Last updated Saturday, March 9, 2024

A sampling of the scientific studies and reports relevant to water fluoridation published since the HHS 2015 recommendation to lower the fluoridation target to 0.7 ppm is listed below.


I suggest these items provide compelling evidence that 0.7 ppm is neither optimal nor safe and that any claims to the contrary are ill-founded. Moreover, protests that more study is required before banning fluoridation is a tacit endorsement of human experimentation without individual consent which is medical assault - Karen F. Spencer


JUICE: Iranian study of watermelon determined that the concentration of fluoride in the watermelon, a popular juice in the Middle East, was correlated with the fluoride concentration in the water source. Paper includes table of fluoride content in other non-animal foods identified by researchers in other countries with 21st century references. Authors advised that children between ages 4 and 9 were at highest risk of adverse fluoride effects from consumption of fluoride tainted food and juice which include neurotoxic effects, dental and skeletal fluorosis, and joint deformation. Authors identified a hazard quotient (HQ) of <1 mg/L. 

KIDNEY KILLER: Animal study describes the mechanisms whereby fluoride exposure damages and ultimately can kill kidney cells: “To sum up, excessive fluorine has a strong nephrotoxicity effect, disrupting the balance of mitochondrial fission and fusion, interfering with the process of mitochondrial fission, and then causing damage to renal tissue structure and apoptosis.”  

FETAL PROTEINS: Mass spectrometry analysis of cord blood samples from 2nd trimester women living in Californian communities with fluoride water concentrations at or below 0.9 ppm found unexpected effects on the fetal hematopoietic system. Nine blood proteins were significantly associated with serum fluoride concentration affecting fetal liver and hippocampal neurogenesis. This pilot study suggests fluoride-induced downregulation affecting multiple fetal systems should be an area of study and concern.

CNS & IMMUNITY: The microglia are the primary immune cells of the central nervous system (CNS). They are an inflammatory cell that attacks pathogens and remove debris from brain and spinal cord. This study validated that sodium fluoride provokes a classical response that results in fluoride-induced microglia damage. 

POINT OF DEPARTURE (PoD): Despite bias and inclusion of questionable material for analysis, such as pro-fluoride government reports and at least one study considered very low-quality, public health authors concluded that action should be taken due to evidence that supports fluoride exposure levels in North America can reduce IQ, cause thyroid and kidney dysfunction and cause dental fluorosis. Consequently, they suggest that the “point of departure” for setting safety guidelines should be 1.56 mg/L based on their determination of a LOAEL for dental fluorosis evidence for the purpose of establishing a reference dose and public health safety guidelines - ignoring the 0.179 mg/L PoD for IQ loss that the RSI authors calculated which is more precise measurement for a more critical endpoint using high quality data, albeit with more variability in the lower range. Regardless, applying a minimal safety factor of 10 would result in a MCLG of  0.156 ppm for fluoride in drinking water, which would end community fluoridation programs. 

MATERNAL THYROID: This MIREC study is the first to investigate sex differences in the association between fluoride exposure and maternal thyroid hormone levels in pregnancy. Most of the 1876 Canadian women were university educated, white and married. Women with thyroid disease or who were iodine deficient were excluded from the study. Women carrying female offspring had significantly higher TSH levels, which could provide a protective effect to the offspring which is dependent on maternal thyroid hormone throughout pregnancy. That effect could explain the results of other studies that found a significant developmental neurotoxic impact in males from fluoride exposure not seen in females. 

THYROID HORMONES: The authors of this systematic review of fluoride-thyroid studies found that although there is a general indication of detrimental effects of fluoride exposure which is biologically plausible given fluoride’s effect in animal studies and evidence of differing dose-response effects on T3 and T4 resulting in a U-shaped curve, there is still much that unknown. What is known is that 1) there is a consistent finding of a dose-dependent increase in TSH concentrations associated with consumption of drinking water above 2.5 mg/L of fluoride, and 2) certain populations and individuals are likely to have a heightened susceptibility to an adverse impact on thyroid function from fluoride exposure. 

COST-BENEFIT: Ten year retrospective cohort LOTuS study of 6.4 million United Kingdom 12 year-olds found “very small positive health effects which may not be meaningful for individuals” which is consistent with the findings of the 2022 CATFISH report.  This pragmatic assessment of the clinical effect and cost-effectiveness of existing water fluoridation schemes did not consider either municipal infrastructure costs or impact of dental fluorosis and other adverse effects on the population. 

BABY FORMULA: Spanish researchers tested 26 baby formulas. There were no ill effects or concern for risks noted when the formula was reconstituted with water with a fluoride concentration <0.1 ppm. However, with higher concentrations still considered “safe” by authorities, 100% of the infants received doses that grossly exceeded the allowable maximum doses putting them at risk for adverse effects. 

TOPICAL v. SYSTEMIC: Dental, legal and public health researchers concerned with risk:benefit wrote, “A significantly greater preventive effect of topical fluorides has been widely established in the recent past, as compared to systemic effects.”  They noted dental fluorosis as well as adverse bone and cognitive-behavioral effects from systemic exposure and recommended education and targeted topical treatments rather than high-risk “mass medication” fluoridation programs. They conclude that fluoridation is a thorny legal issue as it is state paternalism akin to compulsory vaccinations that collides with several “constitutional rights.” 

GENES & GENERATIONS: Mouse study designed in order to “define the role fluoride plays in fetal neurodevelopment’” and “to explain the trend of gene expression and the perturbation of metabolism in the mice brain upon fluoride uptake from maternal generation to maturity”  which reveals the “spectrum of the molecular mechanism of fluoride-induced changes in the nervous system.”  Authors concluded that fluoride exposure during pregnancy and lactation results in abnormal expression of genes with neurotoxic impact. 


INFLAMMATION: Children living in communities with water sources containing less than 1 ppm fluoride concentration are still vulnerable to inflammatory, immunological, and other non-skeletal bodily harm. Dental fluorosis (DF) is present even at these low exposures and seems to be sex- mediated. DF a visible sign of fluoride poisoning while young.

HYPOTHYROIDISM & PREGNANCY: Using multiple measures and gold-standard approaches to examine maternal fluoride exposure and thyroid function in a prospective pregnancy cohort receiving optimally fluoridated water, authors found that a 0.5 mg/L increase in drinking water fluoride concentration was associated with a 1.65 increased odds of primary hypothyroidism in pregnant women and that children born to women with primary hypothyroidism had lower FSIQ scores, particularly boys. The authors found no evidence of confounding by other environmental toxicants in this Canadian cohort (MIREC). Maternal urinary fluoride concentration was not associated with hypothyroidism, which may be due to fluctuations in exposure to fluoride from diet. Ultimately, the water concentration proved the more stable factor, and in fact water fluoridation is the primary source of exposure and consequently representative of body burden.

THRESHOLD: Researchers combined data from a Danish study where fluoridation is banned with North American studies where fluoridated water and salts are prevalent to determine a revised lowest adverse effect threshold for fluoride. The individual fluoride dosage for the 827 Danish children in the cohort was between .08 and 3.04 mg/L with a median of 0.52 mg/L. Authors concluded that individual vulnerability and genetic predisposition likely play a role in susceptibility and that fluoride may not affect all cognitive domains equally. Their findings:  “Given the combined observations on more than 1500 mother–child pairs, the overall BMC (benchmark concentration) results likely reflect a threshold for adverse cognitive effects of prenatal fluoride exposure that occur at levels prevalent in many countries,” and “When merged with data from two previous prospective studies at higher exposures, a revised BMCL (benchmark concentration level) fluoride concentration of about 0.3 mg/l in maternal pregnancy urine suggests that elevated fluoride intakes, whether from drinking water, black tea, or other sources, during pregnancy may require public health attention.”

DIABETES: Low levels of Vitamin D are linked to osteoporosis, bone fractures, hypertension, cardiovascular diseases, chronic kidney disease (CKD), and diabetes. This study found fluoride- induced insulin resistance and vitamin D deficiency lead to diabetes, and confirms fluoride exposure through drinking tap water with F-concentrations considered “safe” by US authorities is a risk factor for developing diabetes. The study demonstrate that vitamin D deficiency and fasting blood glucose levels (BGLs) are significantly associated with water fluoride levels. The authors recommend using safe water (bottled or purified) and vitamin D supplementation.

ECZEMA: Early-life exposure to fluoride is associated with atopic eczema, consistent with other observations of increased allergies and adverse impact of toxic metals on immunity.  

CENTRAL NERVOUS SYSTEM: This study review recognizes that fluoride is an environmental pollutant which crosses the blood-brain-barrier as well as having an adverse effect on hormones and organs. Although the authors didn’t find any studies that considered fluoride’s association with the growing incidence of pediatric brain tumors, the indirect evidence of fluoride’s effects on the central nervous system (CNS) is such that they urge research with a focus on the impact of fluoride on gliomas and other brain tumors.

BAD BONES: Animal study finds low dose equivalencies of human fluoride exposure inhibited the GPX activity and increased the MDA level to activate oxidative stress as well as impairing cancellous bone and causing redox imbalance.  

SYSTEMATIC REVIEW & META-ANALYSIS: Although there is no argument that fluoride exposure can result in dental and skeletal fluorosis, a structural defect, the impact on brains and bodies at current exposure levels is a source of controversy. The National Toxicology Program (NTP) reviewed the evidence of developmental neurotoxicity at concentrations considered optimal or safe by U.S. authorities. The NTP found that most studies suggested an adverse effect of fluoride exposure on children's IQ, starting at low levels of exposure.

ARSENIC, FLUORIDE & KIDNEYS: Alone and in combination, arsenic and fluoride change the microbiome in such a way that it results in nephrotoxic impact” “The   metabiome data showed that single and combined As and F exposure remarkably altered the serum metabolites…”

ORAL MICROBIOME: Two hundred students without cavities, oral health issues or other confounders were chosen from a college population with a dental fluorosis prevalence of 47%. Half were controls. Salivary microbiota was carefully analyzed: “Analyses of β diversity revealed significant differences between control individuals and dental fluorosis patients, while there was no significant difference in the saliva microbial diversity between patients with mild and moderate to severe dental fluorosis.” Gene expression, periodontitis and systemic lung or gut diseases are potential effects of the altered microbiome, regardless of severity of fluorosis.

TOPICAL: A randomized clinical trial of two topical fluoride treatments and a placebo found, “there were no statistically significant differences in preventing of approximal caries development between the semiannual application of 5%NaF, 38%SDF, or placebo.” This finding further calls into question the narrative promoted by dentists who profit from fluoride mythology.  

EXECUTIVE FUNCTION: Prenatal exposure to ‘optimally’ fluoridated water in 616 maternal-child pairs in Alberta Pregnancy Outcomes and Nutrition (APrON) study between 2009 and 2012 found prenatal fluoride exposure increased behavioral and cognitive deficits associated with executive function, including lack of inhibitory control. 

