Florida Surgeon General Joseph Ladapo advised local governments across the state on Friday to stop adding fluoride to their community water supplies. He called it "public health malpractice" despite widespread consensus among public health experts that fluoridation has dramatically improved dental health in the U.S., saved billions in dental costs, and prevented millions of childhood cavities.
Ladapo held a news conference Friday morning in Winter Haven, a small city east of Tampa where officials voted earlier this month to stop fluoridating water. The Florida Department of Health followed up with an announcement and new guidance.
Ladapo cited research that suggests chronic exposure to high levels of fluoride can have harmful neurological effects on children, such as lower IQ and higher rates of ADHD.
Fluoride is a chemical that naturally occurs in water, soil, food and other sources. It helps strengthen teeth and protects them from decaying.
For decades, many U.S. communities have been adding fluoride to their drinking water, which the Centers for Disease Control and Prevention hails as one of the "10 great public health interventions of the 20th century" due to the dramatic decline in cavities.
The guidance from Ladapo comes after Robert F. Kennedy, Jr., President-elect Donald Trump's pick for Health and Human Services Secretary, announced plans to take similar action at the national level if he gets confirmed for the job.
When a reporter asked Ladapo about the timing during Friday's news conference, he said this was an issue he had been working on "for months" but was delayed by the recent hurricanes that hit the state.
What the studies say
"Community water fluoridation is one of the most effective and affordable public health measures we can implement to protect our residents' oral health," said Dr. Jeff Ottley, President of the Florida Dental Association.
Decades of scientific research proves the safety and effectiveness of fluoridation, he said.
"Adding optimal amounts of fluoride into our community water supplies can prevent at least 25% of tooth decay in children and adults, reducing the need for costly dental treatments," Ottley said.
The National Toxicology Program published a systematic review in August of research about the association between fluoride exposure and neurodevelopment and cognition. It concluded that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.
That is twice as much as the 0.7 milligrams of fluoride per liter of water that U.S. health officials recommend for community water supplies.
"The determination about lower IQs in children was based primarily on epidemiology studies in non-U.S. countries such as Canada, China, India, Iran, Pakistan, and Mexico where some pregnant women, infants, and children received total fluoride exposure amounts higher than 1.5 mg fluoride/L of drinking water," the NTP noted in the report.
Scientists added there was "insufficient data" to determine if the lower level recommended in the U.S. has a negative effect on children's IQ. The NTP added there was no evidence fluoride exposure had adverse effects on cognition in adults.
But Ladapo said he found the results "appalling," and believes the risk outweighs any dental benefits. He said there are other ways people can access fluoride now, such as in certain toothpastes, mouthwashes and foods.
"In this day and age, with the additional sources of fluoride that people have access to, it is public health malpractice to continue adding fluoride to community water systems that pregnant women and children have access to," he said during the press conference.
Ladapo was joined by Ashley Malin, an assistant professor in the University of Florida's Epidemiology Department who has studied fluoride's effects in pregnant women.
She led a study published in May that was based in Los Angeles and suggested that fluoride exposure during pregnancy was linked to an increased risk of neurobehavioral problems in children.
"Although this issue has become politicized recently, I don't view this as a political issue; I view this is a human rights issue and a public health issue," Malin said.
The Florida Department of Health estimates about 70 percent of residents on community water systems receive fluoridated water.
Collier County voted to stop fluoridating water in February, while the city of Winter Haven did so on Nov. 12. Ladapo urged Floridians to demand policy makers in their communities follow suit.
"It is clear more research is necessary to address safety and efficacy concerns regarding community water fluoridation," said Ladapo.
Major health groups support adding fluoride to water
Organizations such as the CDC, World Health Organization, American Dental Association and American Academy of Pediatrics support adding fluoride to community water supplies. They say it helps extend dental protection to people with low incomes who may not be able to afford other forms of dental care.
In September, U.S. District Judge Edward Chen ordered the U.S. Environmental Protection Agency to strengthen its fluoride regulations, concluding recent research suggests there is "unreasonable risk" that 0.7 milligrams per liter may not be low enough to shield children from harm. Though he also noted his ruling "does not conclude with certainty that fluoridated water is injurious to public health."
The Florida Dental Association said that it continues to support community water fluoridation.
"Water fluoridation is one of the tools that we have in our toolkit to help children have healthy oral health," said Ottley. "If we remove that, then we are placing the children in those communities at higher levels of tooth decay at an earlier age."
Florida's health department also raised concerns in its guidance about the risks of a rare condition known as skeletal fluorosis from fluoride exposure, which can increase the risk of bone fracture. The EPA requires that water systems not exceed 4 milligrams of fluoride per liter of water to prevent skeletal fluorosis.
The CDC says health experts "have not found convincing scientific evidence linking community water fluoridation with any potential adverse health effect or systemic disorder such as an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer disease, or allergic reactions."
Surgeon General Ladapo shared other recommendations to support dental health in his guidance, including expanding community access to dental services and promoting health habits such as reducing sugar consumption.
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