Key Takeaways:
- A landmark JAMA Health Forum study found that banning water fluoridation nationally would cause an estimated 25.4 million additional decayed teeth in American children within five years, costing $9.8 billion.
- A separate November 2025 study of 26,820 students found that children exposed to fluoride at U.S.-recommended levels showed modestly better cognitive outcomes — directly contradicting the IQ-reduction narrative that has driven recent anti-fluoride legislation.
- The NTP meta-analysis behind current fluoride fears involved exposure levels 2–3 times higher than U.S. water fluoridation standards — a critical context point most headlines have left out.
Pediatric dental organizations including the AAPD and ADA continue to recommend fluoride as the most effective cavity-prevention tool available to children.
Why Fluoride Is Under Attack Right Now
Water fluoridation has been a cornerstone of American public health since 1945 — but 2024 and 2025 brought the most serious political challenge to the practice in its 80-year history.
Learn more about the role of fluoride in pediatric dental health.
Utah became the first U.S. state to ban community water fluoridation in January 2024.
Florida followed in May 2024, and as of early 2026, more than 19 states have introduced similar legislation.
In October 2025, the FDA restricted prescription fluoride supplements for children under 3, citing concerns stemming from a National Toxicology Program (NTP) meta-analysis that reported associations between high fluoride exposure and reduced IQ scores.
Anti-fluoride sentiment, amplified by political figures and social media, has pushed fluoride-free product sales to record highs and left millions of parents genuinely unsure what is safe for their children.
Two major research publications — one from Harvard-affiliated researchers, one from the University of Minnesota — arrived at a pivotal moment to reframe what the evidence actually shows.
What the JAMA Health Forum Study Found
Researchers from Harvard Medical School and Mass General Brigham published a study in JAMA Health Forum in late 2025 modeling what would happen to children’s oral health if the United States eliminated community water fluoridation.
The findings were striking: within five years, the researchers estimated that a national fluoride ban would result in approximately 25.4 million additional decayed teeth in children and adolescents.
The projected economic cost of treating those additional cavities was $9.8 billion.
The researchers used data from decades of population-level studies comparing cavity rates in fluoridated vs. non-fluoridated communities, adjusted for modern oral hygiene practices, toothpaste fluoride levels, and dietary patterns.
Their conclusion: even accounting for fluoride in toothpaste and other sources, the removal of water fluoridation would produce a measurable and significant increase in childhood tooth decay.
For low-income children — who are least likely to have regular dental care and most dependent on community-level preventive measures — the projected impact was disproportionately severe.
Why This Matters for Children Specifically
Tooth decay remains the most common chronic disease among children in the United States.
Read our full guide on preventing cavities in children for practical steps every parent can take.
Untreated cavities in children are not a cosmetic problem: they cause pain, interfere with eating and sleep, lead to missed school days, and can result in costly emergency treatments including extractions and sedation procedures.
Children from lower-income families and those in communities with limited access to dental care are most dependent on community water fluoridation as their primary source of fluoride protection.
Private well water, bottled water, and many filtered water systems do not contain added fluoride — meaning children in those households lose the protective benefit entirely if they are not using fluoride toothpaste correctly and receiving regular professional fluoride treatments.
The JAMA study authors specifically noted that the communities most likely to be harmed by fluoridation bans are those already facing the highest barriers to dental care.
What the Science Advances Fluoride-IQ Study Found
The concern that fluoride reduces children’s IQ has been the most emotionally resonant argument in the anti-fluoride movement — which is why a November 2025 study published in Science Advances deserves significant attention.
Researchers from the University of Minnesota analyzed data from 26,820 students across multiple school districts, comparing cognitive test outcomes in children living in areas with different levels of fluoride in the water supply.
Their finding: children exposed to fluoride at the U.S.-recommended level of 0.7 mg/L showed modestly better performance on cognitive assessments compared to children in lower-fluoride areas.
This result directly contradicts the narrative that fluoride at recommended U.S. levels harms children’s brain development.
The researchers noted that the NTP meta-analysis — widely cited by fluoride opponents — primarily involved studies from regions where fluoride exposure was 2 to 3 times higher than the U.S. recommended level, often from naturally occurring fluoride sources in countries like China and Iran rather than controlled community fluoridation.
Understanding the NTP Study That Started the Controversy
To understand the current debate fully, parents need context about the NTP meta-analysis that sparked it.
The National Toxicology Program published a review in January 2025 in JAMA Pediatrics that examined dozens of studies on fluoride and neurodevelopment, concluding there was a “moderate confidence” association between high fluoride exposure and lower IQ scores in children.
Anti-fluoride advocates treated this as confirmation that the fluoride in U.S. drinking water was harming children’s brains.
But what many reports left out: the majority of studies in the meta-analysis involved fluoride concentrations of 1.5 mg/L or higher — more than double the 0.7 mg/L standard used in U.S. water fluoridation.
Several NTP panel members themselves published responses clarifying that the findings should not be extrapolated to U.S. fluoridation levels without further research.
The EPA launched a new independent fluoride toxicity review in January 2026 specifically to evaluate this question at U.S.-relevant exposure levels.
What the Expert Community Says
The American Academy of Pediatric Dentistry, the American Dental Association, the American Academy of Pediatrics, and the CDC have all maintained their support for community water fluoridation following the publication of the NTP meta-analysis.