META-ANALYSIS: This meta-analysis “suggests that early exposure to fluoride may have neurotoxic effects on neurodevelopment affecting behavioral, cognitive and psychosomatic symptoms related to ADHD diagnosis.” Authors also mention the biological plausibility of such an effect as fluoride easily crosses the blood–brain barrier in prenatal and early life and concentrates in the brain areas responsible for memory and learning abilities as well as affects the metabolism and physiology of neuronal and glial cells through oxidative stress and can suppress thyroid function. 

DENTAL FLUOROSIS IN US: Using government data, pro-fluoride researchers confirm that dental fluorosis is affecting the majority of American children, and rising. The authors admit that they did not access who was consuming tap water. They also noted that fluoride tablet supplementation was self-reported and did not include duration. Researchers also admit that steps to reduce dental fluorosis are warranted. 

PROLONGED EXPOSURE & BRAIN DAMAGE:  Authors studied adolescent and adult male mice and found that even low F-exposure results in protein changes in the hippocampal region of the brain which can affect behavior, but that those changes are substantially different from the changes in that region at high exposure which are associated with cognitive changes. Also noted that higher exposures resulted in changes in neuron density. Authors suggest that prolonged long term adult exposure could be associated with degenerative neurological conditions like Alzheimers disease and that more research is required at different ages and durations of F-exposure at low levels.

DENTAL FLUOROSIS SYSTEMATIC REVIEW: Young children have the highest exposure to fluoride and retain 80% of the fluoride they consume. This population also has higher fluoride plasma concentration as compared to older populations. The authors note the various dental, skeletal, and biological adverse effects of fluoride and note that “it is essential to ensure that children have access to water that has not been treated with fluoride to lessen the likelihood that they will experience any adverse effects.”  

TAIWAN, TEA & ALLERGIES: Taiwan study of 562 school children found a urinary fluoride range of 0.03 to 2.08 mg/L, with a geometric mean of 0.32 mg/L with drinking water fluoride levels ranging from 0.02 to 0.14 mg/L. The primary exposure to fluoride is from tea consumption. There was no moderate to severe dental fluorosis among the study children and the children with mild fluorosis did not demonstrate significantly lower IQ, however those children did have significantly more allergies than their cohorts without dental fluorosis.

TEA: Variable and often high concentrations of fluoride and of aluminum in green and black teas pose a hidden health risk to consumers.  

OSTEOARTHRITIS IN KNEE: Even low exposure to fluoride almost triples the incidence of OA in knees (KOA). 

RAT POSION:  Animal study found higher urinary fluoride, bone fluoride and blood fluoride associated with oxidative stress and inflammatory factor levels as well as decreased learning and memory abilities in the dosed rats as compared to the control group. The fluoride-exposed rat brain tissue also had abnormal AchE and ChAT activity, sparsely arranged hippocampal neurons, blurred cell boundaries, significantly fewer astrocytes, and swollen cells. Furthermore, the nucleoli were absent from the fluoride-exposed rat brain tissue, which also contained folded neuron membranes, deformed mitochondria, absent cristae, vacuole formation, and pyknotic and hyperchromatic chromatin. Concludes, “there is no effective treatment method for the tissue damage caused by fluorosis.” 

AMERICAN WOMEN: NIH sponsored Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort study found Los Angeles women exposure to fluoride during pregnancy is the equivalent of Canadian & Mexican women in recent studies which found that exposure results in “poorer neurodevelopmental outcomes.” More lead and other metals in blood also correlated with higher fluoride exposure which is consistent with other studies. 

FLUOROSIS & INTELLIGENCE: Detailed study taking into account participant variables correlated dental fluorosis and IQ in 711 school-aged Chinese children. Authors found significantly more “dull normal and below” children  and “a decrease in superior intelligence” associated with dental fluorosis and excessive urinary fluoride consistent with findings of other studies.  Authors noted that dental and skeletal fluorosis are gradual degenerative illnesses that results from fluoride exposure over extended time periods.  

PEDIATRIC FRACTURES: Using CDC data, researchers determined higher rates of forearm and femur fractures among children between 4- and 10-years-old in fluoridated regions of America. Moreover, they wrote, "Fluoride levels had positive correlations with fracture rates for all fracture types” and encouraged more research. 

THYROID: Although the results are muddled in this systematic review and dose-response meta-analysis of primarily Asian studies, the authors wrote: “Fluoride may damage the proper functioning of the thyroid, interfering with Na/K-ATPase and with iodothyronine deiodinase, disrupting sensitive G-proteins of hormone receptors, mimicking TSH, and impairing T4 conversion into to T3, through effects on the enzymes catalyzing deiodination i.e., iodothyronine deiodinases Fluoride could also damage thyroid cells by determining mitochondrial swelling and disintegration, and by inducing DNA-RNA damage. It may also have adverse effects on thyroid cells and thyroid follicular morphology, altering thyroid structure.” 

VISUAL ACUITY, CARDIAC FUNCTION, SOCIO-EMOTIONAL FUNCTION: Using a large cohort (MIREC) of mother-child pairs in fluoridated and non-fluoridated Canadian communities, researchers determined that visual acuity and heart-rate variability affecting the cardiac autonomic nervous system (ANS) are adversely affected by pre-natal exposure to low doses of fluoride. “The ANS, which plays a critical role in maintaining homeostasis across organ systems, can be reliably assessed during the first postnatal year using measures of heart rate variability (HRV). Lower HRV is thought to reflect poorer ANS capacity to coordinate adaptive responses to situational demands/environmental challenges….(which are) associated with poorer socioemotional functioning, psychiatric risk and risk for adverse cardiometabolic outcomes across the lifespan.”

GUT BACTERIA & CHRONIC ILLNESS: Although the authors of this animal study were concerned with “high-dose” fluoride exposure, they noted that the metabolic and functional changes in rat intestinal microbiome were consistent with patterns observed in human pathologies of “autoimmunity, the kidneys, liver, nervous system, and reproductive development.” Furthermore, they recommended that the dose-response toxicity observed warrant further exploration in humans as “microbial community toxicity may represent the missing link between environmental exposure and microbial community-associated human diseases.” 

BRAIN CANCER: This detailed study by German scientists documents multiple adverse impacts of fluoride on body chemistry, organs and the central nervous system (CNS) consistent with patterns seen in oncology. The rising incidence of predominantly fatal pediatric brain cancers since circa 1980 combined with the well documented ability of fluoride to cross the blood-brain-barrier (BBB) resulting in an adverse impact on brain structure associated in various learning disabilities suggests that fluoride may indirectly promote the invasive potential of cancers such as pediatric gliomas.

ALZHEIMER’S DISEASE: Alzheimer’s Disease (AD) is a burgeoning global problem. This animal study explored different potential causations and specific effects in order to aid in the development of remedies. Sodium fluoride exposures at relatively low animal doses was found to create structural changes in the brain, cell death (apoptosis) and tissue damage (oxidative stress) consistent with progressive AD. 


CATFISH REPORT: Despite the optimistic assumption of the pro-fluoridation National Institute for Health who funded this comprehensive review of fluoridation schemes in Cumbria, England, researchers have found no significant improvement for the ‘poor children’ and indeed little if any dental benefit, with only 0.3 fewer cavities in baby teeth and 0.2 fewer cavities in permanent teeth among the children surveyed in fluoridated communities as compared to children in unfluoridated communities. This obviously translates into next to no economic benefit.

•       Goodwin M, Emsley R, Kelly MP, Sutton M, Tickle M, Walsh T, et al. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. Public Health Res 2022;10(11).

CWF, DIET, PREGNANCY & TOXICITY: “There may be a place for the use of topical fluoride, including silver diamine fluoride, to prevent and arrest dental caries but the use of community water fluoridation for the prevention of dental caries can no longer be considered to be safe.”

      Research report: The Dark Side of Fluoride. Amir Hossein Mahvi, Bruce Spittle. Fluoride 55(4):388-390 October-December 2022 

RIGHT QUESTION: Given the robust and consistent evidence regarding the developmental neurotoxic impact of fluoridation policy, the question that needs to be evaluated by communities should be: is this intervention worth the risk of lowering the IQ of at least certain individuals when we have a viable substitute, i.e. fluoridated toothpastes?

•       Vieira AR The Overlooked Individual: Susceptibility to Dental Caries, Erosive Tooth Wear and Amelogenesis. Monogr Oral Sci. Basel, Karger, 2022, vol 30, pp 140–148.


NUTRITION & POLITICS: Private interests played a significant role at the start of 1940s public health endorsements of “fluoride-supplemented high-carbohydrate nutritional guidelines.” This political effort biased scientific processes and required the reversals of three key scientific points in an absence of supporting evidence: 1) potential harms of fluoride exposure, 2) role of nutritional deficiencies in dental caries, and 3) that low-carbohydrate diets are recommended for dental caries prevention. This corrupted bias continues today: “The USDA and the WHO not only ignore the evidence that high-carbohydrate diets may lead to diseases other than dental caries, but also fail to prioritize high-quality evidence over low-quality evidence when writing their nutritional guidelines” per experts in evidence-based grading systems.

•       Hujoel, P.P. Private Interests and the Start of Fluoride-Supplemented High-Carbohydrate Nutritional Guidelines. Nutrients 2022, 14, 4263.


PAROTID GLANDS: Animal study finds fluoride exposure results in oxidative stress and changes in oxidative biochemistry of the largest salivary gland which stimulates compensatory mechanisms and increases risk to the complex cell cytoskeleton.

•       Miranda GHN, et al. Effects of long-term fluoride exposure are associated with oxidative biochemistry impairment and global proteomic modulation, but not genotoxicity, in parotid glands of mice. PLoS One. 2022 Jan 27;17(1):e0261252.

LOWER PERFORMANCE IQ: Examined children's IQ at three separate time points (age 4, 5, and 6–12 years) to determine longitudinal and domain specific effects of prenatal fluoride exposure on IQ in mother-child dyads from the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort. Found prenatal exposure to fluoride, which is primarily from fluoridated salt programs, is associated with sustained impacts on IQ. Non-verbal abilities may be more susceptible to impairment from prenatal fluoride exposure as compared to verbal abilities.

•       Goodman C, et al. Domain-specific effects of prenatal fluoride exposure on child IQ at 4, 5, and 6–12 years in the ELEMENT cohort. Environmental Research. 2022


IODINE & IQ: MIREC study of child-mother dyads finds “the association between prenatal fluoride exposure and full-scale intelligence previously identified in this cohort was exacerbated by low maternal iodine in pregnancy among boys. These results, which were found among mother-child pairs living in fluoridated and non-fluoridated communities in Canada, underscore the importance of sufficient iodine intake in pregnancy to minimize the neurotoxicity of fluoride in boys.”

•       Goodman CV, et al. Iodine Status Modifies the Association between Fluoride Exposure in Pregnancy and Preschool Boys’ Intelligence. Nutrients 2022, 14, 2920.


HISTORICAL CONTEXT: Senior former public health officer and research scientist who has been skeptical about fluoridation since the 1950s with a particular interest in kidneys reflects on science, law, and conversations with notable pro and anti personalities over the decades.

•       Taves, Donald R. (2022) Fluoride: From Nutrient to Suspected Neurotoxin. Nutrients 14, no. 17: 3507.


