Fluoride in Public Water: Reexamining the Global Health Risks

Introduction

Fluoridation of public water supplies is often framed as a major public health achievement, credited with reducing tooth decay and promoting oral health. However, contemporary international research has raised serious concerns about the safety and ethical implications of mass fluoride exposure. Particularly troubling are findings that link fluoride ingestion to neurotoxicity, endocrine disruption, and disproportionate health effects in vulnerable populations. This article critically assesses these findings and urges a reevaluation of systemic fluoride use through a global, trauma-informed lens.

A Brief History of Fluoridation

Water fluoridation was introduced in the United States in the 1940s following studies that found lower levels of dental caries in areas with naturally fluoridated water. By the 1960s, it had become a widespread public policy, and today about 73% of the U.S. population receives fluoridated drinking water (Centers for Disease Control and Prevention [CDC], 2022). Proponents argue that fluoride prevents dental decay, especially in communities with limited access to dental care.

However, most European countries—including Germany, France, Sweden, and the Netherlands—do not fluoridate their water. Instead, they promote topical fluoride use (e.g., toothpaste), citing ethical concerns, insufficient evidence for systemic benefits, and the risk of overexposure.

Fluoride as a Neurotoxin

One of the most significant challenges to the fluoridation narrative comes from research on fluoride’s neurotoxic effects. A comprehensive 2019 study published in JAMA Pediatrics found that maternal exposure to fluoride during pregnancy was associated with lower IQ scores in offspring, particularly boys. This Canadian study included 601 mother-child pairs and controlled for multiple confounding variables (Green et al., 2019).

Additional support comes from a 2012 Harvard meta-analysis of 27 studies, which concluded that children living in areas with high fluoride exposure had significantly lower IQ scores than those in low-exposure areas (Choi et al., 2012). These findings were reinforced in 2023 by the U.S. National Toxicology Program’s (NTP) final report, which concluded there is a consistent pattern of lower IQ in children exposed to higher fluoride levels in drinking water (NTP, 2023).

Endocrine Disruption and the Thyroid Connection

Fluoride also acts as an endocrine disruptor, with significant implications for thyroid health. Ingested fluoride competes with iodine, a mineral essential for thyroid hormone production. Research in the Journal of Epidemiology and Community Health found that English regions with fluoridated water had significantly higher rates of hypothyroidism compared to non-fluoridated areas (Peckham et al., 2015).

Additionally, the pineal gland—responsible for producing melatonin and regulating circadian rhythms—has been found to accumulate more fluoride than any other soft tissue in the body. This raises concerns about fluoride’s long-term impact on sleep quality, hormonal regulation, and even reproductive development (Luke, 2001).

Dental Fluorosis: A Marker of Overexposure

Ironically, fluoride’s most visible impact may be the damage it causes to teeth. Dental fluorosis, a condition resulting from excess fluoride intake during tooth development, affects approximately 25% of children in the United States, according to the CDC. Though classified as cosmetic in mild cases, moderate to severe fluorosis can permanently stain, pit, or weaken enamel—an indication of systemic toxicity during key developmental years.

Ethical and Equity Concerns

Mass fluoridation eliminates individual consent and disproportionately affects those with less access to healthcare, nutrition, or education. Fluoride exposure cannot be adjusted for age, weight, or medical condition, violating the principle of medical autonomy.

Moreover, trauma-informed care teaches that bodily autonomy is essential for individuals recovering from systemic neglect or institutional harm. Mandating fluoride consumption through public water without informed consent may be re-traumatizing for individuals who have survived medical discrimination or exploitation.

Global Policy Divergence

Globally, fewer than 5% of people receive fluoridated water, with most countries opting for alternative dental health strategies. The United States, Canada, Australia, and Ireland remain exceptions. This divergence suggests that fluoridation is not a universally accepted or essential public health measure, but rather a contested one.

Nations that prioritize the precautionary principle—erring on the side of safety when evidence is incomplete—have discontinued systemic fluoride exposure in favor of safer, more targeted interventions.

Conclusion

While fluoride may offer topical dental benefits, widespread ingestion through water fluoridation presents documented risks to neurological and endocrine health. With mounting global evidence and a growing demand for trauma-informed, ethically grounded healthcare practices, it is time to reconsider water fluoridation policies. Protecting vulnerable populations and respecting bodily autonomy must take precedence in the evolution of public health strategies.

References

Centers for Disease Control and Prevention. (2022). Community water fluoridation. U.S. Department of Health and Human Services. https://www.cdc.gov/fluoridation/index.html

Choi, A. L., Sun, G., Zhang, Y., & Grandjean, P. (2012). Developmental fluoride neurotoxicity: A systematic review and meta-analysis. Environmental Health Perspectives, 120(10), 1362–1368. https://doi.org/10.1289/ehp.1104912

Green, R., Lanphear, B., Hornung, R., et al. (2019). Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada. JAMA Pediatrics, 173(10), 940–948. https://doi.org/10.1001/jamapediatrics.2019.1729

National Toxicology Program. (2023). Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. National Institute of Environmental Health Sciences.

Peckham, S., Lowery, D., & Spencer, S. (2015). Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. Journal of Epidemiology and Community Health, 69(7), 619–624. https://doi.org/10.1136/jech-2014-204971

Luke, J. (2001). Fluoride deposition in the aged human pineal gland. Caries Research, 35(2), 125–128. https://doi.org/10.1159/000047443