Experts from the University of Rochester’s Eastman Institute for Oral Health underscore the safety, effectiveness, and enduring public health benefits of community water fluoridation in a commentary published in The Journal of the American Dental Association.

The paper, “Defending community water fluoridation: A public health imperative grounded in evidence,” reviews the data. While some observational studies conducted outside the U.S. have raised concerns about potential neurocognitive effects of fluoride, high-quality evidence consistently shows that water fluoridation at recommended levels (0.7 ppm) poses no risk to children’s neurodevelopment.

Many studies suggesting IQ reductions were conducted in regions with fluoride levels far above U.S. standards—sometimes exceeding 4.0 ppm—and often involved co-exposures to other environmental toxins, including arsenic, iodine, and aluminum, which were not adequately controlled. Systematic reviews and recent robust cohort studies in developed countries have found no significant differences in cognitive outcomes between children exposed to fluoridated and non-fluoridated water.

“Community water fluoridation is one of the most effective and safe public health interventions to prevent dental caries,” said EIOH Director Eli Eliav, DMD, Ph.D., MBA. “It not only protects oral health across all ages and populations but also ensures equitable access to preventive care.”

EIOH experts emphasize that removing fluoridation from public water systems would result in billions of dollars in avoidable treatment costs and worsened oral health outcomes. Economic models from multiple countries confirm fluoride’s role as one of the most cost-effective public health investments available.

The authors assert that in the face of politicized rhetoric, policy must remain anchored in science. For more than 80 years, EIOH scientists have been a leader in studying the effects of fluoride and its impact in treating and preventing tooth decay. EIOH’s second director, Dr. Basil Bibby, was among the pioneers who demonstrated the benefits of fluoride in the 1940’s.

“Removing water fluoridation based on selectively interpreted or low-quality evidence would forfeit decades of progress in oral health and exacerbate existing health inequities,” added the lead author Yanfang Ren, DDS, Ph.D., MPH, EIOH professor. “The benefits of fluoridation are clear, measurable, and lasting. Science, ethics, and economics all align—community water fluoridation must continue.”

The paper also emphasizes that all health care providers play a vital role in translating public health evidence to their communities. An accurate understanding of the fluoride and neurodevelopment literature enables dental and medical professionals to dispel misinformation and support effective prevention strategies.

A commentary by co-author Lainie Ross, MD, Ph.D., chair, Department of Health and Humanities and Bioethics at the University of Rochester Medical Center, was recently published in The Journal of Pediatrics, where she examines the existing evidence and flawed studies related to community water fluoridation and lower IQ.

In addition to Drs. Eliav, Ren and Ross, the other authors of the JADA commentary include Eastman Institute for Oral Health faculty Jin Xiao, DDS, Ph.D., Dorota Kopycka-Kedzierawski, DDS, MPH, William Calnon, DDS and Cyril Meyerowitz, DDS, MS.