EPA pushes water fluoridation “gold standard” forward, releases preliminary data assessment

Last week, the Environmental Protection Agency (EPA) announced a preliminary assessment and data survey as the next step in its plan to establish a “gold-standard” review of fluoridated water in the US.¹ 

This effort is led by EPA administrator Lee Zeldin with the aim of gathering and reviewing current scientific evidence to determine the future of federal drinking water standards. Under the Safe Drinking Water Act (SWDA), the EPA is actively researching potential health risks associated with fluoridated water, with a focus on “radical transparency” and expedited results.¹ Data on how fluoride impacts sensitive populations such as children and infants will also inform potential updates. 

Urgency in the EPA’s mission 

Sixteen US states have already introduced legislation to ban water fluoridation, partially in response to the National Toxicology Program’s (NTP) 2024 report purporting that fluoride exposure above 1.5 milligrams per liter is associated with lower IQ scores in children at fluoride exposure levels above current US drinking water standards. This conclusion sparked widespread debate; researchers at John Hopkins University noted that a San Francisco judge who reviewed the NTP’s report upon publication falsely concluded that fluoridated water poses a risk to public health despite the report explicitly saying fluoride’s link to low IQ scores was not meant to apply to community water fluoridation—or to levels below 1.5 parts per million.^2,3 

Conversely, over 7,000 scientific studies have shown fluoride is advantageous to protecting oral health and can be safely ingested at regulated levels, according to a press release by the CareQuest Oral Health Institute.⁴

The EPA’s new preliminary assessment comes after Zeldin’s April 2025 announcement to rapidly accelerate their review of current fluoride-related data—which was a response to the aforementioned NTP report. 

Trump administration responds 

Zeldin and the EPA are working alongside the Trump administration for their “gold-standard” review, with the organization’s decision on whether fluoride should be added to drinking water influenced by Health and Human Services (HHS) and CDC recommendations.¹ 

However, in the EPA’s official announcement of their expedited assessment, HHS secretary Robert F. Kennedy, Jr. noted: "A growing body of evidence indicates that ingesting fluoride can cause neurological harm, and other adverse effects. By contrast, fluoride's benefits to teeth come almost entirely from topical contact, not from ingestion. Most of Europe has already moved away from water fluoridation in favor of topical products such as toothpaste, and it may well be time for the US to follow suit.” 

The American Dental Association (ADA) has not publicly commented on the next phase in the EPA’s assessment but still recommends drinking optimally fluoridated water alongside maintaining proper oral health routines to prevent dental disease.⁵ 

Why this review matters for clinicians

According to CareQuest, “weakening fluoridation policies would ignore a vast scientific consensus and risk reversing progress on preventable dental disease, disproportionately harming vulnerable populations.”⁴ Ultimately, the EPA has expressed that its utmost concern is providing a transparent and comprehensive assessment of the current literature surrounding water fluoridation.  

With ongoing public debate and misinformation around fluoride, clinicians must be prepared to clearly explain the science, benefits, limitations, and safe use of fluoride to their patients. This applies to both preventive and therapeutic contexts. Ultimately having an informed and open dialogue with concerned patients helps build trust, supports evidence-based decision-making, and positions dental professionals as credible guides in a controversial but essential area of oral health care.  

If you are interested in learning more, the EPA will be hosting a webinar discussing its assessment plan on January 28, 2026. 

References 

1. EPA announces next step in gold-standard review of fluoride to inform protective recommendations. Environmental Protection Agency. January 22, 2026. https://www.epa.gov/newsreleases/epa-announces-next-step-gold-standard-review-fluoride-inform-protective  

2. EPA will expeditiously review new science on fluoride in drinking water. Environmental Protection Agency. April 27, 2025.  https://www.epa.gov/newsreleases/epa-will-expeditiously-review-new-science-fluoride-drinking-water  

3. Why fluoride is necessary for public health. John Hopkins University. November 26, 2024.  https://publichealth.jhu.edu/2024/why-is-fluoride-in-our-water  

4. EPA review of fluoride underscores importance of evidence-based oral health policy. CareQuest Oral Health Institute. Press release. January 23, 2026.

5. Making America healthy again means keeping water fluoridated. American Dental Association. April 7, 2025.  https://www.ada.org/about/press-releases/making-america-healthy-means-keeping-water-fluoridated