In response to concerns about fluoride in drinking water, the U.S. Environmental Protection Agency (EPA) is developing a new toxicity assessment to review scientific information on the potential health risks of fluoride in drinking water. They will be reviewing studies about dental fluorosis and neurocognition to determine the safe level of fluoride in drinking water.

We need to tell this administration that the oral health community trusts the long-standing comprehensive body of peer-reviewed research demonstrating optimal levels of fluoride in Americans’ water are safe, beneficial, and necessary. Please encourage the EPA to scrutinize research and exclude biased and faulty literature before it completes its assessment on the current fluoridation levels in the US.

Comment submission

• We are inviting you to share your professional, evidence-based perspective with the EPA.
• The process for submitting comments to a federal agency is setup differently than in the past where you would contact your members of Congress. When you click “comment”, the link will be to an external website that will open in new window. Be sure to copy and paste the letter first.
• To save time, we have provided the sample letter below. Be sure to copy and paste and personalize your information in the submission to the EPA. Follow the steps to submit your comments. All comments must be submitted within the 30-day review by February 27, 2026.

Submission to the EPA

• The ADA and many other organizations (including state dental associations) are submitting comments this month. We urge you to send your individual comments.
• Review the EPA’s plan for an accelerated review of fluoride in drinking water. EPA Announcement.

Sample letter template:

Dear EPA Administrator Zeldin:

The EPA’s plans to review the literature on fluoride health effects must be consistent with Gold Standard Science that incorporates the agency’s peer-reviewed methods as per its mission. I urge the agency to include reputable, well-respected peers who have objective research on the subject of neurocognition and fluoride exposure.

As a dentist following over 80 years of trusted science, I urge the EPA to enlist the National Academies of Sciences, Engineering, and Medicine (NASEM) to peer review its assessment plan and systematic review prior to finalization. NASEM is considered the gold standard for peer review.

A peer review by NASEM will help ensure future regulatory decisions about community water fluoridation are based on reproducible, objective and high-quality evidence. If the EPA wishes to promote the best available, unbiased, peer-reviewed studies through broad literature searches in scientific databases, it must remove the biased studies included in this review and add numerous, better-conducted studies from the last few years.

The collaboration with subject matter experts must exclude those who bring bias and erroneous research to the table. The EPA’s latest toxicity assessment must gather feedback from researchers who are well-established and trusted within the scientific community as water fluoridation experts and those producing studies that stand up to peer review and replication. Please exclude those studies from non-peer reviewed outlets that are not backed by the overwhelming majority within the scientific community.

EPA should review the scientific information and include only the best available scientific literature examining the safety of fluoride in drinking water. The American Dental Association (ADA) also advocates providing access to independent peer reviewers and recommends excluding the NTP Monograph on Fluoride and Neurocognition which clearly states that it does not apply to water fluoridation at 0.7 mg/L as practiced in the US and Canada. The NTP report only found an association (not causation) with fluoride levels greater than 1.5 mg/L as occurs naturally in countries like China and India. Utilizing studies from countries with similar fluoride levels as the US should be prioritized under scrutiny of safety of fluoride. In addition, the NTP authors clearly state that the majority of studies on which they based their conclusions (three-fourths) were of low-quality and high risk of bias, and that their findings should not be used to develop a dose-response analysis- which is precisely what EPA has stated they plan to do.

Given the politicized nature of this issue, I again urge EPA to enlist NASEM to peer review its assessment plan and systematic review prior to finalization.

The ADA has offered the opportunity to assist the EPA with its review of scientific information, which includes sharing the best available scientific literature examining the safety of fluoride in drinking water. I also encourage the EPA’s utilization of independent peer reviewers with intimate knowledge about the strengths and weaknesses of the current fluoride literature. As a member of the ADA, I know that detailed recommendations have been submitted to the EPA. Please trust the dedication of oral health professionals focused on evidence-based guidance to provide further scientific review during the next phase of your assessment.