The American Academy of Pediatric Dentistry (AAPD), representing more than 11,000 pediatric dental specialists nationwide, formally challenged the Environmental Protection Agency’s approach to reviewing fluoride in drinking water on February 27, 2026.
The AAPD, joined by 140 state and national organizations including the American Dental Association, multiple American Academy of Pediatrics state chapters, and the New York Academy of Pediatric Dentistry, submitted a formal comment letter warning that the EPA’s Fluoride Preliminary Assessment Plan relies on discredited science, misclassifies a cosmetic dental condition as a health risk, and completely ignores the established health benefits of fluoride an approach the AAPD called “irresponsible.”
The outcome of this federal review could directly affect the fluoride level in the tap water your child drinks every day, including in Queens.
WHAT YOU NEED TO KNOW
- What happened: The AAPD and 140 allied organizations formally objected to the EPA’s fluoride assessment methodology on February 27, 2026, warning it could lead to reductions in community water fluoridation.
- Who is affected: Every child who drinks fluoridated tap water including millions of children in New York City, where the water supply is currently fluoridated at the recommended level.
- What the science says: Community water fluoridation reduces cavities in children’s baby teeth by up to 35 percent and in permanent teeth by up to 26 percent, according to the AAPD’s Reference Manual of Pediatric Dentistry (2025-2026).
- What the AAPD wants: The EPA should pause its current process and engage the National Academies of Sciences, Engineering, and Medicine to conduct an independent, scientifically rigorous review.
- Who confirmed this: American Academy of Pediatric Dentistry, via formal EPA public comment submission, February 27, 2026.
EPA Fluoride Assessment: The Full Details
In January 2026, the EPA published its Fluoride Preliminary Assessment Plan and Literature Survey (Docket No. EPA-HQ-OW-2025-3823), opening a public comment period that closed February 27, 2026.
The plan outlined how the EPA intends to conduct a new scientific review of fluoride’s safety in drinking water, a review that could ultimately lead to changes in the recommended fluoride concentration currently set at 0.7 parts per million (ppm).
That standard, established by the U.S. Public Health Service, represents the level at which fluoride delivers maximum cavity-prevention benefit with minimal risk of cosmetic dental fluorosis.
The AAPD’s formal comment letter described four major scientific failures in the EPA’s proposed methodology.
First, the plan relies heavily on the 2024 National Toxicology Program (NTP) report a document the National Academies of Sciences, Engineering, and Medicine (NASEM) refused to approve in peer review and whose authors explicitly cautioned against using to set fluoride dosage recommendations.
Second, the EPA plans to classify mild dental fluorosis white spots on tooth enamel that are purely cosmetic and actually correlate with lower rates of tooth decay as a toxic health effect of fluoride.
Third, and most critically, the EPA explicitly stated it will not consider the health benefits of fluoride in its toxicity assessment, evaluating only potential harms in isolation.
Fourth, the plan’s literature search is already outdated, as it excludes studies published in 2025.
The AAPD’s letter to the EPA stated: “If this assessment is not conducted with scientific integrity, children will experience more dental pain, infection, and lower quality of life” due to tooth decay, which it describes as the nation’s leading chronic disease in children.
You can learn more about fluoride’s role in children’s dental health in our complete guide for parents.
Why This Matters for Parents
The stakes of this regulatory review are not abstract. Community water fluoridation has been practiced in the United States for more than 80 years and is recognized by the CDC as one of the ten greatest public health achievements of the twentieth century.
According to the AAPD’s 2025-2026 Reference Manual of Pediatric Dentistry, fluoridated water at the optimal level produces a 35 percent reduction in decayed, missing, and filled baby teeth and a 26 percent reduction in decayed, missing, and filled permanent teeth.
No other single public health intervention delivers this level of cavity protection to children at essentially zero individual cost.
Historical evidence from communities that removed fluoride from their water supply tells a consistent story.
The AAPD’s comment letter points to data from other countries showing that when communities intentionally stopped fluoridating their water, children experienced measurable increases in dental pain, tooth infections, and missed school days.
A landmark study of Juneau, Alaska, which stopped fluoridation in 2007, documented a significant rise in childhood tooth decay in the years following.
The current anti-fluoride policy push is not purely scientific. EPA Administrator Lee Zeldin announced the fluoride reevaluation in Salt Lake City alongside Robert F. Kennedy Jr., Secretary of HHS, who has long opposed community water fluoridation.
At least 15 states introduced legislation in 2026 to ban or limit fluoride in public water supplies.
The AAPD, ADA, and AAP have consistently opposed these measures, pointing out that the populations most dependent on fluoridated tap water rather than bottled water are low-income children in urban communities, including Queens.
Tim Wright, a professor of pediatric dentistry at UNC Chapel Hill and editor-in-chief of the Journal of the American Dental Association, told North Carolina Health News that the EPA’s 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.”
What the ADA Said at the Congressional Hearing
On February 27, 2026, the same day the public comment period closed, the American Dental Association testified before a House subcommittee, urging Congress to support the Protect Our TEETH Act (H.R. 4556), which would require an independent scientific review before any changes to fluoride regulations could take effect.
ADA President-elect Dr. Rosato and ADA Science Institute Director Dr. Shapiro outlined specific recommendations for the EPA’s assessment, including a call to re-review the literature cited in consensus documents, including studies that question associations between fluoride and neurodevelopmental effects, and differentiate between mild cosmetic fluorosis and severe fluorosis in its analysis.
They also called on the EPA to engage the National Academies of Sciences, Engineering, and Medicine to conduct an independent peer review of any final report, the same recommendation made by the AAPD.