GENOTOXIC: According to public health authorities, fluoride has a narrow range between the concentration which is beneficial and that which has adverse effects. The primary exposure to the fluoride-ion is through drinking water supplemented with fluorosilicic acid (FA). FA in ‘safe’ doses causes DNA damage in human osteoblast cells, reduces the telomere length and induces oxidative stress. Although combinations of fluoride with other toxins could have a synergistic effect, this study found that FA alone affects the genomic integrity of human bone cells.

•       Garcia ALH, Matzenbacher CA, Soares S, Rohr P, da Silva J. Fluorosilicic acid and cotinine, separately and in combination, induce genotoxicity and telomeric reduction in human osteoblast cell line MG63. Mutat Res Genet Toxicol Environ Mutagen. 2022 Apr-May;876-877:503474.

PROBIOTICS: Adding probiotics to school milk is more effective and less costly than fluoride varnish in preventing cavities in children.

      Rodriguez GA, Cabello RA, Borroni CP, Palacio RA. Cost-effectiveness of probiotics and fluoride varnish in caries prevention in preschool children. J Public Health Dent. 2022 May 14.

ARTHRITIS, ENTHESITIS & PERIOSTITIS: Case study. Prolonged exposure to a fluoride containing drug resulted in fluoride deposition within the bone extracellular matrix, resulting in periostitis and arthritis. “Complete resolution of clinical symptoms with normalisation of the serum ALP occurred within four weeks of voriconazole cessation.”  

MALE FERTILITY: Fluoride, alone or in combination with arsenite both of which are common elements in drinking water, significantly suppressed the expression of steroidogenic enzymes and of the genes encoding these enzymes. “In conclusion, this study showed that exposure to As and F at environmentally relevant concentrations dispersed by water decreased testosterone production in Leydig cells, an important cell of the male reproductive system. The deleterious effects of even the lowest concentrations of As and F elements that can reach humans from the environment on the Leydig cell, and therefore on male infertility, emphasize necessity new safe limits for these elements.”

•       Orta Yilmaz B, Aydin Y. Disruption of Leydig cell steroidogenic function by sodium arsenite and/or sodium fluoride. Theriogenology. 2022 Sep 22;193:146-156.

FLUORIDE-INDUCED DEVELOPMENTAL NEUROTOXICITY: Animal study using in vivo and in vitro data finds several mechanisms where fluoride exposure induced learning and memory deficits in male offspring mice affecting structure, chemical function, and size.

      Li W, Lu L, Zhu D, Liu J, Shi Y, Zeng H, Yu X, Guo J, Wei B, Cai Y, Sun M. Gestational exposure to fluoride impairs cognition in C57 BL/6 J male offspring mice via the p-Creb1- BDNF-TrkB signaling pathway. Ecotoxicol Environ Saf. 2022 Jul 1.

BODY & BRAIN: “Fluoride in higher concentrations or continuous exposure to lower doses are both found to induce mental imbalance in animals apart from the genotoxic, immunotoxic, and cytotoxic effects commonly observed. The behavioral profile of fluoride-treated animals has corroborated the clinical symptoms seen in fluoride-poisoned humans.”

•       Ottappilakkil H, Babu S, Balasubramanian S, Manoharan S, Perumal E. Fluoride Induced Neurobehavioral Impairments in Experimental Animals: a Brief Review. Biol Trace Elem Res. 2022 Apr 30.


OVARIAN & TESTICULAR: Animal study from in utero through puberty showing adverse impact on reproductive function. “Approximately 80–90% of fluoride absorbed by infants and children accumulates in the body. It can enter into the umbilical cord blood of the child from the mother through the placenta. In addition, significantly high fluoride content in breast milk is indicative of fluoride exposure to infants. Young children show less resistance to the toxic effects of fluoride than adults because of under-developed defense mechanisms and highly permeable blood-brain barrier.”

•       Li, W., Sun, Z., Li, M. et al. Exposure to Fluoride From in Utero to Puberty Alters Gonadal Structure and Steroid Hormone Expression in Offspring Rats. Biol Trace Elem Res (2022).


BIRTH ANTHROPOMETRY: Using ELEMENT cohort, authors determined maternal exposure to fluoride affects length and weight of newborns with different susceptibility windows. Advises women avoid fluoride during pregnancy.

•       Ortíz-García SG, Torres-Sánchez LE, Muñoz-Rocha TV, Mercado-García A, Peterson KE, Hu H, Osorio-Yáñez C, Téllez-Rojo MM. Maternal urinary fluoride during pregnancy and birth weight and length: Results from ELEMENT cohort study. Sci Total Environ. 2022 Jun 2.


KIDNEY KILLER: Using U.S. NHANES data, finds water fluoridation results in significantly higher plasma fluoride levels in healthy teens with lower renal function, suggesting a vicious feedback loop for those with CKD.

•       John Danziger, Laura E.Dodge, Howard Hu. Role of renal function in the association of drinking water fluoride and plasma fluoride among adolescents in the United States: NHANES, 2013–2016. Environmental Research. 7 June 2022.


SKELETAL FLUOROSIS: Summary of the adverse effects of < 0.7 mg/L exposure on skeletal and non-skeletal systems finds “low fluoride can indeed cause damage to human health. As a consequence, it is necessary to formulate the more appropriate water fluoride standard by taking into account the effects of low fluoride on various bodily systems. In addition, more and more evidence suggest that there exist individual differences in the effect of low fluoride on the body… most likely due to genetic polymorphisms. Therefore, it is necessary to consider both environmental exposure and the actual genetic situation of the individuals with respect to fluoride exposure.”

•       Zhou J, Sun D, Wei W. Necessity to Pay Attention to the Effects of Low Fluoride on Human Health: an Overview of Skeletal and Non-skeletal Damages in Epidemiologic Investigations and Laboratory Studies. Biol Trace Elem Res. 2022 Jun 6.

BRAIN CONNECTION: Dental fluorosis (DF) is a structural tooth defect associated with a structural brain defects, i.e. “abnormal brain structure and brain function” which impacts concentration, learning, and memory, as well as increasing mental symptoms such as anxiety, tension, and depression.

•       Ren C, Li HH, Zhang CY, Song XC. Effects of chronic fluorosis on the brain. Ecotoxicol Environ Saf. 2022 Aug 29;244:114021.


FLUORIDE-INDUCED LIVER INJURY: Animal study validates fluoride disrupted the glycolipid metabolism in the liver and resulted in the differential expression of 35 miRNAs and 480 mRNAs.

•       Zhao Y, Yu Y, Ommati MM, Xu J, Wang J, Zhang J, Sun Z, Niu R, Wang J. Multiomics Analysis Revealed the Molecular Mechanism of miRNAs in Fluoride-Induced Hepatic Glucose and Lipid Metabolism Disorders. J Agric Food Chem. 2022 Oct 12.


NOT BENEFICIAL: Dental fluorosis (DF) is a qualitative defect in enamel from fluoride exposure early in life. DF is associated with other systemic conditions i.e. cognitive deficits, bone problems, thyroid disorders, etc. Significant incidences of DF are found in areas with 0.25 ppm fluoride in water concentration. Remineralization without fluoride exposure is advisable.

•       Strużycka I,et al. Assessing Fluorosis Incidence in Areas with Low Fluoride Content in the Drinking Water, Fluorotic Enamel Architecture, and Composition Alterations. Int J Environ Res Public Health. 2022 Jun 10;19(12):7153.


GENETIC SUSCEPTIBILITY: “In conclusion, there are alleles and genotypes of different single nucleotide polymorphisms involved in increasing or decreasing the risk of developing dental fluorosis.”

•       González-Casamada C, Nevarez-Rascón M, Nevarez-Rascón A, et al. Single Nucleotide Polymorphisms and Dental Fluorosis: A Systematic Review. Dent J (Basel). 2022 Nov 6;10(11):211.


FEMALE GUTS: Animal study details the process whereby fluoride exposure damages intestinal cells in the absence of estrogen which is consistent with a pattern of increased gastrointestinal illness among post-menopausal women in fluoridated communities.

•       Jin Y, Gao XY, Zhao J, Tian WS, Zhang YL, Tian EJ, Zhou BH, Wang HW. Estrogen deficiency aggravates fluoride-induced small intestinal mucosa damage and junctional complexes proteins expression disorder in rats. Ecotoxicol Environ Saf. 2022 Oct 14;246:114181.

INFLAMMATION: Using US NHANES data on children and animal studies, authors determined that fluoride exposure of typical children can and does result in inflammatory responses affecting immune function and disrupting white blood cell (WBC) function resulting in tissue damage.

•       Den Besten P, Wells CR, Abduweli Uyghurturk D. Fluoride exposure and blood cell markers of inflammation in children and adolescents in the United States: NHANES, 2013-2016. Environ Health. 2022 Oct 27;21(1):102.


DOSE IN FOOD: Finds that fluoride exposure from foods prepared with fluoridated water have heavy fluoride concentrations not previously suspected that may exceed exposure from drinking water, dependent on dietary habits. Proposes reduction in fluoride exposure especially critical for low weight populations, such as infants, children and the frail.

•       Sawangjang B, Takizawa S. Re-evaluating fluoride intake from food and drinking water: Effect of boiling and fluoride adsorption on food. J Hazard Mater. 2022 Oct 12.

BLOOD PRESSURE: “This study suggested that fluoride exposure may affect childhood blood pressure.”

•   Guo M, Afrim FK, Li Z, Li N, Fu X, Ding L, Feng Z, Yang S, Huang H, Yu F, Zhou G, Ba Y. Association between fluoride exposure and blood pressure in children and adolescents aged 6 to19 years in the United States: NHANES, 2013-2016. Int J Environ Health Res. 2022 Feb 15:1-11.


LOW BIRTH WEIGHT & ENVIRONMENTAL JUSTICE: “Our findings suggest a significant association between excess water fluoride exposure (>0.7 ppm) and LBW weight in Hispanic women, independent of established LBW risk factors.” The EPA MCL/MCLG is 4 ppm.

•   Arun AK, Rustveld L, Sunny A. Association between Water Fluoride Levels and Low Birth Weight: National Health and Nutrition Examination Survey (NHANES) 2013-2016. Int J Environ Res Public Health. 2022 Jul 23;19(15):8956

EPA FAILURE & TSCA: Does not mention fluoride, but focuses on organizational patterns that result in greater risk and actual harm from chemical exposure to susceptible subpopulations. 


BENCHMARK DOSE ANALYSIS: Using fluoride studies from MIREC and ELEMENT projects as input, the results of which are consistent with other studies, authors identify 0.2 mg/L as having an adverse impact on neurodevelopment. “The prospective studies offer strong evidence of prenatal neurotoxicity, and the benchmark results should inspire a revision of water-fluoride recommendations aimed at protecting pregnant women and young children.”

•       Grandjean P, Hu H, Till C, Green R, Bashash M, Flora D, Tellez-Rojo MM, Song P, Lanphear B, Budtz-Jørgensen E. A Benchmark Dose Analysis for Maternal Pregnancy Urine-Fluoride and IQ in Children. Risk Analysis. 8 June 2021.

