The British Fluoridation Society is supporting colleagues in the United States who are concerned about a potentially damaging report prepared by the National Toxicology Program (NTP). Its report on fluoride exposure and IQ is based on limited studies with findings of questionable significance.

Work by the NTP started some time ago on the report and a first draft was produced in 2019. The National Academies of Sciences Engineering and Medicine (NASEM), a pre-eminent scientific body in the US, was asked to review the document. NASEM identified deficiencies in the report and suggested improvements. In response, the NTP updated its work but NASEM’s verdict (1) on the second version was that it: “still falls short of providing clear and convincing documentation of the evidence to support its conclusions.” Despite the lack of robust evidence, the second monograph but may yet be published later this year.

The American Fluoridation Society (AFS) and many other organisations of dentists and public health doctors in the US are concerned about the impact that possible publication of the flawed document might have.  Dr Johnny Johnson, President of the AFS, says it would be irresponsible for the NTP monograph to be published. “Discouraging people from receiving the benefits of topical fluoride and fluoridated tap water could lead to a significant spike in dental disease.” 

Given that NASEM identified ‘worrisome remaining inconsistencies’ in the second report and also described the approach as ‘impressionistic and haphazard’ Dr Johnson’s concern is that NTP has an agenda which is interfering with its objectivity.

The current situation is typical of the growing polarisation of opinion occurring in countries around the world on a whole range of issues. Whether it’s vaccinations to protect populations from COVID-19 or water fluoridation to protect from dental decay, there is a small but extreme minority who resist measures designed to protect them. 

Progress has been achieved in the UK because the Government decided to act on the copious evidence that supports the benefits of water fluoridation at one part of fluoride to one million parts of water; the White Paper (2) on health and social care published in February announced that central Government is going to take back control of implementing water fluoridation schemes. Once public consultations are completed, there are communities around the UK with high dental decay levels which may finally benefit from the measure after years of campaigning. Meanwhile, BFS will continue to share helpful evidence-based information in order to minimise CWF hesitancy.

By contrast with the UK, where only one tenth of the population benefits from a fluoridated water supply, the US has many water fluoridation schemes.  The first ever scheme in the world was implemented in the US in 1945 – and continues to this day. However, the NTP  report is regarded as a potential setback.

Virtually all of the studies on which the NTP bases it findings relate to populations in low-income countries with water supplies which have very different levels of fluoride in the water; so, the findings are not relevant or helpful to populations in the US or the UK. 

BFS spokesperson, Barry Cockcroft said: “We have serious concerns at the NTP’s conclusions, which are only relevant to areas where the amount of fluoride in the water is very high, and to the level of scientific rigor applied to the papers on which they base their findings. We are aligned with our dental and public health colleagues in the United States on this.”