
34. Does fluoride, as provided by community water fluoridation, inhibit the activity
of enzymes in humans?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
35. Does the ingestion of fluoridated water at recommended levels adversely
affect the thyroid gland or its function?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
36. Does fluoride affect the function of the pineal gland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
