By Brigitte Rodriguez, Publishing Associate: Researcher and Writer at Save the Water™ | June 26, 2025

Edited by Shannon Hsieh, Publishing Associate: Editor at Save the Water™

Millions of people worldwide still drink fluoridated tap water every day, but growing scientific evidence has raised concerns about potential health risks. Countries like the United States, Canada, Australia, and New Zealand continue to add fluoride to public water supplies. This is to help reduce tooth decay. However, across Europe, water fluoridation has largely disappeared. Few maintain the practice, while most countries rely on alternative strategies to protect dental health.

Fluoride Water Use on Teeth

For more than 70 years, fluoride has helped reduce dental cavities. It protects teeth by:

• • Slowing the loss of minerals
  • Reducing harmful bacteria in the mouth
  • Supporting remineralization by adding calcium and phosphate

Therefore, organizations such as the American Dental Association (ADA) recommend community water fluoridation at approximately 0.7 parts per million (ppm) as both safe and effective.

Are there any Safety Concerns?

In January 2025, a review study showed that high fluoride exposure, primarily greater than 1.5 mg/L, is associated with lower IQ in children. Furthermore, smaller studies found that even moderate levels of fluoride (around 1 mg/L) were associated with slight decreases in IQ when measured in children’s urine.

Additionally, in April 2025, the U.S. Environmental Protection Agency (EPA) released a report from the National Toxicology Program(part of the Department of Health and Human Services) stating that levels exceeding 1.5 mg/L could harm children’s cognitive development. The EPA is also reviewing the national fluoride standard to ensure it remains safe.

Europe’s Decision to Stop Using Fluoride

Germany, Sweden, and the Netherlands banned water fluoridation in the 1970s and 1980s. The reasons were:

• • Public preferences
  • Lack of sufficient legal laws, since current rules do not allow the addition of medicinal substances to water.
  • Concerns about dosage: systemic dosing, adding fluoride to the water supply, versus topical use, using fluoride directly through products.

Therefore, these countries maintain good dental health thanks to fluoridated salt, dairy programs, and educational campaigns.

Using Other Alternatives

In Europe, there’s a strong preference for fluoride alternatives, including fluoride salt, fluoride toothpaste, mouthwash, and varnishes. Additionally, recent fluoride-free options such as nanohydroxyapatite toothpaste are looking promising. These toothpastes can repair enamel just as effectively as traditional fluoride. Despite this, some experts warn that these newer alternatives may not offer the same level of protection for children with a high risk of cavities.

What Can You do?

• • Monitoring matters: Check fluoride levels in your public water report. Levels over 1.5 mg/L may require attention.
  • Choose targeted protection: Use fluoridated toothpaste or varnishes instead of systemic dosing.
  • Stay updated: The EPA’s ongoing review may shift safe fluoride limits based on cognitive risk evidence.