For parents currently concerned about fluoride and their child’s toothpaste, our complete guide to cavities in children covers age-appropriate fluoride toothpaste amounts and when to use fluoride-free alternatives.
What This Means for Your Child in Queens
New York City’s water supply is currently fluoridated at 0.7 ppm, the optimal recommended concentration.
The New York Academy of Pediatric Dentistry is among the 140 organizations that co-signed the AAPD’s objection letter to the EPA, reflecting the professional community’s strong concern that this federal review could ultimately affect NYC’s water fluoridation policy.
For parents in Queens, the practical guidance right now is straightforward: the water coming from your tap continues to deliver its cavity-protective benefits at safe levels.
No changes have been made.
What is at stake is what happens next, as the EPA moves through its assessment process over the coming months.
If the EPA assessment ultimately recommends lowering the permissible fluoride level in drinking water, or if anti-fluoride legislation advances at the state or federal level, the cavity burden on children in low-income Queens communities would likely increase.
The children most at risk are those who rely entirely on tap water for hydration, do not have regular dental checkups, and whose families cannot easily absorb the cost of treating preventable cavities.
This is precisely why your child’s pediatric dentist applies fluoride varnish and silver diamine fluoride at routine visits.
Clinical fluoride applications provide a backup layer of protection even if tap water fluoride levels change.
If your child is not receiving regular preventive dental care, now is the time to establish that routine regardless of what happens with water fluoridation policy.
Schedule a checkup, ask your dentist about fluoride varnish applications, and make sure your child is brushing with the age-appropriate amount of fluoride toothpaste twice daily.
Frequently Asked Questions About the EPA Fluoride Review
Is fluoride in tap water safe for children?
Yes, according to the American Academy of Pediatric Dentistry, the American Dental Association, the American Academy of Pediatrics, and the CDC.
Community water fluoridation at 0.7 ppm has been practiced safely in the United States for more than 80 years.
The EPA’s current review is examining whether its regulatory framework needs updating; it is not a response to evidence of harm at current US fluoridation levels.
What is dental fluorosis, and should I be worried about it?
Dental fluorosis refers to faint white spots or streaks on tooth enamel caused by fluoride exposure during tooth development.
Mild fluorosis, the most common form, is purely cosmetic and has no effect on tooth function or health.
The AAPD notes that mild fluorosis actually correlates with lower rates of tooth decay.
Only severe fluorosis, which is rare at US water fluoridation levels, affects enamel structure.
The EPA’s proposed plan classifies mild cosmetic fluorosis as a toxic health effect, which the AAPD calls scientifically inaccurate.
What should I do if I’m concerned about fluoride in my child’s water?
Talk to your child’s pediatric dentist before making any changes.
If you are considering switching your child to bottled water or installing a filter that removes fluoride, discuss this with your dentist first.
You may need to compensate with fluoride supplements or increased fluoride varnish applications at dental visits.
Removing fluoride from tap water without a clinical plan in place could increase your child’s cavity risk.
Has anything actually changed about fluoride in NYC’s water?
No. As of March 2026, NYC tap water continues to be fluoridated at 0.7 ppm.
The EPA review is in an early stage.
Any regulatory changes would require a full rulemaking process and could take years to finalize.
The AAPD, ADA, and more than 140 partner organizations are actively working to ensure the review is conducted with scientific integrity before any policy changes occur.
Medical disclaimer: This article is for informational purposes only and does not constitute medical or dental advice. Always consult a licensed pediatric dentist regarding your child's specific fluoride needs and dental health plan.
Reviewed by the Pediatric Dentist in Queens Editorial Team. Last Updated: March 14, 2026.
SOURCE LIST
1. AAPD Press Release — “Pediatric Dentists, Children’s Health Advocates Sound Alarm Over EPA’s Inadequate Fluoride Assessment Plan.” February 27, 2026. https://www.prnewswire.com/news-releases/pediatric-dentists-childrens-health-advocates-sound-alarm-over-epas-inadequate-fluoride-assessment-plan-302699675.html
2. ADA News — “ADA urges EPA to strengthen scientific rigor in fluoride health assessment.” February 2026. https://adanews.ada.org/ada-news/2026/february/ada-urges-epa-to-strengthen-scientific-rigor-in-fluoride-health-assessment/
3. AAPD Reference Manual of Pediatric Dentistry 2025-2026 — Policy on Use of Fluoride. https://www.aapd.org/research/oral-health-policies–recommendations/use-of-fluoride/
4. North Carolina Health News — “Dentists, oral health advocates urge EPA to use ‘gold standard science’ in its fluoride review.” February 19, 2026. https://www.northcarolinahealthnews.org/2026/02/19/dentists-oral-health-advocates-urge-epa-to-use-gold-standard-science-in-its-fluoride-review/
5. Dentistry Today — “AAPD Challenges EPA Fluoride Assessment Plan.” February 2026. https://www.dentistrytoday.com/aapd-challenges-epa-fluoride-assessment-plan/
Mary – Queens Pediatric Dental Resource Manager. I’m a dental health researcher and parent advocate based in Queens, NY. After struggling to find reliable pediatric dental information during my own child’s dental emergency, I created this resource to help other Queens families navigate their children’s oral health needs.
I curate evidence-based information from leading pediatric dental organizations, peer-reviewed research, and trusted dental health experts. While I’m not a dentist, I’m committed to providing accurate, practical guidance that helps parents make informed decisions.
All content is thoroughly researched and includes proper medical disclaimers directing families to consult qualified pediatric dentists for their children’s specific needs.