74 l © 2025 American Dental Association
Section 2: Safety
42. Does drinking fluoridated water increase the level of lead in the
blood or cause lead poisoning in children?
Answer
No. The best available scientific evidence has not shown any association between water fluoridation
and blood lead levels.
Fact
A number of reviews and data analyses indicate no association between water fluoridation and blood
lead levels.
European Scientific Committee on Health and Environmental Risks Critical Review
In 2011, the European Commission requested that SCHER perform a critical review of fluoridating
agents of drinking water. The committee concluded that “it is highly unlikely that there would be an
increased release of lead from pipes due to hexafluorosilicic acid.”43 Hexafluorosilicic acid is another
name for fluorosilicic acid, which is one of the additives used to fluoridate water in the United States.
Additional information on this topic can be found in the Fluoridation Practice Section, Question 49.
National Health and Nutrition Examination Survey Study and Fluoridation Census
A 2006 study337 analyzed data from the third NHANES (1988–1994) and the 1992 Fluoridation
Census to evaluate the relationship between water fluoridation and lead concentrations in children.
The study concluded that the results did not support that the silicofluorides used in community water
systems caused higher lead concentrations in children.337
Findings from the NHANES from 1976–1980 to 2003–2008 showed that the percentage of children
aged 1–5 years having high lead blood levels (≥10 μg/dL) declined dramatically from 88.2% to 0.9%.338
During that same time (1976–2008), the percentage of the US population receiving fluoridated water
rose from approximately 48.8% to 64.3%.339 Moreover, in the 1991–1994 NHANES, the overall (all age
groups) prevalence of high lead blood levels (≥10 μg/dL) was 2.2%, and it decreased to 0.7% by the
1999–2002 survey.338
CDC Data
According to the CDC, the average blood lead levels of young children in the United States have
continued to decline since the 1970s, primarily due to lead poisoning prevention laws, such as the
phase-out of leaded paint and leaded gasoline.338 The primary remaining sources of childhood lead
exposure are deteriorated leaded paint, house dust contaminated by leaded paint, soil contaminated by
leaded paint, and decades of industrial and motor vehicle emissions. Besides exposure to lead paint in
older homes, lead water pipes and fixtures also can be found in homes built before 1978. In some areas
of the country, folk remedies and pottery also add to lead exposure.338 The CDC updated the blood
lead reference value (BLRV) to 3.5 μg/dL, which provides an opportunity for additional progress in
addressing longstanding disparities in lead exposure and blood lead levels (BLL) in children.340
While opponents of fluoride claim that fluoridated water increases BLLs in children, the fact is that since
1976, while the use of water fluoridation has increased, the percentage of US children with high BLLs has
continued to decrease substantially.341 This demonstrates that the claim made by those opposed to water
fluoridation that fluoride in water increases lead concentrations in children is unfounded.
Section 2: Safety
42. Does drinking fluoridated water increase the level of lead in the
blood or cause lead poisoning in children?
Answer
No. The best available scientific evidence has not shown any association between water fluoridation
and blood lead levels.
Fact
A number of reviews and data analyses indicate no association between water fluoridation and blood
lead levels.
European Scientific Committee on Health and Environmental Risks Critical Review
In 2011, the European Commission requested that SCHER perform a critical review of fluoridating
agents of drinking water. The committee concluded that “it is highly unlikely that there would be an
increased release of lead from pipes due to hexafluorosilicic acid.”43 Hexafluorosilicic acid is another
name for fluorosilicic acid, which is one of the additives used to fluoridate water in the United States.
Additional information on this topic can be found in the Fluoridation Practice Section, Question 49.
National Health and Nutrition Examination Survey Study and Fluoridation Census
A 2006 study337 analyzed data from the third NHANES (1988–1994) and the 1992 Fluoridation
Census to evaluate the relationship between water fluoridation and lead concentrations in children.
The study concluded that the results did not support that the silicofluorides used in community water
systems caused higher lead concentrations in children.337
Findings from the NHANES from 1976–1980 to 2003–2008 showed that the percentage of children
aged 1–5 years having high lead blood levels (≥10 μg/dL) declined dramatically from 88.2% to 0.9%.338
During that same time (1976–2008), the percentage of the US population receiving fluoridated water
rose from approximately 48.8% to 64.3%.339 Moreover, in the 1991–1994 NHANES, the overall (all age
groups) prevalence of high lead blood levels (≥10 μg/dL) was 2.2%, and it decreased to 0.7% by the
1999–2002 survey.338
CDC Data
According to the CDC, the average blood lead levels of young children in the United States have
continued to decline since the 1970s, primarily due to lead poisoning prevention laws, such as the
phase-out of leaded paint and leaded gasoline.338 The primary remaining sources of childhood lead
exposure are deteriorated leaded paint, house dust contaminated by leaded paint, soil contaminated by
leaded paint, and decades of industrial and motor vehicle emissions. Besides exposure to lead paint in
older homes, lead water pipes and fixtures also can be found in homes built before 1978. In some areas
of the country, folk remedies and pottery also add to lead exposure.338 The CDC updated the blood
lead reference value (BLRV) to 3.5 μg/dL, which provides an opportunity for additional progress in
addressing longstanding disparities in lead exposure and blood lead levels (BLL) in children.340
While opponents of fluoride claim that fluoridated water increases BLLs in children, the fact is that since
1976, while the use of water fluoridation has increased, the percentage of US children with high BLLs has
continued to decrease substantially.341 This demonstrates that the claim made by those opposed to water
fluoridation that fluoride in water increases lead concentrations in children is unfounded.