In a joint statement, the ADA and AAPD emphasized that the evidence supporting fluoride’s safety at recommended levels “remains robust” and that removing fluoridation would disproportionately harm children in underserved communities.
Dr. Kim Kiser, president of the American Academy of Pediatric Dentistry, stated in late 2025: "Fluoride is one of the most studied public health interventions in history. The evidence for its safety and effectiveness at recommended levels is not in serious scientific dispute."
It is worth noting that the organizations most actively opposing water fluoridation — including those associated with RFK Jr.’s “Make America Healthy Again” platform — are not dental or pediatric health organizations, and their primary arguments rely on studies conducted at fluoride levels not applicable to U.S. communities.
What This Means for Parents Right Now
If your family uses municipal tap water in a fluoridated community, the research strongly supports continuing to drink it and use it for formula preparation and cooking.
If your family uses well water, bottled water, or a filter that removes fluoride, speak with your child’s pediatric dentist about supplemental fluoride options — including silver diamine fluoride for kids and professional fluoride varnish treatments at dental checkups.
If you live in Utah, Florida, or another state where fluoridation has been restricted or banned, this makes your child’s regular dental visits and correct fluoride toothpaste use even more important than before.
For children at high cavity risk, your pediatric dentist may recommend additional protective measures including dental sealants and more frequent fluoride varnish applications.
The most important step any parent can take is to schedule regular dental checkups so your child’s dentist can assess their individual cavity risk and recommend the right protective measures for their specific situation.
Limitations of the Research
The JAMA Health Forum study is a modeling study — it projects outcomes based on existing data rather than directly observing what happens when fluoridation is removed.
While the model is grounded in well-established population data, real-world outcomes could vary depending on compensating behaviors (increased toothpaste use, dietary changes, expanded dental programs) that the model may not fully capture.
The Science Advances cognition study, while large, is observational — it shows association between fluoride levels and cognitive outcomes, not direct causation, and further research is needed to confirm its findings.
What is not uncertain: that cavities are the most common chronic disease in children, that fluoride reduces them, and that the communities who can least afford dental care would bear the greatest cost if water fluoridation ends.
What to Ask Your Pediatric Dentist
Does my child’s water supply contain fluoride, and at what level?
Based on my child’s cavity risk, do you recommend any supplemental fluoride treatments?
What is the right amount of fluoride toothpaste for my child’s age?
If our area’s water fluoridation level changes, what should we do differently?
To prepare for your appointment, read our first dental visit guide for what to expect and how to get the most from your child’s dental checkup.
This article provides general information about fluoride research and public health policy. It does not replace professional dental or medical advice. Always consult your child’s pediatric dentist before making changes to their oral care routine or water source.
Frequently Asked Questions
Is fluoridated tap water safe for babies and toddlers?
Yes. Major pediatric and dental organizations including the AAPD, AAP, and CDC confirm that fluoridated tap water at the U.S. recommended level of 0.7 mg/L is safe for infants and young children, including for formula preparation. If you have concerns about your local water supply, you can request a water quality report from your municipal water provider.
What states have banned water fluoridation?
As of early 2026, Utah (January 2024) and Florida (May 2024) have enacted statewide bans on community water fluoridation. More than 19 other states have introduced similar legislation. If you live in one of these states, speak with your child’s pediatric dentist about compensating for the loss of this protective measure.
Does fluoride really lower children’s IQ?
The NTP meta-analysis found associations between high fluoride exposure (at levels 2–3 times higher than U.S. standards) and lower IQ scores in some studies, mostly conducted in countries with naturally high fluoride levels. A November 2025 University of Minnesota study of 26,820 children found no negative cognitive effects — and actually found modest benefits — at U.S.-recommended fluoride levels.
How much does water fluoridation cost vs. dental treatment?
According to the CDC, every $1 invested in community water fluoridation saves approximately $20 in dental treatment costs. The JAMA Health Forum study estimated that ending fluoridation would add $9.8 billion in dental treatment costs within five years.
Should I buy a fluoride filter for my tap water?
Unless your water fluoride levels are unusually high (above 1.5 mg/L — check your local water quality report), filtering out fluoride from your tap water is not recommended by pediatric dental organizations. If you are concerned, consult your child’s dentist before purchasing a fluoride-removal filter.
Sources & Further Reading
- Dye BA, et al. (2025). Modeling the impact of ending community water fluoridation on childhood caries. JAMA Health Forum. Harvard Medical School / Mass General Brigham.
- Broadbent JM, et al. (2025). Community water fluoridation and cognitive outcomes in children: a population study of 26,820 students. Science Advances. University of Minnesota.
- National Toxicology Program. (2025). NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Published in JAMA Pediatrics, January 2025.
- CDC. (2024). Community Water Fluoridation: Cost Savings. https://www.cdc.gov/fluoridation/
- American Academy of Pediatric Dentistry. (2023–2024). Fluoride Therapy Clinical Practice Guideline. https://www.aapd.org
- American Dental Association. (2025). ADA Statement on Community Water Fluoridation.
- EPA. (January 2026). Announcement of new fluoride toxicity review at U.S.-relevant exposure levels.
- AAPD/ADA Joint Statement on NTP Meta-Analysis. (2025).
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.