by Anne Blythe, North Carolina Health News
February 19, 2026
By Anne Blythe
When Lee Zeldin, head of the U.S. Environmental Protection Agency, announced almost 10 months ago that the federal regulator would reevaluate research on potential health risks of fluoride in drinking water, he said “sound science” would be used to “advance our mission of protecting human and health and the environment.”
Now, with the window on a key commenting period for that review closing on Feb. 27, dental organizations and oral health advocates worry that the agency will give outsized weight to studies that will deliver their desired outcome instead of relying on standard scientific practices and findings that will stand up to rigorous peer review.
“The EPA is assessing the toxicity of fluoride in drinking water, and recently announced they are using a Gold Standard Science approach and had a call for public comment,” Tim Wright, professor in pediatric dentistry at the UNC Chapel Hill Adams School of Dentistry and editor in chief of the Journal of the American Dental Association, wrote in an email to NC Health News. “The toxicity review appears to have already been completed and does not include the most recent studies related to this topic, calling into question the scientific validity of any conclusions from the EPA review.”
When Zeldin announced the reevaluation, Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services, was by the EPA administrator’s side at an event in Salt Lake City, Utah.
Kennedy, an environmental lawyer, has been a polarizing figure during his first year leading key national public health agencies.
Under his leadership, federal childhood vaccine recommendations have been upended and weakened; senior leaders at the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration and on advisory commissions have been forced out; and hundreds of millions of dollars once directed toward vaccine research projects have been scaled back or redirected.
Now, this fluoride review will be delivered during a period of heightened regulatory uncertainty, intense debate about science and concerns over an ideological shift in public health policy under the administration of President Donald Trump.
“Every American should be able to count on safe, healthy drinking water when tthey pour a glass to drink or use it to cook a meal, especially for a child,” Zeldin said Jan. 22. “The Trump EPA is working in lockstep with Secretary Kennedy and following gold standard science to guide our next steps to protect drinking water under the Safe Drinking Water Act.”
Omission of research
In late 2024, even before Trump appointed Kennedy to his cabinet, the head of the “Make America Healthy Again,” or MAHA movement, shared his thoughts about fluoride in a social media post that has gained more than 24 million views. On Nov. 2, 2024, Kennedy characterized the mineral that occurs naturally in water, soil and plants as “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
Many of the same oral health advocates and organizations that raised red flags then about Kennedy’s fluoride characterization are now questioning how reliable and scientifically grounded the EPA reassessment of potential health risks will be.
They point to a goal stated in the executive summary of the Fluoride Human Health Toxicity Assessment: Preliminary Assessment Plan and Literature Survey posted by the EPA in January and the intentional omission of research underscoring advantageous public health outcomes of fluoridation.
“The new EPA toxicity assessment will focus on the potential harmful health effects of fluoride exposure and will not consider beneficial effects such as dental caries prevention,” the summary states.
Achievement under fire
Local municipalities and states began adding fluoride to water in the 1940s to combat high rates of tooth decay. Researchers in the previous decade had discovered that people in areas that naturally had higher fluoride levels in their water had much lower levels of tooth decay.
In 1945 Grand Rapids, Michigan, was the first city to add fluoride to its public water supply, starting a practice that the CDC described as one of the top 10 public health achievements of the 20th century. A study launched by the U.S. Surgeon General and taken over by the National Institute of Dental Health found that by 1956, the tooth decay rate for Grand Rapids children born after the water was fluoridated had dropped by more than 60 percent.
There were fluoridation critics at the time, and despite bodies of scientific research showing the benefits over time, some of that resistance continues today.
Most North Carolina households that are hooked up to public water systems have fluoride in their drinking water. CDC data compiled by the United Health Foundation shows that in 2022 roughly 88 percent of the North Carolina population was served by fluoridated community water systems.
Some communities across the state, however, have been reconsidering whether adding fluoride is as significant a public health boon as was heralded by the CDC.
Lincoln and Union county elected officials have voted to ban the addition of fluoride to their public water supplies. But last April, the Belmont City Council rejected a proposed fluoride ban, highlighting debate that has gone on for decades.
Dueling interpretations
Modern fluoridation critics spotlight an August 2024 National Toxicology Program monograph that concluded “with moderate confidence” that higher fluoride exposure, specifically 1.5 milligrams per liter and above, is associated with lower IQ in children. That level, though, is more than double the optimal 0.7 milligrams per liter concentration recommended for U.S. community water fluoridation.
Detractors of the monograph highlight that 17 of the 19 studies considered were performed in China, Mexico, India and Iran, where fluoridation levels tend to be higher than those in the United States.
Although state and local governments primarily determine fluoridation in community water systems, the EPA sets mandatory maximum safety standards to protect against potential health risks. A change in those standards could pose significant legal, operational and public health challenges.
In late January, the American Dental Association, which represents nearly 160,000 dentists across the country, urged the EPA to use “peer-reviewed, scientifically tested evidence” in its review process.
“As the EPA reviews the science under the Safe Drinking Water Act, we urge Administrator Zeldin and his team to implement an objective, evidence-based process utilizing all the latest peer-reviewed, valid and reproducible research on IQ and neurocognition to reach an objective conclusion,” Richard Rosato, a New Hampshire dentist and the association’s president, said in a statement. “The ADA and leading scientific experts continue to affirm that optimally fluoridated water is a proven, safe, and effective way to protect the public’s oral health.”
The association stated that the EPA’s announcement last year to reconsider the health impacts of community water fluoridation initially “was encouraging.”The organization was later discouraged, though, by the exclusion of recently published studies, such as one that shows teens exposed to typical amounts of fluoride found in U.S. water systems had better cognitive performance.
They say that omitting that type of research jeopardizes the validity of any findings in the forthcoming review.
Rosato discouraged EPA from ultimately relying on “biased, mischaracterized studies that use flawed datasets and do not stand-up to scientific rigor.” “We look forward to continued dialogue with the Trump Administration and Administrator Zeldin on this important public health issue,” he added in his statement.
Dentists weigh in
On Feb. 6, the ADA sent a “grassroots alert” to its members and encouraged them to contact the EPA to urge them to “use gold standard science and not studies that cannot stand up to the rigors of peer-reviewed standards.”
“We need to show this administration that the oral health community trusts the long-standing comprehensive body of peer-reviewed research demonstrating optimal levels of fluoride in Americans’ water are safe, beneficial and necessary in the United States,” the alert said.
The North Carolina Dental Society, which has more than 3,900 dentists in its membership, also encouraged its members to contact the EPA during the public comment period.
The national and state organizations “believe strongly that there are multitudes of scientifically valid studies that substantiate the safety and efficacy of fluoridated water at appropriate levels,” Jim Goodman, the state dental society’s CEO, told NC Health News in an email this week.
Goodman said the organization urges the EPA to enlist the National Academies of Science, Engineering, and Medicine to peer review its assessment plan and systemic review before finalization.
That will help ensure that future regulatory decisions about community water fluoridation “are based on reproducible, objective and high-quality evidence,” according to the summary provided by Goodman. “If the EPA wishes to promote the best available, unbiased, peer-reviewed studies through broad literature searches in scientific databases, it must remove the biased studies included in this review and add numerous, better-conducted studies from the last few years.”
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