Health Policy Podcast Guest Susan Goldhaber: “Fluoride… has different effects at different levels”

Susan Goldhaber, a writer for the American Council on Science and Health and former environmental consultant, said federal regulators are revisiting fluoride standards in drinking water as new research and political pressure bring renewed scrutiny to the long-standing public health practice.

Goldhaber, speaking on the Health Policy Podcast, said the Environmental Protection Agency is conducting a new toxicity assessment that could lead to changes in federal guidance.

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“Fluoride, like all chemicals, has different effects at different levels,” Goldhaber said. “Fluoride actually has some good effects on our teeth at lower levels.”

Goldhaber, who previously worked on fluoride standards early in her career, explained that current federal limits were designed to prevent severe conditions such as skeletal fluorosis at higher exposure levels. She said the EPA’s drinking water standard of four milligrams per liter was set to guard against those risks.

At lower concentrations, she said, fluoride has historically been used to reduce tooth decay. “They followed like 30,000 children for 15 years, and they found out there was like a 60% drop in cavity rate,” she said, referring to early fluoridation studies.

However, Goldhaber said newer research has raised questions about potential neurological effects at levels closer to those used in public water systems. She pointed to findings from the National Toxicology Program indicating that “fluoride concentrations above 1.5 are associated with neurological effects,” including lower IQ scores in children.

“That’s really close to what the CDC says is the recommended level,” she said, referring to guidance from the Centers for Disease Control and Prevention, which recommends fluoridation levels between 0.7 and 1.2 milligrams per liter.

Goldhaber said those findings are likely to influence regulators. “My very strong feeling is that EPA is gonna end up lowering their standard,” she said.

The issue has also become a focal point for the “Make America Healthy Again” movement, which questions the addition of chemicals to drinking water. Goldhaber said some of the concerns are grounded in changing exposure patterns.

“Fluoride exposure is much wider today than it was in the 1940s,” she said, noting that fluoride is now found in toothpaste, mouthwash, and processed foods. “Exposure is no longer single source.”

Still, she said eliminating fluoridation could have consequences. Studies in areas that stopped fluoridating water have shown “an increase in cavities in children,” she said.

Goldhaber said the American Dental Association is expected to play a central role in defending fluoridation policies.

“They have the point that this has been probably one of the most effective public health measures over the last century,” she said.

Looking ahead, Goldhaber said the debate is likely to unfold both in courts and at the local level, where fluoridation decisions are typically made.

“It’ll come out in the courts and also in the public opinion,” she said. “When they hear from their local dentist… that’s gonna be a very big part of this.”