Agency removes fluoride hazard classification

Child Fluoride Application

The latest draft monograph from the U.S. Department of Health and Human Services' National Toxicology Program (NTP) has removed the hazard classification of fluoride. It is the latest development in the agency's effort to publish its report on fluoride exposure and potential neurodevelopmental effects in humans.

On March 15, the NTP released a working draft from September 2022 of its fluoride monograph. The draft includes changes based on two reviews by the National Academies of Science, Engineering, and Medicine (NASEM) that concluded the NTP had not sufficiently validated that fluoride should be classified as a cognitive neurodevelopment hazard for humans.

"The NASEM committee determined that, 'Overall the revised monograph seems to include a wealth of evidence and a number of evaluations that support its main conclusion, but the monograph falls short of providing a clear and convincing argument that support its assessments,'" the new draft states.

In addition to removing the hazard conclusions in prior drafts, the NTP changed the report title to emphasize the state of the science related to fluoride. The new report also includes comments and responses from subject matter experts at the U.S. Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, and the U.S. National Institutes of Health.

Dental commentary

Dr. Johnny Johnson.Dr. Johnny Johnson.

In a press release, the American Fluoridation Society provided mixed reviews of the changes. While the society approved the removal of the hazard classification section, it criticized the NTP for not addressing all of the concerns raised by NASEM, including how the NTP evaluated the quality of studies, and inconsistencies in determining bias risk.

"NTP realized correctly that it should remove the hazard classification," American Fluoridation Society President Dr. Johnny Johnson said in a press release. "On the other hand, it is disturbing that NTP chose to abandon its peer review process. The National Academies is the most prestigious, independent scientific body in our nation."

Johnson also highlighted two new studies from Australia and Spain that did not show a link between exposure to fluoride and altered neurodevelopment in children. In the first study, children in Australia who had 100% lifetime exposure to fluoridated water had equivalent development scores compared to children with 0% lifetime exposure to fluoride (J Dent Res, October 9, 2022, Vol. 102:1, pp. 28-36). In the second study, maternal fluoride levels were associated with better cognitive scores for children (Environ Res, May 1, 2022, Vol. 207, 112181).

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