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ADA ‘remains committed’ to community water fluoridation

August 19, 2019

By Jennifer Garvin

The ADA on Aug. 19 issued a press statement in response to widespread media interest in a study that suggested an association between higher prenatal fluoride exposure and lower IQ scores in children 3-4 years of age. 

“The American Dental Association remains committed to fluoridation of public water supplies as the single most effective public health measure to help prevent tooth decay,” according to the ADA statement. The Association also noted that this commitment is shared by the World Health Organization, U.S. Public Health Service, Centers for Disease Control and Prevention, American Medical Association and American Academy of Pediatrics.

One of the study’s authors, Dr. Angeles Martinez-Mier, chair, cariology, operative dentistry and dental public health at the Indiana University School of Dentistry, said while she stands “fully behind our study’s conclusions, as an individual, I am happy to go on the record to say that I continue to support water fluoridation.”

For the study, researchers in Canada examined whether fluoride exposure during pregnancy was associated with cognitive deficits in children. The study measured the maternal urinary fluoride levels in 512 women across 10 Canadian cities during each trimester of their pregnancies as well as the self-reported fluoride intake from 400 women. The study also recruited a subset of 601 children — 254 who lived in a nonfluoridated region, 180 who lived in a fluoridated region and 167 whose fluoridation status was unknown — and completed neurodevelopmental testing. The results showed that a 1 milligram per liter increase in maternal urinary fluoride was associated with a 4.49-point lower IQ score in boys but there was no significant impact for girls. The researchers concluded that “maternal exposure to higher levels of fluoride during pregnancy was associated with lower IQ in children age 3-4.”

In responding to the study’s conclusion, the ADA said that “public health policy is based on a collective weight of scientific evidence” and called for “further scientific study of the issue to see if the [study’s] findings can be replicated with methods that demonstrate more conclusive evidence.”

In a statement published online Aug. 19 in the AAP News, the American Academy of Pediatrics said it will also continue to recommend children use age-appropriate amounts of fluoride toothpaste and drink fluoridated tap water.

“There are thousands of articles pointing to the safety of community water fluoridation and we need to continue to look at the impacts, but this study doesn’t change the benefits of optimally fluoridated water and exposure to fluoride,” said Patricia A. Braun, M.D., professor of pediatrics at the University of Colorado and chair of the AAP Section on Oral Health Executive Committee.

Dr. Braun and Aparna Bole, M.D., chair of the AAP Council on Environmental Health Executive Committee, said “the results of the study are difficult to interpret given that the IQ difference was small and in one group it only appeared in boys. In the group where an association was seen for boys and girls, the fluoride intake was self-reported, which is less reliable.” The two spokespersons also stressed the study did not look at children’s fluoride intake, only that of pregnant women.

The ADA said that “throughout more than 70 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe. The evidence-based research shows the recommended concentrations of fluoride (0.7 mg/L) used in community water fluoridation is beneficial and safe for the public.” 

The study, Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada, was published in the Journal of the American Medical Association Pediatrics.

The ADA endorses community water fluoridation as safe and effective for preventing tooth decay based on 70 years of scientific research. To see scientific evidence and other information about fluoridation, visit