Is Fluoride Affecting Kids' IQs?

You might have noticed a trend towards fluoride-free toothpaste in recent years. Now, thanks to a new report by the US National Toxicology Program (NTP) that chatter has grown. The report, which analyzed data from 19 different studies, says that drinking water with elevated levels of fluoride is linked to lower IQ in children. Before you panic about your child's brain development, here's what you need to know about fluoride and IQ levels.

What is fluoride and what does it do?

Flouride is a key part of overall dental health for both adults and kids, says Dr. Ashley Lerman, a board-certified pediatric dentist and founder of Your First Grin, a maternal and pediatric dental health initiative. It's a naturally occurring mineral that plays a critical part in preventing tooth decay by strengthening enamel and remineralizing early stages of cavities.

It can be administered either systemically, such as through fluoridated drinking water, supplements or some foods, or topically, such as through toothpaste or a fluoride treatment you'd get in a dentist's office.

"The key distinction is that systemic fluoride primarily strengthens teeth before they erupt, while topical fluoride protects teeth that are already present," she explains. "Most dentists recommend a combination of both for comprehensive protection against tooth decay. It works best, though, when applied directly to the teeth as it helps incorporate more fluoride in the enamel."

Is fluoride safe?

Fluoride is in both regards is safe and effective, says Dr. Lerman, when used as recommended. It is endorsed by numerous health organizations including the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC). "The CDC regards water fluoridation as one of the greatest public health advancements of the last century," she says. 

The NTP's report summarized other studies conducted in China, India, Iran, Pakistan, Mexico and Canada. However, the report did not quantify how many IQ points might be lost at different levels of exposure, although some studies within the report suggest it was as high as five points.

Dr. Lerman says that there really shouldn't be anything to worry about. "The recommended level of fluoride in community water (0.7 mg/L) is considered safe and is supported by decades of research showing significant benefits in preventing cavities," she says. "Community water fluoridation has been a common practice in the U.S. and Canada, significantly improving dental health. On average, children in regions with fluoridated water have two fewer decayed teeth compared to their peers in non-fluoridated areas."

Additionally, the study failed to reach conclusions about risks at lower fluoride levels relevant to most public water systems on the opposite side of the coin, making it imbalanced in Dr. Lerman's eyes.

Dr. Lerman does acknowledge that there is a risk of consuming extremely high levels of fluoride in drinking water which occurs in areas with naturally high fluoride concentrations, but it's very rare. "Only about 0.6 percent of the U.S. population is exposed to fluoride at or above 1.5mg/L, which is double what is typically added to U.S. water systems," she says. "Anything at twice the normal limit can have negative health outcomes. That's why there are limits. This is crucial to understand the findings."

It's important to note that the American Dental Academy has also criticized the study's methodology, stating that none of the IQ studies were done in the U.S. and it failed to consider the benefits of fluoride, which are well-established. The ADA also points out that there is a risk of bias and selective reporting of non-significant study results.

The National Academies of Sciences, Engineering, and Medicine also concluded that the NTP's report had insufficient evidence to draw conclusions, and the American Academy of Pediatrics still recommends children be exposed to fluoride after reviewing the report's findings. "This report highlights the importance of further investigation and ongoing monitoring, particularly in areas with naturally elevated fluoride levels in the water supply," says Dr. Lerman.

Should you stop using fluoride toothpaste?

Dr. Lerman says that while the study raises valid concerns, it does not call into question the safety of current water fluoridation programs. The fluoride concentrations linked to potential IQ impacts are far above those found in community water systems, and the benefits in preventing tooth decay outweigh the potential risks when fluoride levels are normal, as stated by organizations such as the CDC and Health Canada.

She says there's no need to stop using fluoride toothpaste since the high levels of naturally occurring fluoride come from community water in only certain areas, not products. Following the guidelines for using fluoride toothpaste in children, such as only using a pea-sized amount, can help control your child's fluoride intake and prevent fluorosis, a cosmetic condition found on the teeth of children who consume too much fluoride through toothpaste.

Avoiding fluoride altogether because of this study would be misguided in Dr. Lerman's eyes. "Fluoride, at the levels used in water and dental products, has a well-established track record of safety and efficacy. If you have concerns about fluoride, consult with a healthcare provider, but understand that removing fluoride from your routine could increase the risk of tooth decay, particularly in children," she says. "We can't ignore fluoride's well-established dental health benefits."

What to do if you're still worried

She also says that cumulative fluoride exposure shouldn't be a cause for concern. It's a valid point for further research, but Dr. Lerman says that the current evidence doesn't suggest that the normal use of fluoridated products and drinking fluoridated water poses any risk.

Some non-fluoride alternatives on the market use a mineral called nano-hydroxyapatite, such as Boka and RiseWell. Dr. Lerman says that the compound is still being researched as a potential alternative to fluoride for strengthening teeth.

"Fluoride remains the gold standard," she says. If you choose a non-fluoride option, it’s important to maintain diligent oral hygiene, be aware of your diet, nutrition, ingested sugars and processed carbohydrates, frequency of eating and drinking (other than plain water) and regular dental check-ups."