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Fluoride, well-known for its anticavity properties, has seen a growing number of state and federal initiatives seeking to limit or prohibit various uses of the substance. Federal agency heads, as well as top state officials, have expressed a strong interest in "taking action" against existing fluoride use in public drinking water and ingestible drug products.
Evolution of Fluoride Regulation, Past to Present
Fluoride has a long history of regulation in the United States. The U.S. Environmental Protection Agency (EPA) has regulated fluoride under the Safe Drinking Water Act (SDWA) since 1988. The U.S. Department of Health and Human Services (HHS) has recommended optimal levels of community water fluoridation under various programs since 1962. Because of these endeavors, over two-thirds of Americans receive fluoridated drinking water via tap as of 2020. State health and environmental agencies also regulate drinking water fluoridation at the state level. Additionally, an appeal of a 2017 lawsuit against EPA resulted in a federal District Judge in California ruling that EPA must consider the health impacts of fluoride under the Toxic Substances Control Act (TSCA). Whether this consideration will lead to regulatory standards under TSCA remains unclear.
Fluoride in 2025
Fluoride has been a contentious subject in 2025, with competing stakeholders asserting a variety of conflicting claims that have impacted decision-making at both state and federal levels. In January 2025, the National Toxicology Program (NTP) released a "meta-analysis" report that reviewed findings from 74 studies on fluoride health impacts spanning ten countries. The report finds "a statistically significant association between higher fluoride exposure and lower children's IQ scores..." The study does not comment on whether a fluoride level as low as 0.7 milligrams per liter (mg/L), the level recommended for public community drinking water systems by HHS, has an adverse impact on children's intelligence quotient (IQ) scores. As noted in our June 2, 2025, blog item, NTP importantly acknowledged that the data underlying the study are not representative of fluoridation in the United States. Still, policymakers and political leaders in the United States seized upon this meta-analysis as a call to action to restrict fluoride in drinking water and certain ingestible products.
Domestic actions resulting from these findings have inspired concern from leaders in science and industry. The American Dental Association (ADA) questioned the application of the study's findings to fluoride regulation in the United States, noting that the levels of fluoridation analyzed in the meta-analysis are much higher than the recommended levels for drinking water in the United States. ADA referred to a December 2024 study of fluoridation levels within and around the recommended range in the United States, which found no link between fluoridation and reduced IQ in children. On November 20, 2025, ADA also noted a recent study showing a positive correlation between fluoride exposure and higher cognitive function in adolescents, with no cognitive defects in adulthood. Additionally, a study published May 30, 2025, warns that "[c]essation of fluoridation of US public water systems is projected to worsen oral health in children and to significantly increase national health care costs."
Despite concerns about dental health resulting from diminished community water fluoridation, questions about fluoride's health impacts have prompted multiple federal agencies and state entities to take actions to address or research water fluoridation, fluoride in ingestible drug products, and more.
Federal Action
Health and Human Services
Secretary of HHS Robert F. Kennedy Jr. has made clear that reducing fluoride and limiting fluoridation of public water is a priority under his HHS tenure. This agenda, in part, includes directing the Centers for Disease Control and Prevention (CDC) to no longer recommend fluoridation in drinking water. Kennedy cites the meta-analysis, discussed above, calling fluoride's impact on children's health and IQ into question as the motivation behind the initiative. The White House, in an April 8, 2025, article responding to The New York Times' summary of Secretary Kennedy's announcement, supported HHS's commitment to reducing fluoride in public drinking water sources.
HHS may already be taking actions pursuant to Secretary Kennedy's directives. CDC's fluoridation website explicitly states that increasing the percentage of Americans with fluoridated drinking water to 77.1 percent is a goal under the HHS Office of Disease Prevention and Health Promotion's (ODPHP) Healthy People 2030 program, but the Office of the Assistant Secretary for Health (OASH) has archived that specific goal and no longer includes it under the program.
