Robert F. Kennedy Jr., a prominent environmental advocate and former independent presidential candidate, has recently reignited the debate surrounding the presence of fluoride in the nation's water supply.

In a social media post, Kennedy claimed that if Donald Trump were to be re-elected on Tuesday, his administration would recommend the removal of fluoride from public water systems. He stated, "On January 20, the Trump White House will advise all U.S. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease." Trump has previously hinted that Kennedy, with his background as an environmental lawyer, could oversee a health-related role in his potential next term. At a campaign event in New York, Trump expressed his willingness to allow Kennedy to take the lead on health, food, and medicine issues, suggesting a significant role for Kennedy in healthcare.

The debate over fluoride's role in public health has been intensifying as its addition to water supplies faces increased scrutiny. Fluoride is a naturally occurring mineral found in water, rocks, and some foods, and it can also be a byproduct of certain industrial processes, according to the CDC. In September, a federal judge ordered the US Environmental Protection Agency (EPA) to take further steps to regulate fluoride in drinking water due to potential risks to children's intellectual development.

US District Judge Edward Chen ruled that while it is not definitive whether the typical levels of fluoride added to water are causing a decrease in children's IQ, the potential risk warrants further investigation and regulation by the EPA. The ruling did not specify the actions required of the EPA, which is currently in the process of reviewing the decision.

Health experts concur that more research is necessary to understand the effects of fluoride, not only on children but also on the general population. Dr. Ashley Malin, an assistant professor in the Department of Epidemiology at the University of Florida's College of Public Health and Health Professions, emphasized the importance of scientific evidence in guiding policy.

She told in an email, "Protecting vulnerable populations from environmental toxicants is a nonpartisan matter that should remain informed by the current state of the science." Dr. Malin further stated, "I think that health effects of fluoride on young children, particularly in the realm of neurodevelopment have been sufficiently studied such that it has now been identified that a hazard to child IQ is present. However, I would argue that more research is needed to better understand impacts of chronic low-level fluoride exposure on adult health outcomes because that research is scarce."

A federal review published in August by the National Toxicology Program at the National Institutes of Health concluded that higher levels of fluoride are linked to lowered IQ in children. The program based its conclusion on studies involving fluoride levels at about twice the recommended US limit for drinking water. However, the review also noted that the evidence of an association between fluoride exposure below 1.5 mg/L and lower IQ in children appeared less consistent than results of studies at higher exposure levels.

Previous research has also found higher levels of fluoride exposure during pregnancy were associated with declines in IQ in children. A 2019 study looking at Canadian mothers and children found for each additional 1 milligram per liter in concentration of fluoride in a mother’s urine, there was a 4.5-point drop in IQ in males. The study did not find such a significant association in female children, nor did it examine why boys were more significantly affected.

The US Centers for Disease Control and Prevention (CDC) recommends community water fluoridation as a cost-effective way to improve Americans’ oral health. Prolonged exposure to fluoride above the public health recommended amount can result in skeletal fluorosis, a condition that is rare in the US and that causes weaker bones and joint pain. Excessive fluoride can also lead to dental fluorosis, which is cosmetic and can cause the outer enamel layer of the tooth to have white specks or lines. Recent research examining the link between cancer and fluoride levels has not found an association, according to the CDC and the American Cancer Society. There also isn’t any evidence that fluoride can cause birth defects in humans, according to the CDC.

The mineral can help prevent tooth decay by strengthening the protective outer layer of enamel that can be worn away by acids formed by bacteria, plaque, and sugars in the mouth. The practice of adding fluoride to public water systems began in the United States in 1945. Today, nearly three-quarters of the US population—about 209 million people—are served by drinking water systems that have been fluoridated, according to CDC data. State and local governments control most of the water supplies in municipalities across the country. Some communities, such as Portland, Oregon, and Tucson, Arizona, have voted to opt out of adding fluoride to their water.

Recent reports suggest that the benefits of adding fluoride to water supplies may not be as significant as they once were, especially with the widespread use of toothpaste that includes fluoride, which has been available since the 1970s. Last month, a report from the Cochrane Collaboration, an independent group that systematically analyzes scientific research, found only a slight benefit in adding fluoride to tap water, leading to slightly fewer cavities in children’s baby teeth. Other studies determined that fluoride in water led to a difference of decay in only about a quarter of a tooth, on average, according to the Cochrane report. However, the American Dental Association says fluoride in community water supplies is “the single most effective public health measure to prevent tooth decay.”

"Studies prove water fluoridation continues to be effective in reducing dental decay by at least 25% in children and adults, even in the era of widespread availability of fluoride from other sources, such as fluoride toothpaste", the ADA says on its website. The CDC continues to promote the safety and benefits of community water fluoridation. "Water fluoridation has been identified as the most cost-effective method of delivering fluoride to all members of the community regardless of age, educational attainment, or income level", the agency wrote in a statement in May.

If you’re concerned about your fluoride intake, you can consider switching to bottled water, looking for water filters that remove fluoride, and ensuring your children do not swallow their toothpaste.