36 l © 2025 American Dental Association
Section 1: Effectiveness and Benefits
17. Does fluoride in the water supply, at the levels recommended for
the prevention of tooth decay, adversely affect human health?
Answer
No. The overwhelming weight of scientific evidence supports the safety of community water
fluoridation.
Fact
Assuring the safety of community water fluoridation has been at the forefront of public health practice
since the earliest studies were conducted on fluoride more than 80 years ago. The evidence for
safety is compelling. For generations, millions of people in North America have lived in areas where
fluoride is found naturally in drinking water in concentrations as high or higher than the optimal level
recommended to prevent tooth decay. To date, research conducted among these populations
confirms the safety of fluoride in the water supply.182-190
As with other nutrients, fluoride is safe and effective when used and consumed as recommended.
No charge against the benefits and safety of fluoridation has ever been substantiated by generally
accepted scientific knowledge. Reviews on fluoride in drinking water have been issued periodically over
the years. Beginning in 1951 the NRC issued its first report191 stating that fluoridation was safe and
effective. Additional reviews by the NRC followed in 1977,24 1993,25 and 2006.26 Additional reviews
completed over the 17-year period from 2007 to 2024 include:
2024 Iheozor-Ejiofor Z, Walsh T, Lewis SR, Riley P, Boyers D, Clarkson JE, Worthington HV, Glenny
A-M, O’Malley L. Water fluoridation for the prevention of dental caries. Cochrane Database
Syst Rev. 2024, Issue 10. Art. No.: CD010856. DOI: 10.1002/14651858.CD010856.pub3.
Accessed December 9, 2024.27
2023 Fiore G, Veneri F, Di Lorenzo R, Generali L, Vinceti M, Filippini T. Fluoride exposure and
ADHD: A systematic review of epidemiologic studies. Medicina. 2023, 59(4), 797
https://pmc.ncbi.nlm.nih.gov/articles/PMC10143272/pdf/medicina-59-00797.pdf.28
2023 Kumar JV, Moss ME, Liu H, Fisher-Owens S. Association between low fluoride exposure
and children’s intelligence: a meta-analysis relevant to community water fluoridation.
Public Health. 2023, 219, 73-84. DOI:10.1016/j.puhe.2023.03.011.29
2022 Belotti L, Frazão P. Effectiveness of water fluoridation in an upper-middle-income country:
a systematic review and meta-analysis. Int J Paediatr Dent. 2022, 32(4), 503-513.30
2019 Cury J, Ricomini-Filho AP, Perecin Berti FL, Tabchoury CPM. Systemic effects (risks) of
water fluoridation. Brazilian Dent J. 2019, 30(5), 421-428.31
2018 Ajiboye AS, Dawson DR, Fox CH. American association for dental research policy statement
on community water fluoridation. J Dent Res. 2018, 97(12), 1293-1296.32
2018 Chaitanya NC, Karunakar P, Allam NSJ, Priya MH, Alekhya B, Nauseen S. A systematic analysis
on possibility of water fluoridation causing hypothyroidism. Indian J Dent Res. 2018, 29(3),
358-363.33
Safety
Section 2
Section 1: Effectiveness and Benefits
17. Does fluoride in the water supply, at the levels recommended for
the prevention of tooth decay, adversely affect human health?
Answer
No. The overwhelming weight of scientific evidence supports the safety of community water
fluoridation.
Fact
Assuring the safety of community water fluoridation has been at the forefront of public health practice
since the earliest studies were conducted on fluoride more than 80 years ago. The evidence for
safety is compelling. For generations, millions of people in North America have lived in areas where
fluoride is found naturally in drinking water in concentrations as high or higher than the optimal level
recommended to prevent tooth decay. To date, research conducted among these populations
confirms the safety of fluoride in the water supply.182-190
As with other nutrients, fluoride is safe and effective when used and consumed as recommended.
No charge against the benefits and safety of fluoridation has ever been substantiated by generally
accepted scientific knowledge. Reviews on fluoride in drinking water have been issued periodically over
the years. Beginning in 1951 the NRC issued its first report191 stating that fluoridation was safe and
effective. Additional reviews by the NRC followed in 1977,24 1993,25 and 2006.26 Additional reviews
completed over the 17-year period from 2007 to 2024 include:
2024 Iheozor-Ejiofor Z, Walsh T, Lewis SR, Riley P, Boyers D, Clarkson JE, Worthington HV, Glenny
A-M, O’Malley L. Water fluoridation for the prevention of dental caries. Cochrane Database
Syst Rev. 2024, Issue 10. Art. No.: CD010856. DOI: 10.1002/14651858.CD010856.pub3.
Accessed December 9, 2024.27
2023 Fiore G, Veneri F, Di Lorenzo R, Generali L, Vinceti M, Filippini T. Fluoride exposure and
ADHD: A systematic review of epidemiologic studies. Medicina. 2023, 59(4), 797
https://pmc.ncbi.nlm.nih.gov/articles/PMC10143272/pdf/medicina-59-00797.pdf.28
2023 Kumar JV, Moss ME, Liu H, Fisher-Owens S. Association between low fluoride exposure
and children’s intelligence: a meta-analysis relevant to community water fluoridation.
Public Health. 2023, 219, 73-84. DOI:10.1016/j.puhe.2023.03.011.29
2022 Belotti L, Frazão P. Effectiveness of water fluoridation in an upper-middle-income country:
a systematic review and meta-analysis. Int J Paediatr Dent. 2022, 32(4), 503-513.30
2019 Cury J, Ricomini-Filho AP, Perecin Berti FL, Tabchoury CPM. Systemic effects (risks) of
water fluoridation. Brazilian Dent J. 2019, 30(5), 421-428.31
2018 Ajiboye AS, Dawson DR, Fox CH. American association for dental research policy statement
on community water fluoridation. J Dent Res. 2018, 97(12), 1293-1296.32
2018 Chaitanya NC, Karunakar P, Allam NSJ, Priya MH, Alekhya B, Nauseen S. A systematic analysis
on possibility of water fluoridation causing hypothyroidism. Indian J Dent Res. 2018, 29(3),
358-363.33
Safety
Section 2