EPA
After TSCA was amended in 2016, a coalition of non-governmental organizations (NGO) filed a TSCA Section 21 petition seeking a TSCA Section 6 rule banning the addition of fluoride chemicals to water. EPA denied the petition in 2017, and the NGOs petitioners challenged the denial in the U.S. District Court for the Northern District of California. Food & Water Watch v. EPA, No. 3:17-cv-02162-EMC. After the court ruled in September 2024 that plaintiffs established by a preponderance of the evidence that the levels of fluoride typical in drinking water in the United States pose an unreasonable risk of injury to the health of the public, the Biden EPA filed a notice of appeal on January 17, 2025. The Trump EPA has continued the case, but states that rather than asking the court to review the district court's factual findings on the "technical, complex scientific issues," it presents a "more straightforward legal grounds for reversal."
Despite appealing the lower court's decision in Food & Water Watch, EPA announced in April 2025 that it plans to review new findings related to fluoride in drinking water to determine how to move forward with the chemical's regulation. This decision is based in part on the meta-analysis results that NTP released after EPA issued in final its most recent review of fluoride's drinking water standards. According to EPA Administrator Lee Zeldin, Secretary Kennedy's "advocacy was instrumental in [EPA's] decision to review fluoride exposure risks."
U.S. Food and Drug Administration
On May 13, 2025, the U.S. Food and Drug Administration (FDA) announced that it is taking action "to remove ingestible fluoride prescription drug products for children from the market." FDA Commissioner Marty Makary stated that "[t]he best way to prevent cavities in children is by avoiding excessive sugar intake and good dental hygiene . . ." rather than through fluoride products. FDA plans to work in concert with HHS on this effort, and Secretary Kennedy has expressed his support of FDA's efforts to remove the ingestible products from market. On October 31, 2025, FDA announced the next steps of these efforts, including that enforcement notices were sent to four companies.
The White House supports FDA's actions. On September 9, 2025, an executive commission released the Trump Administration's "Make Our Children Healthy Again" strategy, which includes an explicit directive for FDA to evaluate fluoride products.
Congressional Initiatives
Other federal action initiated in response to efforts to limit and restrict fluoride in certain contexts are on the rise. On July 21, 2025, the Protect Our Treatment for Enamel, Erosion and Tooth Health Act (Protect Our TEETH Act) (H.R. 4556) was introduced. The Act would require independent evaluation of SDWA fluoride standards, and is supported by the ADA. The bill has been introduced to the House Committee on Energy and Commerce.
State Actions
In calendar year 2025, Utah and Florida prohibited communities from choosing intentionally to fluoridate their public drinking water systems. Other states, such as Ohio and South Carolina, considered similar measures.
Utah passed HB 81, Fluoride Amendments, during the 2025 legislative session. The prohibition in HB 81 against fluoridation of the public drinking water system went into effect on May 7, 2025. The state legislature's rationale was, in part, that the choice of whether to consume fluoride for dental health reasons is a choice that should be left to the individual, rather than to the government. Florida's fluoride prohibition was signed into law on May 15, 2025, and takes effect on July 1, 2025.
Commentary
The recent federal initiatives to address fluoride expressly and implicitly show a coordinated effort among senior officials of the current Administration to address fluoride, as the heads of agencies work together to build momentum around enhanced regulation of the chemical. The aligned efforts of these agencies and vocal support from the White House highlight fluoride as a priority chemical of this Administration. The coordination and support shown to the respective planned approaches to limit exposure to fluoride by all three agencies increases the likelihood of success for revised standards and regulations.
Given the Administration's push for more stringent fluoride regulations, pending review of fluoride under TSCA, and the apparent gradual decline in public support of the chemical, facilities using fluoride in industrial processing or manufacturing products containing fluoride may find themselves caught in the net of state or federal initiatives. Currently, state and federal discussions around fluoride do not appear to contemplate new regulations or restrictions for industrial sources.
Manufacturers, processors, and other entities in the ingestible drug value chain involved with children's fluoride products may be directly impacted by future FDA actions and should follow these trends closely.
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