LIFETIME EXPOSURE: Fluoridation is the primary source of fluoride exposure for 1,629 Canadians between 3 and 79 that finds substantially higher lifetime fluoride exposure in fluoridated communities using CHMS data, increasing with age. Vulnerable subpopulations to adverse effects of fluoride noted as the young, those who are iodine deficient, and post- menopausal women.

•       Julia K. Riddell, Ashley J. Malin, Hugh McCague, David B. Flora, and Christine Till. Urinary Fluoride Levels among Canadians with and without Community Water Fluoridation. Int. J. Environ. Res. Public Health 2021, 18(12), 6203.

DF & COGNITION: Indian study finds significant relationship between impaired cognition and dental fluorosis in children.

•       Prabhakar A, Abdulkhayarkutty K, Cheruvallil SV, Sudhakaran P. Effect of Endemic Fluorosis on Cognitive Function of School Children in Alappuzha District, Kerala: A Cross Sectional Study. Ann Indian Acad Neurol. 2021 Sep-Oct;24(5):715-720.


KIDNEYS: This study of 1,070 adults found every 1 mg/L increment in the urinary fluoride concentrations was associated with significant increases of 22.8% in the risk of kidney function injury after adjusting for potential confounding factors. Authors conclude that long-term fluoride exposure is associated with compromised kidney function in adults, and that urinary NAG is a sensitive and robust marker of kidney dysfunction caused by fluoride exposure.

•       Wu L, Fan C, Zhang Z, Zhang X, et al. Association between fluoride exposure and kidney function in adults: A cross-sectional study based on endemic fluorosis area in China. Ecotoxicol Environ Saf. 2021 Aug 31;225:112735.

BEHAVIORAL CHANGES: Children in Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) assessed at age 12. Boys in particular did not experience significant anxiety or depression, yet had somatic behaviors based on their childhood urinary fluoride (CUF) concentrations, “seven times more likely to exhibit ‘at-risk’ internalizing symptomology.”

•       Adkins EA, Yolton K, Strawn JR, Lippert F, Ryan PH, Brunst KJ. Fluoride exposure during early adolescence and its association with internalizing symptoms. Environ Res. 2021 Oct 29:112296.


DENTAL FLUOROSIS; “The prevalence of dental fluorosis was 70% in the U.S. children and adolescents in survey of NHANES 2015–2016.”

•       Dong H, Yang X, Zhang S, Wang X, Guo C, Zhang X, Ma J, Niu P, Chen T. Associations of low level of fluoride exposure with dental fluorosis among U.S. children and adolescents, NHANES 2015-2016. Ecotoxicol Environ Saf. 2021 Sep 15;221:112439.


CRITICAL WINDOWS: Using urine samples and test scores from 596 mother-child Canadian pairs in the MIREC prospective cohort, researchers found evidence that developmental neurological damage was based on timing of fluoride exposure and gender, “Associations between fluoride exposure and PIQ (performance IQ) differed based on timing of exposure. The prenatal window may be critical for boys, whereas infancy may be a critical window for girls.”

•       Farmus L, Till C, Green R, Hornung R, Martinez-Mier EA, Ayotte P, Muckle G, Lanphear B, Flora D. Critical Windows of Fluoride Neurotoxicity in Canadian Children. Environ Res. 2021 May 26:111315.


GENES: Several genes make individuals more vulnerable to the neurotoxic impact with gender differences, also affecting mitochondria and suggesting vulnerability to dementia. Chinese study of 952 school children between 7 and 13 using water, urinary, hair and nail fluoride identified multiple neurodevelopmental metabolic pathways that result in adverse effects from low fluoride exposures.

•       Yu X, Xia L, Zhang S, et al. Fluoride exposure and children's intelligence: Gene-environment interaction based on SNP-set, gene and pathway analysis, using a case-control design based on a cross-sectional study. Environ Int. 2021 Jun 4;155:106681.


GENETIC VULNERABILITY: Dopamine relative genes affect the susceptibility of individuals to fluoride toxicity even in safe water concentrations which result in lowered IQ so that “low- moderate fluoride exposure is inversely related to children’s IQ.”

•       Zhao L, Yu C, Lv J, et al. Fluoride exposure, dopamine relative gene polymorphism and intelligence: A cross-sectional study in China. Ecotoxicology and Environmental Safety. 2021 Feb;209:111826.


BRITTLE BONES: “In this cohort of postmenopausal women, the risk of fractures was increased in association with two separate indicators of fluoride exposure. Our findings are consistent with RCTs and suggest that high consumption of drinking water with a fluoride concentration of ∼1 mg/L may increase both BMD (bone mineral density) and skeletal fragility in older women.”

•       Helte E, Donat Vargas C, Kippler M, Wolk A, Michaëlsson K, Åkesson A. Fluoride in Drinking Water, Diet, and Urine in Relation to Bone Mineral Density and Fracture Incidence in Postmenopausal Women. Environ Health Perspect. 2021 Apr;129(4):47005.

OSTEOARTHRITIS: Identifies fluoride as an environmental chemical that has adverse effects on articular cartilage and osteoarthritis (OA) risk. “In full sample analysis, a 1 mg/L increase in UF (urinary fluoride) level was associated with a 27% higher risk of OA.”

•       Sowanou, A., Meng, X., Zhong, N. et al. Association Between Osteoarthritis and Water Fluoride Among Tongyu Residents, China, 2019: a Case–Control of Population-Based Study. Biol Trace Elem Res (2021).


NO BENEFIT FOR PRESCHOOLERS: Polish study finds ‘optimal’ fluoride concentrations in water provide no dental benefit. Dental caries experience depended on oral hygiene and diet.

•       Opydo-Szymaczek J, et al. Fluoride exposure and factors affecting dental caries in preschool children living in two areas with different natural levels of fluorides. Journal of Trace Elements in Medicine and Biology. Volume 65. 2021.


REPRODUCTIVE HEALTH: “Median (IQR) water and plasma fluoride levels were 0.48 (0.53) mg/L and 0.34 (0.30) µmol/L respectively. An IQR increase in water fluoride was associated with a 3.3 month earlier first menstrual period (B= -0.28, 95%CI: -0.54, -0.02, p = 0.05). Additionally, we observed a significant interaction between plasma fluoride and race/ethnicity in association with age of menarche (p = 0.01). For non-Hispanic black females, each IQR increase in plasma fluoride was associated with a 5-month earlier age of menarche (B=-0.42, 95%CI: -0.61, -0.23, p < 0.001).”

•   Fluoride exposure and reproductive health among adolescent females in the United States: NHANES 2013-2016. A. J. Malin, S. A. Busgang, J. C. Garcia, P. Curtin, and A.P. Sanders. ISEE National Meeting Presentation. Environmental Health Perspectives. 23-26 August 2021.


ALTERNATIVE: This systematic review and meta-analysis concludes that biomimetic hydroxyapatite-containing, fluoride-free oral care products are effective in reducing dental decay, especially in children without the risk of dental fluorosis and neurotoxicity inherent in topical use of fluoridated products.

•       Hardy Limeback, BSc, PhD, DDS; Joachim Enax, Dr; Frederic Meyer, Dr. Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis. | Can J Dent Hyg 2021;55(3): 148-159.


AMERICAN KIDNEYS: Using U.S. NHANES data from two recent cycles, finds ‘optimal’ amounts of fluoridated water results in high incidence of uric acid in adolescents suggesting higher risk of kidney disease and other illnesses. Identifies dose-response trend in plasma fluoride of teens.

•       Yudan Wei, Jianmin Zhu, Sara Ann Wetzstein. Plasma and water fluoride levels and hyperuricemia among adolescents: A cross-sectional study of a nationally representative sample of the United States for 2013–2016. Ecotoxicology and Environmental Safety. Volume 208. 15 January 2021.

TODDLERS: The Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort included 948 mother-child pairs from Mexico City. Blinded testing of children between one and 24 months to examine associations between maternal fluoride intake from food and beverages during pregnancy and offspring neurodevelopment in this prospective and longitudinal study found, “higher exposure to fluoride from food and beverage consumption in pregnancy was associated with reduced cognitive outcome, but not with language and motor outcome in male offspring over the first two years of life.”

•       Alejandra Cantoral, Martha M. Tellez-Rojo, Ashley J. Malin, Lourdes Schnaas d, ErikaOsorio-Valencia, Adriana Mercadob, E. Angeles Martínez-Mier, Robert O. Wright, Christine Till. Dietary fluoride intake during pregnancy and neurodevelopment in toddlers: A prospective study in the progress cohort. Neurotoxicology 87 (2021) 86–93.


CNS: Study of Chinese children consuming water with the low to moderate concentrations of fluoride considered safe by the US EPA determines that fluoride exposure was associated with the alteration of cholinergic system, dental fluorosis, IQ, and AChE, i.e the central nervous system is adversely impacted concurrent with fluoride exposure which also causes tooth defects and measurable deficits in cognition.

•       Wang S, Zhao Q, Li G, Wang M, Liu H, Yu X, Chen J, Li P, Dong L, Zhou G, Cui Y, Wang M, Liu L, Wang A. The cholinergic system, intelligence, and dental fluorosis in school-aged children with low-to-moderate fluoride exposure. Ecotoxicol Environ Saf. 2021 Nov 20;228:112959.


NO SAFE DOSE: Study of Mexican children and their mothers using measurements of urinary fluoride and water concentrations associated dental fluorosis and lowered IQ with fluoride dose consistent with findings of larger studies in other countries. Authors declare WHO fluoride guidelines are unsafe and hypothesize that 0.045 F- mg/day is a protective exposure

•       Farías P, Estevez-García JA, Onofre-Pardo EN, Pérez-Humara ML, Rojas-Lima E, Álamo- Hernández U, Rocha-Amador DO. Fluoride Exposure through Different Drinking Water Sources in a Contaminated Basin in Guanajuato, Mexico: A Deterministic Human Health Risk Assessment. International Journal of Environmental Research and Public Health. 2021; 18(21):11490.


BABY BRAIN POISON: Exposure to fluoridated water (10 mg/L & 50 mg/L) beginning on the first day of pregnancy and continuing through the last day of breastfeeding shows chemical imbalances, cellular damage and changes in the hippocampus of Wistar rat offspring that would affect neurological development.

•       Ferreira MKM, Aragão WAB, Bittencourt LO, Puty B, Dionizio A, Souza MPC, Buzalaf MAR, de Oliveira EH, Crespo-Lopez ME, Lima RR. Fluoride exposure during pregnancy and lactation triggers oxidative stress and molecular changes in hippocampus of offspring rats. Ecotoxicology and Environmental Safety. 2021 Jan 15;208:111437.


BAD TEETH - BAD BRAIN: Chinese study confirm 1.6 ppm v. 0.1 ppm results in children with both damaged teeth and lower IQ. Authors validate that fluoride affects thyroid function, neurotransmitters and mitochondrial energy enzymes. There were no students with low IQ found in the area with low F level. There was high IQ among the 96.6% of the students who did not experience fluorosis.

•       Yani SI, Seweng A, Mallongi A, et al. The influence of fluoride in drinking water on the incidence of fluorosis and intelligence of elementary school students in Palu City. Gac Sanit. 2021;35 Suppl 2:S159-S163.

