AWWA, AMWA urge EPA to broaden fluoride health review before revising standards
The American Water Works Association (AWWA) and the Association of Metropolitan Water Agencies (AMWA) are calling on the U.S. Environmental Protection Agency to conduct a more comprehensive and independent scientific review as it reassesses the health risks of fluoride in drinking water.
In joint comments submitted Feb. 26 on EPA’s “Review of Science on Fluoride in Drinking Water: Preliminary Assessment Plan and Literature Survey,” the groups argue that the agency should not rely on existing hazard conclusions — particularly related to dental fluorosis and developmental neurotoxicity — without performing its own full systematic literature review.
AWWA and AMWA contend that EPA’s current approach “skips” key evidence synthesis steps and assumes consensus on neurodevelopmental risks that they say are not firmly established in the broader scientific community. The letter cites critiques of the National Toxicology Program’s 2024 fluoride monograph, as well as subsequent analyses, noting concerns about study quality, reproducibility and applicability to U.S. populations.
The associations also urge EPA to evaluate total fluoride exposure — including from food, beverages and dental products — rather than focusing solely on drinking water under the Safe Drinking Water Act framework. They argue that failing to account for fluoride’s documented dental health benefits could lead to uncoordinated policy outcomes across federal agencies.
AWWA and AMWA conclude that, given the potential implications for national drinking water standards, EPA should restart its systematic review process and invest in high-quality U.S.-based studies before moving toward any revised maximum contaminant level goal or standard.