USA: EPA Hits Key Milestone in Expedited Review of Fluoride under the Safe Drinking Water Act

[pfpcnews]

EPA Hits Key Milestone in Expedited Review of Fluoride under the Safe Drinking Water Act

EPA Press Office - August 3, 2026

WASHINGTON – Today, U.S. Environmental Protection Agency (EPA) announced the next step in its review of public health risks linked to fluoride in drinking water: the release of the Protocol for Developing the Fluoride Human Health Toxicity Assessment. This marks a significant milestone in the agency’s expedited assessment of fluoride under the Safe Drinking Water Act (SDWA), a priority set by EPA Administrator Lee Zeldin as part of the Trump Administration’s commitment to Make America Healthy Again, while following gold standard science.

“Every American should be able to count on safe and healthy drinking water, plain and simple. In light of new science and real concerns from the public, the Trump EPA is working in lockstep with HHS to expedite our review of fluoride under the Safe Drinking Water Act,” said EPA Administrator Lee Zeldin. “Today’s important milestone means we are another step closer to completing this assessment years ahead of schedule. Our new action outlines specifically how EPA’s assessment will be conducted and advances our commitment to transparency and gold standard science.”

“Parents deserve the truth about fluoride in drinking water—not assumptions, not politics, but rigorous science,” said U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr. "That is why HHS is working side by side with EPA to ensure this assessment focuses on the health risks that matter most for children, including neurodevelopmental effects and dental fluorosis. By conducting a rigorous dose-response analysis and making every step of the process transparent, we will give states, communities, and families the scientific foundation they need to make informed decisions about fluoride in drinking water.”

Earlier this year, EPA released its Preliminary Assessment Plan and Literature Survey for public comment. The agency’s new Protocol for Developing the Fluoride Human Health Toxicity Assessment reflects public input received on that plan. The Protocol is an essential part of developing the human health assessment; it is a road map that transparently describes how EPA will conduct the assessment while applying gold standard science.

EPA’s assessment of fluoride under the SDWA will consider neurodevelopmental effects in children (e.g., negative effects on brain function, including lower IQ). EPA’s assessment will also consider the negative health effects of dental fluorosis (e.g., discoloration and pitting of tooth enamel) in children. The agency will develop a human health toxicity assessment examining how much exposure to fluoride causes these negative health effects. This is called dose-response analysis, which EPA uses to determine the fluoride levels that a person can be exposed to without experiencing harmful health effects. The Protocol explains the scientific plan for conducting this analysis.

The agency will use this Protocol to develop the draft fluoride human health toxicity assessment, which once completed will be available for public comment. EPA will use systematic review practices that are consistent with gold standard science and SDWA requirements, draw on expertise from the U.S. Department of Health and Human Services (HHS), and will not prejudge any outcomes of the assessment. When final, the assessment will inform potential revisions to federal drinking water regulations. It will also help states and local leaders make informed decisions about fluoridating drinking water.

For more information on EPA’s efforts on fluoride in drinking water and to view the Protocol for Developing the Fluoride Human Health Toxicity Assessment, please visit EPA's Fluoride in Drinking Water webpage.

Background

EPA’s role under the SDWA is to limit the amount of contaminants in drinking water provided by public water systems to protect public health. EPA previously set the maximum contaminant level (MCL) for fluoride at 4.0 milligrams per liter, a standard designed to prevent known or anticipated adverse health effects that was set in 1986 and most recently reviewed in 2024. Under normal SDWA timelines, the next comprehensive analysis of new scientific information, which includes evaluation of the potential health risks of fluoride in drinking water would not be due until 2030, but EPA has accelerated this work to deliver updated health information to the public sooner while maintaining rigorous review and quality controls.

Decisions on whether to add fluoride to drinking water are guided by public health recommendations from HHS and the Centers for Disease Control and Prevention (CDC) and are ultimately made at the state or local level. U.S. Public Health Service has issued Recommendations for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries, otherwise known as tooth decay. CDC’s Community Water Fluoridation Program recommends amounts of fluoride in drinking water to best prevent cavities. Their recommended optimal level of fluoride is 0.7 milligrams per liter. These recommendations are just that – recommendations that are advisory and do not apply to EPA’s authority under the SDWA.

The federal regulatory standards set by EPA apply regardless of whether fluoride is naturally occurring in a system’s source water or is intentionally added by the water system. EPA’s responsibility is to ensure that overall fluoride levels remain within health-protective limits, but the agency does not make policy recommendations to state or local systems to add fluoride to drinking water.

SOURCE:
https://www.epa.gov/newsreleases/epa-hi ... -water-act

[admin]

PFPC Commentary

As expected, another highly fraudulent fluoride assessment appears to be forthcoming.

EPA presents EFSA's deeply defective 2025 assessment as the "most recent and comprehensive" review, reproduces its conclusion that the evidence for thyroid toxicity was insufficient, and then explicitly rejects the inclusion of thyroid and other additional health outcomes, stating that a comprehensive review of fluoride's potential health effects is unnecessary. The result is a closed circle: EFSA's false dismissal of the thyroid evidence is imported into the EPA protocol as an established conclusion, and EPA then prevents that conclusion from being tested by excluding thyroid toxicity from systematic review.

It is the laundering of a compromised prior assessment into a new supposedly independent toxicity review, with ICF again involved in the search and screening process that enforces the exclusion.

[wendy]

The treatment of iodine exposes another fundamental contradiction in the protocol. EPA lists iodine as a potential co-occurring exposure and confounder in neurodevelopmental studies, stating that it "may be important" in populations at risk of iodine insufficiency, yet it explicitly excludes thyroid outcomes and does not require thyroid-function measurements. Iodine insufficiency is relevant to neurodevelopment precisely because it can impair thyroid-hormone production during critical developmental periods, so iodine cannot be meaningfully separated from the thyroid system through which its effects occur. By reducing iodine to an optional, study-by-study covariate while excluding thyroid toxicity from systematic review, EPA avoids determining whether iodine status modifies fluoride toxicity, whether fluoride itself disrupts thyroid function, or whether thyroid dysfunction mediates part of the observed neurodevelopmental effect. Its selective reference to iodine insufficiency, without corresponding consideration of iodine excess or other abnormal iodine states, further demonstrates how superficial and one-sided this treatment is.