GUTS & BRAINS: Memory function was reduced and gut microbiota structure was significantly altered in fluoride-exposed mice.

•       Xin J, Wang H, Sun N, Bughio S, Zeng D, Li L, Wang Y, Khalique A, Zeng Y, Pan K, Jing B, Ma H, Bai Y, Ni X. Probiotic alleviate fluoride-induced memory impairment by reconstructing gut microbiota in mice. Ecotoxicol Environ Saf. 2021 Jun 1;215:112108


INFLAMED GUTS: Exposure to fluoridated water at both doses (10 mg/L & 50 mg/L) inflame guts in rats and alters the gut microbiome as compared to control (0 mg/L).

•       Dionizio A, Uyghurturk DA, Melo CGS, Sabino-Arias IT, Araujo TT, Ventura TMS, Perles JVCM, Zanoni JN, Den Besten P, Buzalaf MAR. Intestinal changes associated with fluoride exposure in rats: Integrative morphological, proteomic and microbiome analyses. Chemosphere. 2021 Jan 11;273:129607.


PUBERTY: Black girls consuming optimally fluoridated water have earlier menarche.

•       Malin, A.J., Busgang, S.A., Garcia, J.C. et al. Fluoride Exposure and Age of Menarche: Potential Differences Among Adolescent Girls and Women in the United States. Expo Health (2021).


HARMFUL ADEQUATE INTAKE (AI): Study found "the levels of dietary F- intake were below the current AI, were greater towards the end of gestation and in women who were moderately and highly compliant with Mexican dietary recommendation” in ELEMENT cohort and recommended changing future dietary recommendations due to evidence of developmental neurotoxicity at even low dose exposure.

•       Castiblanco-Rubio, G., Muñoz-Rocha, T., Cantoral, A., Téllez-Rojo, M., Ettinger, A., Mercado-García, A., Peterson, K.E., Hu, H., Martínez-Mier, E. (2021). Dietary Fluoride Intake Over the Course of Pregnancy in Mexican Women. Public Health Nutrition, 1-25.


CALCIUM & FLUORIDE IN PREGNANCY: Calcium intake during pregnancy lowers urinary fluoride (UF) concentrations by some unknown mechanism in ELEMENT cohort.

•       Castiblanco-Rubio GA, Muñoz-Rocha TV, Téllez-Rojo MM, Ettinger AS, Mercado-García A, Peterson KE, Hu H, Cantoral A, Martínez-Mier EA. Dietary Influences on Urinary Fluoride over the Course of Pregnancy and at One-Year Postpartum. Biol Trace Elem Res. 2021 Jun 26.


SAFETY: Evidence of dental fluorosis and other adverse effects to bodies and brains from supposed safe concentrations is alarming. “The safety of public health approach of drinking water fluoridation for global dental caries reduction are urgently needed further research.”

•       Dong H, Yang X, Zhang S, Wang X, Guo C, Zhang X, Ma J, Niu P, Chen T. Associations of low level of fluoride exposure with dental fluorosis among U.S. children and adolescents, NHANES 2015-2016. Ecotoxicol Environ Saf. 2021 Jun 22;221:112439.


SKELETAL FLUOROSIS: This Chinese study of the pathogenetic progression of skeletal fluorosis, details how local signaling pathways, hormones, promoter DNA hypermethylation, RNA expression etc. are affected by fluoride exposure leading to pain and disability.

•       Qiao L, Liu X, He Y, Zhang J, Huang H, Bian W, Chilufya MM, Zhao Y, Han J. Progress of Signaling Pathways, Stress Pathways and Epigenetics in the Pathogenesis of Skeletal Fluorosis. International Journal of Molecular Sciences. 2021; 22(21):11932.

DEPRESSION: Animal study finds negative changes in brain structure and behavior with exposure to sodium fluoride (NAF).

•       Zhou G, Hu Y, Wang A, Guo M, Du Y, Gong Y, Ding L, Feng Z, Hou X, Xu K, Yu F, Li Z, Ba Y. Fluoride Stimulates Anxiety- and Depression-like Behaviors Associated with SIK2-CRTC1 Signaling Dysfunction. J Agric Food Chem. 2021 Nov 4. PMID: 34735150.


OLD PEOPLE: Chinese study using individual measure of blood fluoride finds those consuming fluoride in water at or above 2 ppm as compared to those in areas with <0.8 ppm are more likely to suffer cognitive decline and dementia. The US EPA certifies that up to 4 ppm is safe.

•       Ren C, Zhang P, Yao XY, Li HH, Chen R, Zhang CY, Geng DQ. The cognitive impairment and risk factors of the older people living in high fluorosis areas: DKK1 need attention. BMC Public Health. 2021 Dec 9;21(1):2237.


DECEPTION: This historical analysis documents how the ADA suppressed the established science that vitamin D was necessary for healthy teeth and bones in order to promote falsely fluoride which was and is more profitable for their membership. “Public health may well depend on looking at professional societies no different than the way we look at the pharmaceutical industry—conflicted organizations with a power to shape conventional wisdom based on fragile evidence.”

•       Hujoel PE. How a Nutritional Deficiency Became Treated with Fluoride. Nutrients. 2021.


AMERICAN FETAL EXPOSURE: Study on pregnant women in California and Montana find, “Fluoride concentrations in urine, serum, and amniotic fluid from women were positively correlated to public records of community water fluoridation” and that concentration is consistent with findings of Canadian studies that find these concentrations are associated with increased learning disabilities and lower IQ in offspring.

•       Abduweli Uyghurturk D, Goin DE, Martinez-Mier EA, Woodruff TJ, DenBesten PK. Maternal and fetal exposures to fluoride during mid-gestation among pregnant women in northern California. Environ Health. 2020 Apr 6;19(1):38.


THYROID & IQ: Concentrations of fluoride in drinking water considered optimal and safe in the US result in altered thyroid function and lowered IQ in Chinese children.

•       Wang M, Liu L, Li H, et al.Thyroid function, intelligence, and low-moderate fluoride exposure among Chinese school-age children. Environment International. Volume 134, January 2020.


BLOOD: Canadian Health Measures Survey (CHMS) collects extensive biomonitoring data used to assess the exposure of Canadians to environmental chemicals finds higher fluoride in urine associated with significantly higher blood lead, urinary lead, etc. Also finds urinary selenium is significantly lower in fluoridated Canadian communities, “this is the first study where biomonitoring data from multiple cycles of CHMS were combined in order to generate robust estimates for subsets of the Canadian population. Such assessments can contribute to a regional-level prioritization of control measures to reduce the exposure of Canadians to chemicals in their environment.”

•       Valcke M, Karthikeyan S, Walker M, Gagné M, Copes R, St-Amand A. Regional variations in human chemical exposures in Canada: A case study using biomonitoring data from the Canadian Health Measures Survey for the provinces of Quebec and Ontario. Int J Hyg Environ Health. 2020 Jan 20;225:113451.

OVERDOSED CANADIAN BABIES: MIREC study documents Canadian bottle-fed babies have lower IQ in optimally fluoridated communities compared to babies in non-fluoridated communities. Study also found breast-fed babies have extremely low F exposure and significantly higher IQ even after controlling for fetal fluoride exposure.

•       Till C, Green R, Flora D, Hornung R, Martinez-Miller EA, Blazer M, Farmus L, Ayotte P, Muckle G, Lanphear B. Fluoride exposure from infant formula and child IQ in a Canadian birth cohort. Environment International. 2020.

BIASED NARRATIVES: Canadian researchers comment on “expert” attacks on the high quality studies that contradict the dental CWF narrative, i.e. political suppression of scientific facts.

•       Till, C., Green, R. Controversy: The evolving science of fluoride: when new evidence doesn’t conform with existing beliefs. Pediatr Res (2020).


BONE HEALTH: Low to moderate fluoride exposure weakens and damages bones in women.

•       Minghui Gao et al, Association between low-to-moderate fluoride exposure and bone mineral density in Chinese adults: Non-negligible role of RUNX2 promoter methylation. Ecotoxicology and Environmental Safety. Volume 203, 15 October 2020.


BONES: Found an age-specific association between fluoride exposure and altered CALCA methylation in adult women, affecting bone health.

•       Sun R, Zhou G, Liu L, Ren L, Xi Y, Zhu J, Huang H, Li Z, Li Y, Cheng X, Ba Y. Fluoride exposure and CALCA methylation is associated with the bone mineral density of Chinese women. Chemosphere. 2020 Aug;253:126616.


SEX HORMONES IN FLUORIDATED US: “The data indicated gender- and age-specific inverse associations of fluoride in plasma and water with sex steroid hormones of total testosterone, estradiol and SHBG in U.S. children and adolescents.”

•       Bai, R., Huang, Y., Wang, F., & Guo, J. (2020). Associations of fluoride exposure with sex steroid hormones among U.S. children and adolescents, NHANES 2013–2016. Environmental Pollution, 114003


NERVOUS SYSTEM: The enteric nervous system (ENS) is called the second brain and governs the gastrointestinal track. Includes dopamine & serotonin function. Study finds “fluoride exposure during pregnancy and lactation might induce ENS developmental defects.”

•       Sarwar, S., Quadri, J.A., Kumar, M. et al. Apoptotic and Degenerative Changes in the Enteric Nervous System Following Exposure to Fluoride During Pre- and Post-natal Periods. Biol Trace Elem Res (2020).


ENDOCRINE SYSTEM REVIEW: The endocrine system includes the pineal gland, hypothalamus, pituitary gland, thyroid with parathyroid glands, thymus, pancreas (partial endocrine function), adrenal glands, as well as male and female gonads (testes and ovaries) which are adversely effected by exposure to fluoride.

•       Marta Skórka-Majewicz et al, Effect of fluoride on endocrine tissues and their secretory functions -- review. Chemosphere, Volume 260, December 2020, 127565.


PINEAL GLAND & MELATONIN: Fluoride calcifies the pineal gland and interferes with enzyme function, hormones and sleep patterns.

•       Dariusz Chlubek, Maciej Sikora. Fluoride and Pineal Glad. Applied Sciences. 22 April 2020

WHO IGNORES KIDNEYS: WHO guidelines of safety below 1.5 ppm fluoride concentration is wrong. “The available guidelines for drinking water are solely based on healthy populations with normal renal function. But, it is evident that once the kidney function is impaired, patients enter a vicious cycle as fluoride gradually accumulates in the body, further damaging the kidney tissue.”

•       Shanika Nanayakkara, et al. The Influence of fluoride on chronic kidney disease of uncertain aetiology (CKDu) in Sri Lanka. Chemosphere. Volume 257, October 2020, 127186


PEDIATRIC BONE DISEASE: Identifies fluoride concentrations in water above 1.2 ppm as “dangerously high” that can cause pediatric bone disease. Urine measurements of fluoride in those afflicted are below the fluoride concentrations in women living in optimally fluoridated communities per 2017 Canadian study by Green et al.

