Health Leaders Sound Alarm Over EPA Fluoride Plan, Citing 'Flawed Science' and Risk to Children

CHICAGO, IL – February 27, 2026 – A formidable coalition of over 140 dental, medical, and public health organizations is raising serious alarms over a new Environmental Protection Agency (EPA) plan to assess the toxicity of fluoride, warning that its flawed scientific approach threatens to dismantle one of the most successful public health achievements of the last century: community water fluoridation.

Led by the American Academy of Pediatric Dentistry (AAPD), which represents over 11,000 pediatric dental specialists, the group submitted a formal rebuke of the EPA's "Fluoride Preliminary Assessment Plan" (Docket No. EPA-HQ-OW-2025-3823). In a detailed letter, the academy argues the agency's current path relies on discredited science and ignores decades of evidence, potentially triggering a national public health crisis by paving the way for the de-fluoridation of America's water supplies.

A Dispute Over 'Gold Standard' Science

At the heart of the conflict are what the AAPD calls "significant concerns" regarding the scientific integrity of the EPA's proposed assessment. The academy contends the plan fails to meet the administration's own requirements for using "Gold Standard Science" in regulatory decisions.

A central point of contention is the EPA's heavy reliance on a 2024 National Toxicology Program (NTP) report. According to the AAPD, this report repeatedly failed to pass peer review with the prestigious National Academies of Sciences, Engineering, and Medicine (NASEM). Furthermore, the health groups point out that the NTP report's own authors cautioned against using its findings to set a recommended fluoride dose. The majority of the studies included in the NTP report were conducted outside the U.S., in regions with fluoride exposure levels that do not reflect those found in American communities with optimally fluoridated water.

Adding to the scientific objections, the AAPD strongly opposes the EPA's proposal to classify "mild dental fluorosis" as a toxic or adverse health effect. The academy's letter describes the condition as "purely cosmetic" and having "no deleterious or pathologic qualities." In fact, they note that the appearance of these faint white markings on teeth often correlates with lower rates of tooth decay, the very condition fluoride is meant to prevent.

"If this assessment is not conducted with scientific integrity, children will experience more dental pain, infection, and lower quality of life," the Academy stated, underscoring that tooth decay remains the nation's leading chronic childhood disease.

An Assessment in a Vacuum

The EPA's mandate under the Safe Drinking Water Act (SDWA) is to identify and regulate potential contaminants, a role that drives its narrow focus on toxicity. The agency explicitly stated it would not consider the extensive health benefits of fluoride in its assessment. This decision has drawn sharp criticism from the health community.

The AAPD labeled a toxicity review conducted in a vacuum, without a corresponding risk-benefit analysis, as "irresponsible." The group pointed to historical data from other countries where the intentional removal of fluoride from public water systems led to measurable increases in children's dental pain, infections, and missed school days.

The agency's accelerated review, initiated in early 2026, stems in part from a September 2024 federal court order directing the EPA to examine evidence linking higher fluoride exposure to potential neurodevelopmental effects in children. This legal pressure has placed the long-standing practice of water fluoridation under a new and powerful microscope, forcing the agency to produce a toxicity assessment to inform future regulatory standards.

However, the AAPD and its partners argue that this pressure does not excuse a scientifically unsound process. They highlighted additional methodological red flags, including an outdated literature search that excludes recent 2025 studies and the lack of a transparent, pre-specified protocol for the systematic review, further undermining confidence in the plan.

The Stakes for Public Health and Equity

For over 80 years, community water fluoridation has been celebrated by the Centers for Disease Control and Prevention (CDC) as one of the ten great public health achievements of the 20th century. By delivering preventative dental care to entire communities through the tap, it has drastically reduced the prevalence of tooth decay, a disease that disproportionately affects children from low-income families and communities of color.

Public health experts stress that fluoridation is a cornerstone of health equity. It provides a universal benefit regardless of a person's age, income, or access to dental care, saving billions in healthcare costs associated with treating preventable dental diseases. The potential rollback of this policy, which the AAPD warns is the likely outcome of the EPA's flawed plan, could have devastating consequences.

"The result of this deeply flawed plan points toward a de-fluoridation of water supplies that would undoubtedly lead to a surge in dental caries and healthcare costs," the AAPD's letter warns. Such a scenario would not only erase decades of progress but also place a greater burden on families and emergency rooms, which often become the provider of last resort for severe dental infections.

A Call for an Independent Review

Rather than scrapping the review entirely, the AAPD and its 140 partners, including the American Dental Association, the American Academy of Pediatrics, and the American Public Health Association, are urging the EPA to take a crucial step back. They have formally requested that the agency pause its current process and engage an independent, external reviewer to ensure a fair and scientifically rigorous assessment.

Specifically, they have called on the EPA to commission the National Academies of Sciences, Engineering, and Medicine (NASEM) to conduct the review. NASEM is widely regarded as the nation's premier independent scientific advisory body, and its involvement, the health groups argue, would restore scientific integrity to the process.

This unified call for a halt and an independent review highlights the profound division between the regulatory agency and the public health community it is meant to protect. The outcome of this standoff will determine the future of a foundational public health policy and the oral health of millions of American children for generations to come.