ADA urges NTP to base upcoming fluoride report on scientific evidence

Washington — The American Dental Association is asking the National Toxicology Program to carefully review the body of evidence before making any presumptive hazard statements in a forthcoming research report about fluoride and neurocognitive development.

In a Feb. 7 letter to Rick Woychik, Ph.D., director, National Toxicology Program and National Institute of Environmental Health Sciences, ADA President Cesar R. Sabates, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., said the Association is concerned about the National Toxicology Program’s forthcoming state-of-the-science report examining whether there is a causal relationship between fluoride exposure and potential neurodevelopmental and cognitive effects.

“Specifically, we ask you to exclude — or carefully consider how to characterize — any neurotoxin claims lingering from [National Toxicology Program’s] now-abandoned monograph, even if placed in a forward or executive summary,” Drs. Sabates and Cohlmia wrote.

For the last several years, the National Toxicology Program has examined the literature to determine whether there is a causal relationship between fluoride exposure and neurocognitive health. The work culminated in a proposed monograph, Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Both the first and revised drafts included statements about neurotoxicity of fluoride that were not supported by scientific evidence.

Drs. Sabates and Cohlmia reminded the National Toxicology Program that the National Academies of Sciences, Engineering and Medicine issued scathing peer reviews of both drafts of the monograph. The academies pointed out that the program also failed to provide adequate scientific evidence for its conclusion, noting difficulty following the review methods, an inability to find key data, “worrisome” inconsistencies, and concerns about the wording of some conclusions.

In its second peer review, the National Academies of Sciences, Engineering and Medicine wrote:

“[National Toxicology Program] did not conduct a formal dose-response assessment that could inform a discussion on water fluoridation. The National Toxicology Program needs to state clearly that the monograph is not designed to be informative with respect to decisions about the concentrations of fluoride that are used for water fluoridation. That point should be reiterated at the end of the monograph with some indication that…[the monograph] does not draw any conclusions regarding drinking-water fluoridation or other fluoride sources, such as toothpaste or other dental treatments… [T]he context into which the monograph falls calls for much more carefully developed and articulated communication on this issue.”

The ADA is concerned that the monograph’s risk biased claim about fluoride being a “potential” neurotoxin at any exposure level will resurface in the National Toxicology Program’s upcoming state-of-the-science report.

The ADA letter also noted that the Centers for Disease Control and Prevention has hailed community water fluoridation as one of 10 great public health achievements of the 20th century and noted it is an inexpensive way to reduce tooth decay by at least 25% in the population.

“It would be a shame to distract from over 75 years of public health success over a simple matter of communicating the science, which is often more nuanced than a sound bite can convey,” Drs. Sabates and Cohlmia said.

“We would welcome the opportunity to meet with you to discuss our concerns. In the meantime, we ask you to exclude — or carefully consider how to characterize — any neurotoxin claims lingering from the National Toxicology Program’s now-abandoned monograph, even if placed in a forward or executive summary,” the letter concluded.

Follow all the ADA’s advocacy efforts at ADA.org/advocacy.