•       Nipith Charoenngam, Muhammet B Cevik, Michael F Holick. Diagnosis and management of pediatric metabolic bone diseases associated with skeletal fragility. Curr Opin Pediatr. 2020 Aug;32(4):560-573.


EPA ON ENVIRONMENTAL STRESS: EPA authors find that exposure to fluoride has the greatest adverse impact on cognitive ability in children, even more than lead.

•       Frances M. Nilsen, Jazmin D.C. Ruiz and Nicolle S. Tulve. A Meta-Analysis of Stressors from the Total Environment Associated with Children’s General Cognitive Ability. Int. J. Environ. Res. Public Health 2020, 17(15), 5451.



differed from PROGRESS in that “daily food and beverage fluoride intake was not associated with CUF in PROGRESS” but study “found that CUF (child urinary fluoride) levels are comparable among children in Mexico City and fluoridated Canadian communities, despite distinct sources of exposure. “

      Green, R., Till, C., Cantoral Preciado, A. D. J., Lanphear, B., Angeles Martinez-Mier, E., Ayotte, P., Wright, R. O., Tellez-Rojo, M. M., & Malin, A. J. (2020). Associations between urinary, dietary, and water fluoride concentrations among children in Mexico and Canada. Toxics, 8(4), 1-11. [110].


SPERM MOTILITY: Animal study determines mechanisms how fluoride exposure lowers sperm quality and male reproductive function.

•       Liang C, He Y, Liu Y, Gao Y, Han Y, Li X, Zhao Y, Wang J, Zhang J. Fluoride exposure alters the ultra-structure of sperm flagellum via reducing key protein expressions in testis. Chemosphere. 2020 May;246:125772.


DENTAL FLUOROSIS & CWF CESSATION: Dental literature review by dentists finds “a significant decrease in the prevalence of fluorosis post cessation or reduction in the concentration of fluoride added to the water supply.”

•       Nor Azlida Mohd Nor, Kuala Lumpur, Barbara L. Chadwick, Damian JJ. Farnell, Ivor G. Chestnutt. The impact of stopping or reducing the level of fluoride in public water supplies on dental fluorosis: a systematic review. Reviews on Environmental Health. 2020.

PREECLAMPSIA: Indian study finds that although some individuals are more susceptible to fluoride toxicity than others, fluoride exposure is significantly associated with preeclampsia. Authors also note that fluoride accumulates in the placenta, is found in cord blood and crosses into the fetus where it has other ill effects. Authors suggest that routine monitoring of fluoride in maternal serum is wise as the fluoride level serves a strong predictor of preeclampsia, a complex and potentially fatal condition for mother and child. 


SLEEP & PINEAL GLAND: ”Chronic low-level fluoride exposure may contribute to changes in sleep cycle regulation and sleep behaviors among older adolescents in the US.”

•       Malin, A.J., Bose, S., Busgang, S.A. et al. Fluoride exposure and sleep patterns among older adolescents in the United States: a cross-sectional study of NHANES 2015–2016. Environ Health 18, 106 (2019)


ADHD: Youth in optimally fluoridated Canadian communities are almost 3 times more likely to be diagnosed with ADHD and have significantly higher rates of other learning disabilities as compared to their counterparts in non-fluoridated communities on a dose-response trend line.

•       Riddell JK, et al. Association of water fluoride and urinary fluoride concentrations with attention deficit hyperactivity disorder in Canadian youth. Environment International. Volume 133, Part B, December 2019.


ASD: Increased exposure to fluoride is associated with higher incidence of ASD in regions with fluoridated water or endemic fluorosis. Based on biological plausibility and incidence, authors hypothesize that increased fluoride exposure is an environmental risk factor for autism.

•       Strunecka A, Strunecky O. Chronic Fluoride Exposure and the Risk of Autism Spectrum Disorder. Int. J. Environ. Res. Public Health 2019, 16(18), 3431.


PRENATAL: Three measurements in high quality NIH sponsored prospective cohort study (MIREC) found significantly lowered IQ in offspring of mostly white, well-educated Canadian women living in ‘optimally’ fluoridated communities.

•       Green R, Lanphear B, Hornung R, et al. (2019) Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatrics. 2019.


KIDNEY & LIVER: Researchers at Mt. Sinai Medical School find American teens in optimally fluoridated American towns have markers for altered kidney & liver parameters that puts them at higher risk for kidney & liver disease as adults. Notes the primary source of fluoride is water.

•       Malin AJ, Lesseur C, Busgang SA, Curtin P, Wright RO, Sanders AP. Fluoride exposure and kidney and liver function among adolescents in the United States: NHANES, 2013–2016. Environment International. August 8, 2019.


GUTS: Animal study on microbiome health and immunity documents fluoride causes serious damage to rectal structure and significantly inhibits proliferation of rectal epithelial cells.

•       Wang H., Miao C., Liu J. et al. Fluoride-induced rectal barrier damage and microflora disorder in mice. Environ Sci Pollut Res (2019).

TEETH: An analysis of the dental fluorosis data in three U.S. NHANES reports noted that more than half of American teens have fluoride damaged teeth as the result of too much fluoride consumption during childhood. This results in costly cosmetic dentistry in young adulthood for millions as well as increased decay in the more severely affected.

(20% very mild + 15% mild + 28% moderate + 3% severe = 65% afflicted per 2011-12 data)

•       Neurath C, Limeback H, Osmunson Bm et al. (2019) Dental Fluorosis Trends in US Oral Health Surveys: 1986 to 2012. JDR Clinical & Translational Research.

ALZHEIMER’S: Even low concentrations of fluoride in drinking water at or below concentrations deemed optimal or safe by the WHO result in a pattern of increased dementia.

•       Russ TC, Killin LOJ, Hannah J, Batty GD. Aluminium and fluoride in drinking water in relation to later dementia risk. The British Journal of Psychology. March 2019.


DNA DAMAGE: Mitochondrial dysfunction associated with dental fluorosis observed in Chinese children with fluoride concentrations in water identified as optimal or safe per U.S. authorities.  Gender differences to the fluoride induced oxidative stress also noted.

•       Zhou G, Yang L, Luo C, et al. Low-to-moderate fluoride exposure, relative mitochondrial DNA levels, and dental fluorosis in Chinese children. Environment International. Volume 127, June 2019, Pages 70-77.


DEMENTIA: Describes mechanism by which the effectiveness of the two most popular drugs used to treat Alzheimer’s & other neurodegenerative dementia disease is reduced or blocked by fluoride.

Marta Goschorska, Izabela Gutowska, Irena Baranowska-Bosiacka, Katarzyna Piotrowska, Emilia Metryka, Krzysztof Safranow, Dariusz Chublek. Influence of Acetylcholinesterase Inhibitors Used in Alzheimer’s Disease Treatment on the Activity of Antioxidant Enzymes and the Concentration of Glutathione in THP-1 Macrophages under Fluoride-Induced Oxidative Stress. Int. J. Environ. Res. Public Health, 2019, 16(1), 10.


ADULT BRAINS: First long term NaF animal study (10 weeks) using moderate levels of fluoride finds a number of histological changes including in parts of the brain associated with memory and learning.

•       Pei Jiang, Gongying Li, Xueyuan Zhou, Changshui Wang, Yi Qiao, Dehua Liao, Dongmei Shi. Chronic fluoride exposure induces neuronal apoptosis and impairs neurogenesis and synaptic plasticity: Role of GSK-3b/b-catenin pathway.Chemosphere. Volume 214, January 2019, Pages 430-435.


DELAYED MALE PUBERTY: This 4th study from the NIH sponsored ELEMENT investigation of the prenatal impact of low-dose prenatal exposure found a significant pattern of delayed puberty for boys associated with maternal fluoride as measured in urine samples. Female data showed non-significant trend towards earlier menarche. More study needed to determine the impact on sexual development.

•       Liu Y, Téllez-Rojo M, Hu H, et al. Fluoride exposure and pubertal development in children living in Mexico City. Environ Health. 2019 Mar 29;18(1):26.


ANXIETY & DEPRESSION: Both rats and children experience changes in brain chemistry from extended exposure to fluoride which affects mood. Serotonin and the prefrontal cortex are impacted. Studies that only examine short-term exposure are inadequate to detect these changes which are more pronounced in females.

•       Lu F, Zhang Y, Trevedi A, et al. (2019) Fluoride related changes in behavioral outcomes may relate to increased serotonin. Physiology & Behavior.

EYE DISEASE: Fluoride is a poison that has biological impact on consumers in any dose, contributing to the development of cataracts, glaucoma and macular degeneration.

•       Waugh DT. The Contribution of Fluoride to the Pathogenesis of Eye Diseases: Molecular Mechanisms and Implications for Public Health. Int. J. Environ. Res. Public Health. 2019, 16(5), 856.


BONES & GENES: This 30 day animal study at 8 mg/L fluoride documents DNA & RNA damage that inhibits gene expression which can be passed on through generations affecting bone development and contributing to weak bones, blood & bone cancers and skeletal fluorosis.

•       Atule P. Daiwile, Prashant Tarale, Saravanadevi Sivanesan, et al. Role of fluoride induced epigenetic alterations in the development of skeletal fluorosis. Ecotoxicology and Environmental Safety. Volume 169, March 2019, Pages 410-417.


BRAIN INJURY: Fluoride interferes with calcium metabolism which impacts brain chemistry and poisons the hippocampus. “The imbalance of calcium metabolism caused by fluorosis may be a pathogenesis of brain injury induced by fluoride.”

•       Qiuli Yu, Dandan Shao. Rui Zhang, Wei Ouyang, Zigui Zhang. Effects of drinking water fluorosis on L-type calcium channel of hippocampal neurons in mice. Chemosphere. Volume 220, April 2019, Pages 169-175. [Online Ahead of Print]


BRAIN DAMAGE: Prenatal & postnatal animal experiment using 10, 50 and 100 mg/L to simulate human experience documents mitochondrial damage and neuronal death as mechanism that result in learning and memory impairments.

•       Zhao, Q., Niu, Q., Chen, J. et al. Roles of mitochondrial fission inhibition in developmental fluoride neurotoxicity: mechanisms of action in vitro and associations with cognition in rats and children. Arch Toxicol (2019).


IODINE: Identifies and discusses the biochemical and hormonal impact of fluoride and fluoridation policy on iodine metabolism with consideration of related neurodevelopmental and pathological disorders.

•       Waugh DT. Fluoride Exposure Induces Inhibition of Sodium/Iodide Symporter (NIS) Contributing to Impaired Iodine Absorption and Iodine Deficiency: Molecular Mechanisms of Inhibition and Implications for Public Health. Int. J. Environ. Res. Public Health 2019, 16, 1086.


BIOLOGY OF POISON: Deep dive into the biological impact of fluoride that affects metabolism, hormones, immune function, etc. “Moreover, the findings of this study further suggest that there are windows of susceptibility over the life course where chronic F exposure in pregnancy and early infancy may impair Na+ , K+ -ATPase activity with both short- and long-term implications for disease and inequalities in health.”

