text: A federal court has recently ruled that fluoride in drinking water poses “an unreasonable risk” to children, and ordered the United States Environmental Protection Agency to take regulatory action to eliminate the risk.
  The United States District Court of the Northern District of California recently ordered the agency to take the action after a seven-year battle in federal court.
  Roughly 75% of the population of the United States drinks water that has been voluntarily fluoridated by their communities.
  Senior Judge Edward Chen wrote in the decision that the claims of safety made by the American Dental Association and the US Centers for Disease Control for over 75 years were not supported by the evidence.
  “The Court finds that fluoridation of water at 0.7 milligrams per liter (“mg/L”) – the level presently considered “optimal” in the United States – poses an unreasonable risk of reduced IQ in children…the Court finds there is an unreasonable risk of such injury, a risk sufficient to require the EPA to engage with a regulatory response,” Chen wrote. “In all, there is substantial and scientifically credible evidence establishing that fluoride poses a risk to human health; it is associated with a reduction in the IQ of children and is hazardous at dosages that are far too close to fluoride levels in the drinking water of the United States … Reduced IQ poses serious harm. Studies have linked IQ decrements of even one or two points to, e.g., reduced educational attainment, employment status, productivity, and earned wages.”
  While the ruling did not specify what measures the EPA must adopt, under the Toxic Substances Control Act (TSCA), once the court rules that a chemical poses an unreasonable risk, the EPA is obligated by law to restrict or eliminate the risk.
  “One thing the EPA cannot do, however, in the face of this Court’s finding, is to ignore that risk,” Chen wrote. “There is little dispute in this suit as to whether fluoride poses a hazard to human health. Indeed, EPA’s own expert agrees that fluoride is hazardous at some level of exposure. And ample evidence establishes that a mother’s exposure to fluoride during pregnancy is associated with IQ decrements in her offspring.”
  “The pooled benchmark dose analysis concluded that a 1-point drop in IQ of a child is to be expected for each 0.28 mg/L of fluoride in a pregnant mother’s urine,” he wrote. “This is highly concerning, because maternal urinary fluoride levels for pregnant mothers in the United States range from 0.8 mg/L at the median and 1.89 mg/L depending upon the degree of exposure. Not only is there an insufficient margin between the hazard level and these exposure levels, for many, the exposure levels exceed the hazard level of 0.28 mg/L.
  “Even if the toxicologically determined hazard level of 0.28 mg/L were deemed insufficiently substantiated, evidence in the record still establishes with little doubt that fluoridated drinking water presents a risk of injury to health.”
  According to the ruling, approximately 200 million Americans have fluoride intentionally added to their drinking water at a concentration of 0.7 mg/L — which the EPA did not dispute. Other Americans are indirectly exposed to fluoridated water through the consumption of commercial beverages and food manufactured with fluoridated water.
  Moreover, approximately two million pregnant women and over 300,000 exclusively formula-fed babies are exposed to fluoridated water. The number of pregnant women and formula-fed babies alone who are exposed to water fluoridation each year exceeds entire populations exposed to conditions of use for which the EPA has found unreasonable risk; the EPA has found risks unreasonable where the population impacted was less than 500 people.
  “The Court has done what EPA has long refused to do: applied EPA’s risk assessment framework to fluoride,” Fluoride Action Network’s attorney, Michael Connett, said. “It’s a historic decision. And, as we await EPA’s rulemaking proceeding, policymakers would be well advised to ask: ‘Should we really be adding a neurotoxicant to our drinking water?'”
  Background on the fluoride lawsuit
  According to a release from Flouride Action Network, the lawsuit was brought under the Toxic Substances Control Act of 1976. The act allows citizens to petition the EPA to evaluate whether a chemical presents an unreasonable risk to public health and should be regulated. It also empowers citizen groups to challenge the EPA in court after a petition is denied. TSCA gives the EPA the authority to prohibit “the particular use” of a chemical substance if it’s found to present an unreasonable risk to the general public or susceptible subpopulations.
  According to the release, after a two-week bench trial held via Zoom in June 2020, the trial was placed in abeyance as the court awaited the finalization of the National Toxicology Program’s systematic review of fluoride neurotoxicity.
  In 2022, pressure from pro-fluoridation interest groups led to top officials in the U.S. Department of Health & Human Services blocking the release of NTP’s report. Plaintiffs submitted documents obtained via the Freedom of Information Act exposing this intervention to the court. This discovery led to a legal agreement forcing the report to be made public and prompting Chen to rule that the trial should go forward using the draft report from the NTP.
  A second and final phase of the bench trial was held over several weeks during the winter of 2024. And just last month, the NTP finally published the first part of their report, finding a “large body” of evidence that fluoride exposure is “consistently associated with lower IQ in children.” An accompanying NTP meta-analysis is soon to be published in a peer-reviewed journal.
  The EPA has a few choices available to it. The court ordered the agency to initiate a rulemaking proceeding to come up with new regulations to restrict or eliminate the risk posed by fluoridation chemicals, including simply ending water fluoridation.
  The EPA may also appeal to the Court of Appeals for the Ninth Circuit, or they could take a few years to develop rules.
  Stuart Cooper, executive director of FAN said in the release neither of these were necessary.
  “In our view, attempts by the EPA to appeal or delay this ruling will only result in harm to hundreds of thousands of additional children, particularly those whose families are unable to afford expensive reverse osmosis or distillation filtration of their tap water,” he wrote. “Policymakers at the local and state level do not need to wait to take action. The federal government doesn’t mandate fluoridation, and thus local and state decisionmakers can take action immediately. We have a very thorough decision made by the federal courts based on extensive evidence.
  The public didn’t sign up to have a chemical added to public drinking water that could adversely affect the brain. And while a cavity can easily be filled, damage to the brain is permanent, and the consequences are lifelong. There are no second chances when it comes to impaired brain development.”