•       Waugh DT. Fluoride Exposure Induces Inhibition of Sodium-and Potassium-Activated Adenosine Triphosphatase (Na+, K+-ATPase) Enzyme Activity: Molecular Mechanisms and Implications for Public Health. Int. J. Environ. Res. Public Health 2019, 16(8), 1427


DOSE RESPONSE: Three month study on adult rats found “fluoride can impair the learning ability of rats, which may be related to the induction of autophagy in rat hippocampal neurons.”

•       Zhang C, Huo S, Fan Y, Gao Y, Yang Y, Sun D. Autophagy May Be Involved in Fluoride- Induced Learning Impairment in Rats. Biol Trace Elem Res. 2019 May 20.

GENETIC SUSCEPTIBILITY: Review of recent scientific literature on biological impact. Same exposure in same population affect individuals differently, suggesting genetic vulnerability.

•       Wei, W, Pang, S, Sun, D. The pathogenesis of endemic fluorosis: Research progress in the last 5 years. J Cell Mol Med. 2019; 23: 2333– 2342.


MITOCHONDRIA: Prenatal and postnatal exposure to fluoride results in mitochondrial abnormalities, autophagy and apotheosis contributing to neuronal death.

•       Zhao, Q., Niu, Q., Chen, J. et al. Roles of mitochondrial fission inhibition in developmental fluoride neurotoxicity: mechanisms of action in vitro and associations with cognition in rats and children. Arch Toxicol (2019).


NUTRITION: The f-ion is a poison but the bioavailability of CaF is different than NaF as calcium is the antidote to fluoride poisoning. In addition to being in water and dental products, 20% of pharma and 40% of agrichemicals have a fluoride base. Consequently, people are exposed to excessive amounts of fluoride which contributes to chronic disease.

•       Stepec D, Ponikvar-Svet M. Fluoride in Human Health & Nutrition. Acta Chim Slov. 2019, 66.


SYNERGY, SUSCEPTIBILITY & TSCA: Accurately identifying highly exposed groups and the intrinsic and extrinsic factors that affect susceptibility require adequately assessing the aggregate exposure among vulnerable groups. The 2016 Lautenberg update to the 1976 Toxic Substance Control Act (TSCA) requires performing a challenging and scientifically disciplined risk assessment that mitigates risk, such as calculating the impact of combined fluoride exposure from fluoridated pesticides in food and fluoridated water on young children.

•       Koman PD, Singla V, Lam J, Woodruff TJ. Population susceptibility: A vital consideration in chemical risk evaluation under the Lautenberg Toxic Substances Control Act. PLoS Biol. 2019 Aug 29;17(8):e3000372.


THYROID: 18% of people drinking 'optimally' fluoridated water in Canadian communities have a heightened risk of low thyroid function because fluoride interferes with iodine metabolism. Many of them will be sub-clinical and not know they are mildly hypothyroid, which nevertheless increases their risk for diabetes, high cholesterol, and other problems. Study excluded those already diagnosed with thyroid disease. (CHMS)

•       Ashley J. Malin, Julia Riddell, Hugh McCague, Christine Till. Fluoride exposure and thyroid function among adults living in Canada: Effect modification by iodine status. Environment International. Volume 121, Part 1, December 2018, Pages 667-674.


THYROID: Even 0.5 ppm fluoride in water has an adverse impact on thyroid hormones. Water is currently fluoridated to 0.7 ppm, a reduction from up to 1.2 ppm in 2015.

•       Z. Kheradpisheh et al. (2018) Impact of Drinking Water Fluoride on Human Thyroid Hormones: A Case-Control Study. Scientific Reports. volume 8.

OVERDOSED BABIES: Over one third of babies (37%) in fluoridated American communities consume amounts of fluoride in excess of the upper limits of fluoride considered safe per government regulations. Even 4% of babies in non-fluoridated communities are overdosed on fluoride due to consumption of products made with fluoridated water. At the very least, this puts these children at high risk for developing dental fluorosis. Dental fluorosis is associated with increased incidence of learning disabilities, broken bones and kidney disease.

•       Claudia X Harriehausen, Fehmida Z Dosani, Brett T Chiquet, Michelle S Barratt, and Ryan L Quock. Fluoride Intake of Infants from Formula. Journal of Clinical Pediatric Dentistry. 2018.


GOVERNMENT BIAS: A National Toxicology Program animal experiment studying the impact of fluoride consumption used the wrong rats, the wrong dose, and the wrong study design in order to manufacture a finding of no prenatal or postnatal effect.

•       Karen Favazza Spencer, Hardy Limeback. Blood is Thicker Than Water: Flaws in a National Toxicology Program Study. Medical Hypotheses. Volume 121. December 2018. Pages 160-163.


DENTAL FLUOROSIS: “In 2001-2002, the weighted percentage prevalence of the denoted dental fluorosis categories were: 49.8% normal (i.e., unaffected), 20.5% questionable, and 29.7% very mild and above. In 2011-2012, the weighted percentage prevalence categories were: 31.2% normal, 7.5% questionable, and 61.3% very mild and above. When comparing years 2001-2002 with the years 2011-2012, the prevalence of very mild and above fluorosis increased by 31.6% (P <.0001) for the 2011-2012 group.” “There was a difference of 31.6% in dental fluorosis prevalence between 2012-2011 when compared to data from 2002-2001 in adolescents aged 16 and 17 years. The continued increase in fluorosis rates in the U.S. indicates that additional measures need to be implemented to reduce its prevalence.”

•       Wiener RC, Shen C, Findley P, Tan X, Sambamoorthi U. Dental Fluorosis over Time: A comparison of National Health and Nutrition Examination Survey data from 2001-2002 and 2011-2012. J Dent Hyg. 2018 Feb;92(1):23-29.


PREGNANT WOMEN: Pregnant Canadian women drinking 'optimally' fluoridated water had twice the fluoride exposure per individual testing as compared to pregnant women in non- fluoridated Canadian communities - and consistent with the range in the Mexican women in the ELEMENT cohort whose children had up to 6 points lowered IQ based on prenatal exposure to fluoride (from salt). The Canadian study excluded those with health conditions such as kidney disease as well as considered confounding factors such as tea consumption.

•       Christine Till, Rivka Green, John G. Grundy, Richard Hornung, Raichel Neufeld, E. Angeles Martinez-Mier, Pierre Ayotte, Gina Muckle, and Bruce Lanphear. Community Water Fluoridation and Urinary Fluoride Concentrations in a National Sample of Pregnant Women in Canada. Environmental Health Perspectives. October 2018.


ALZHEIMER’S DISEASE: Describes impact of fluoride-induced stress and inflammation in the development of Alzheimer’s disease and demonstrates the mechanism for cell death in its worsening over time.

•       Goschorska M, et al. Potential Role of Fluoride in the Etiopathogenesis of Alzheimer’s Disease. Int. J. Mol. Sci. 2018, 19 (12), 3965.

LEARNING DISABILITIES: Over 200 children were individually tested. Study found attention deficit disorder apparently caused by their prenatal exposure to fluoride specific to dose. This is the 3rd report out of the NIH sponsored 12 year ELEMENT project that has confirmed low dose prenatal exposure to fluoride consistent with exposure in 'optimally' fluoridated communities causes subtle but permanent brain damage for many consumers. Excluded those with history of mental illness or conditions such as diabetes and renal disease.

•       Morteza Bashash, Maelle Marchand, Howard Hu, ChristineTill, Angeles Martinez-Mier, Brisa

N. Sanchez, Niladri Basu, Karen Peterson, Rivka Green, Lourdes Schnaas, Adriana Mercado-García, Mauricio Hernández-Avila, Martha María Téllez-Rojo. Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6– 12 years of age in Mexico City. Environment International. Volume 121, Part 1, December 2018, Pages 658-666.


CANCER: Researchers who include an IARC scientist find esophageal cancer is 9.4 times more prevalent among those with dental fluorosis in the endemic fluorosis regions of Kenya. Provides biological plausibility that inflammatory fluoride affects microbiome and other biological mechanisms. Recommends more study.

•       Menya D, Maina SK, Kibosia C, Kigen N, Oduor M, Some F, Chumba D3, Ayuo P, Middleton DR, Osano O, Abedi-Ardekani B, Schüz J, McCormack V. Dental fluorosis and oral health in the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case-control study and a pan-African perspective. Int J Cancer. 2018 Dec 23.


KIDNEYS: Fluoride is a common exposure that is selectively toxic to the kidneys.

•       Lash LH. Environmental and Genetic Factors Influencing Kidney Toxicity. Seminars in Nephrology. Volume 39, Issue 2, March 2019, Pages 132-140.


IQ & DF: Between 0.5 and 3.9 mg/L, found every 0.1 mg/L increased dental fluorosis by 2.24% and every 0.5 mg/L decreases IQ by 2.67 points. Also found half as many kids with high IQ children with higher F- dose.

•       Yu X et al. Threshold effects of moderately excessive fluoride exposure on children's health: A potential association between dental fluorosis and loss of excellent intelligence. Environ Int. 2018 Jun 2;118:116-124.


WORSE THAN ARSENIC: ”In conclusion, F exposure was related to the urinary excretion of early kidney injury biomarkers, supporting the hypothesis of the nephrotoxic role of F exposure.”

•       Monica I. Jiménez-Córdova, Mariana Cardenas-Gonzaleza, Guadalupe Aguilar-Madrid, Luz

C. Sanchez-Peña, Ángel Barrera-Hernández, Iván A. Domínguez-Guerrero, Carmen González-Horta, Olivier C. Barbier, Luz M. Del Razo. Evaluation of kidney injury biomarkers in an adult Mexican population environmentally exposed to fluoride and low arsenic levels. Toxicology and Applied Pharmacology. May 2018.


Brain-derived neurotrophic factor (BDNF): Chinese animal study verifies mechanisms using in vivo and in vitro methodology for cognitive deficits that “suggest that the developmental neurotoxicity of fluoride is associated with the impairment of synaptogenesis, which is caused by ERK1/2-mediated BDNF-TrkB signaling disruption.” BDNF is involved with learning, memory, aging and psychiatric disease

•       Chen J, et al. ERK1/2-mediated disruption of BDNF-TrkB signaling causes synaptic impairment contributing to fluoride-induced developmental neurotoxicity. Toxicology. 2018 Dec 1;410:222-230.

KIDNEY CASCADE: “Taken together, these findings indicate that there can be some alterations in liver enzyme activities at early stages of fluoride intoxication followed by renal damage.”

•       Perera T. et al. Effect of fluoride on major organs with the different time of exposure in rats. Environmental Health and Preventive Medicine (2018) 23:17

ASD & FLUORIDE: Brain inflammation and immunoexcitotoxicity are associated with autism spectrum disorders (ASD). Aluminum and fluoride are likewise associated with chronic inflammation and immunoexcitotoxicity. An assortment of genetic predispositions interacting with a number of environmental factors which  include the ubiquitous aluminum and fluoride interfere with a number of enzymes, resulting in a significant suppression of cellular energy production and oxidative stress, resulting in observable patterns consistent with immune dysfunctions seen in the ASD population.


REVIEW: Concludes that fluoridation schemes whether from water, food or salt programs “pose risks of various diseases in the asthmatic-skeletal, neurological, endocrine and skin systems.  Dental and skeletal fluorosis are signs of chronic and excessive ingestion of fluoride.”

•       Verena Romero, Frances J. Norris, Juvenal A. Ríos, Isel Cortés, Andrea González, Leonardo Gaete, Andrei N. Tchernitchin. The impact of tap water fluoridation on human health. Rev. méd. Chile vol.145 no.2 Santiago Feb. 2017.


DOSE-RESPONSE: Validated that IQs of children are lowered on a dose-response trend line correlated with the amount of fluoride exposure as measured via urine tests of their mothers during pregnancy and individualized IQ tests of offspring. In the range consistent with doses in optimally fluoridated communities, there was up to a 6 point difference in IQ. This NIH sponsored 12 year longitudinal study conducted by researchers at world class American & Canadian universities excluded diabetics as well as those with kidney disease or pregnancy complications and allowed for many confounders.

•       Morteza Bashash, Deena Thomas, Howard Hu, et al. Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Environ Health Perspect. Sept 2017. Vol 125, Issue 9.


GENES & BONES: “This study provides evidence that chronic oxidative and inflammatory stress may be associated with the fluoride-induced impediment in osteoblast differentiation and bone development.”

•       Gandhi, D., Naoghare, P.K., Bafana, A. et al. Fluoride-Induced Oxidative and Inflammatory Stress in Osteosarcoma Cells: Does It Affect Bone Development Pathway? Biol Trace Elem Res (2017) 175: 103.

PRESCHOOL DIET: Diet of two year olds contain unsafe levels of fluoride.

•       Martinez-Mier EA, Spencer KL, Sanders BJ, Jones JE, Soto-Rojas AE, Tomlin AM, Vinson LA, Weddell JA, and Eckert GJ. Fluoride in the diet of 2-years-old children. Community Dent Oral Epidemiol. 2017;00:1–7.


APOPTOSIS: “Enamel fluorosis is a developmental disturbance caused by intake of supraoptimal levels of fluoride during early childhood.The enamel defects consist of horizontal thin white lines, opacities (subsurface porosities), discolorations, and pits of various sizes. The molecular mechanism underlying enamel fluorosis is still unknown.…. We can hypothesize that fluorosis is due to a combination of direct cytotoxic effects causing cell death, the delayed development of tight junctions, which are necessary to form a sealed barrier between apical and basolateral surfaces, and a direct inhibitory effect of fluoride on vectorial calcium and/or bicarbonate transport.”

•       Rácz, Róbert et al. “No Change in Bicarbonate Transport but Tight-Junction Formation Is Delayed by Fluoride in a Novel Ameloblast Model.” Frontiers in Physiology. 2017; 8: 940.

FLUORIDE & DEMOGRAPHICS: “About 30% of the children were at the risk of dental fluorosis.”


DNA: Finds that “prolonged fluoride intake at chosen concentrations caused imbalance of the cellular oxidative state, affected DNA and disrupted cellular homeostasis… It is recommended that fluoride supplementation requires a fresh consideration in light of the current study.”

•       F.D. Campos-Pereira, L. Lopes-Aguiar, F.L. Renosto, et al. Genotoxic effect and rat hepatocyte death occurred after oxidative stress induction and antioxidant gene downregulation caused by long term fluoride exposure. Chem Biol Interact. 2017 Feb 25;264:25-33.


PRENATAL POISON: “F can pass through the cord blood and breast milk and may have deleterious impact on learning and memory of the mouse pups.”

•       Y Zhang, X Xue, R Niu, J Wang. Maternal fluoride exposure during gestation and lactation decreased learning and memory ability, and glutamate receptor mRNA expressions of mouse pups. Z Sun, Human & Experimental Toxicology. February 13, 2017.


IMMUNITY: Prenatal and early postnatal exposure to fluoride impairs spleen function and development which damages spleen and lifelong immunity.

•       Yanqin Ma, Kankan Zhang, Fengjun Ren, Jundong Wang, Developmental fluoride exposure influenced rat's splenic development and cell cycle via disruption of the ERK signal pathway, In Chemosphere, Volume 187, 2017, Pages 173-180


NEUROINFLAMMATION: Toxic effects of fluoride on the central nervous system and immunity.

•       Chen R, Zhao LD, Liu H. et al. Fluoride Induces Neuroinflammation and Alters Wnt  Signaling Pathway in BV2 Microglial Cells. Inflammation. 2017;40: 1123.


CRITIQUE HHS RECOMMENDATION: Pro-fluoridation team of dental researchers determined that the Department of Health and Human Services reduction of the optimal fluoride concentration to a single 0.7 ppm target is lacking in sound science, i.e. that “policy need to be cognizant of the balancing of risk and protective exposures across the entire population and potentially all ages and to be based on recent data that are purposefully collected, critically analyzed and carefully interpreted… (the recommendation seems) premature in terms of its rationale and its use and interpretation of sometimes dated data.” These authors’ bias is to maintain 1 ppm; nevertheless, their rationale against the HHS document is appropriate. The HHS document is political, not scientific.

•       Spencer AJ, Do LG. Caution needed in altering the 'optimum' fluoride concentration in drinking water. Community Dent Oral Epidemiol. 2016 Apr;44(2):101-8.

OSTEOPOROSIS: “Consequently, although the World Health Organization continues to support F schemes for caries prevention despite a lack of scientific proof, the F schemes are not able to improve the crystal quality but rather contribute adversely to affect tooth development and increases the risk of developing postmenopausal osteoporosis.”

•       Mitsuo Kakei, Masayoshi Yoshikawa and Hiroyuki Mishima. Fluoride Exposure May Accelerate the Osteoporotic Change in Postmenopausal Women: Animal Model of Fluoride- induced Osteoporosis. Adv Tech Biol Med 2016, 4:1


DIABETES: Fluoridation policy significantly increases incidence of age related type 2 diabetes.

•       K. Fluegge. Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health, 2016.


IBD: Crohn’s disease and ulcerative colitis increases after fluoridation begins in multiple countries.

•       Follin-Arbelet B, Moum B. Fluoride: a risk factor for inflammatory bowel disease? Scand J Gastroenterol. 2016 May 19:1-6.


PROPAGANDA: Assisted by the media, fluoridationists misrepresent historical and scientific fact in order to achieve a political end.

•       Anat Gesser-Edelsburg and Yaffa Shir-Raz. Communicating risk for issues that involve 'uncertainty bias': what can the Israeli case of water fluoridation teach us? Journal of Risk Research. August 2016.


COCHRANE CWF REVIEW: Estimates that 12% of the children living in fluoridated communities with 0.7 ppm fluoridation have aesthetically objectionable dental fluorosis with a total dental fluorosis effect of 40%. The effects were 47% & 15% for 1 ppm, only a minor impact on incidence of dental fluorosis and consistent with the findings of the 2000 York Review.

•       Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny A. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2015, Issue 6.


THYROID: Diagnoses of low thyroid significantly higher in ‘optimally’ fluoridated regions.

•       S Peckham, D Lowery, S Spencer. Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. J Epidemiol Community Health. 24 February 2015.


ADHD: Researchers found between 67k and 131k more 11 year olds with ADHD in fluoridated regions of the U.S.

•       A Malin and C Till. Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence. Environmental Health 2015, 14:17

CWF INFLAMMATIONS: Found that “even in small concentrations fluoride changes the amounts and activity of COX-1 and COX-2 enzymes taking part in the initiating and development of inflammatory process.”

•       I. Gutowskaa, et al. Fluoride as a factor initiating and potentiating inflammation in THP1  differentiated monocytes/macrophages. Toxicology in Vitro. Volume 29, Issue 7, October  2015, Pages 1661–1668.


NEUROTOXICANT: EPA scientists classify fluoride as a ‘gold standard’ developmental  neurotoxicant with substantial evidence of harm.

•       William R. Mundy, Stephanie Padilla, Joseph M. Breier, at al. Expanding the test set: Chemicals with potential to disrupt mammalian brain development. Neurotoxicology and Teratology. Volume 52, Part A, November–December 2015, Pages 25–35.


PROPAGANDIZING: The proponents of fluoridation ignored concerning evidence and did not  deliver on their promise of dental benefit then, and now. Neither did they do the expected due  diligence re harms.

•       Carstairs C. (2015). Debating Water Fluoridation Before Dr. Strangelove. American journal of public health, 105(8), 1559–1569.


NOT COST EFFECTIVE: Reveals errors in cost-benefit analysis (CBA) used by CDC. Best case scenario after corrections is a $3 benefit which is more than wiped out by any consideration of dental fluorosis. Fluoridated drinking water results in an economic loss to communities.

•       Lee Ko & Kathleen M. Thiessen (2015) A critique of recent economic evaluations of community water fluoridation, International Journal of Occupational and Environmental Health, 21:2, 91-120

Additional items of note:

2017 IAOMT Position Paper:

2018 Open Letter:

2019 Children’s Health Defense Statement:

2020 Expert Opinion:

2023: NTP Report suppressed by HHS political machinations: whatwestudy/assessments/noncancer/ongoing/fluoride/index.html


”…fluoride is presumed to be a cognitive neurodevelopmental hazard to humans…”

- Draft Monograph from National Toxicology Program, “Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects” (Sept 6, 2019)

“Several of the highest quality studies showing lower IQs in children were done in optimally fluoridated (0.7 mg/L) areas in Canada.” - "Documents Provided to the NTP Board of Scientific Counselors (BSC) and BSC Working Group" p. 352 (March 15, 2023)

“The cessation of all compulsory water fluoridation schemes should be the goal of all public health agencies, ethical lawmakers, and informed citizens.”

- Prof. Rita F. Barnett-Rose, J.D. in “Compulsory Water Fluoridation” (2014)





•       Endorsement: An endorsement is an authoritative statement reflecting a point of view for the purpose of exerting influence. An endorsement is not an expert opinion.

•       Authoritative statement: An opinion that interprets a rule, law or policy for the purpose of guiding, influencing, or mandating action. Authoritative statements are not inherently trustworthy or reliable, but they are inherently manipulative. “Testimonial propaganda” utilizes authoritative statements in marketing and in politics. The slogan “question authority” was intended to encourage critical thinking in order to combat the blind acceptance of biased authoritative statements that endorse policy and/or sanctioned narratives. (Logical Fallacies: Appeal to Authority)

•       Expert Opinion: An expert opinion is dependent on evidence and the due diligence of someone with substantial study in a field. The Daubert Standard is a legal process that validates the trustworthiness of experts offering opinion in a court of law.



ENDORSEMENT: The April 2015 HHS statement recommending 0.7 ppm fluoride concentration in drinking water for ‘safe & effective’ prevention of tooth decay promoted the long standing fluoridation policy of the agency.


EXPERT OPINION: The June 2015 Cochrane report finds no reliable evidence of dental benefit to adults or low income children, but documents substantially higher rates of dental fluorosis, some of which will likely result in costly cosmetic dentistry.

The 2019 National Toxicology Program systematic review offered an expert opinion based on the evidence that fluoride is a presumed hazard to human health

specific to neurotoxic impact when exposure is pre- or post-natal.