The Benefits of Fluoride: Addressing Public Concern and Supporting Topical Use.

The introduction of fluoride in drinking water to reduce the incidence of dental caries, once hailed as a major public health success, has recently come under scrutiny. In August 2024, a monograph from the National Toxicology Program (NTP) reported that fluoride at levels above 1.5 mg/L is associated with reduced intelligence quotient (IQ) in children. In September 2024, a US district judge required that the Environmental Protection Agency take action regarding the "unreasonable risk" posed by fluoride in drinking water. In May 2025, the Food and Drug Administration initiated efforts to remove ingestible fluoride prescription products. Effective May and July of 2025, Utah and Florida, respectively, became the first states to ban fluoride from public drinking water. These recent policy changes warrant a review of the history of fluoride's use for reducing caries, the evidence for fluoride in water and oral health products, the current criticism of fluoride, and the evidence for the effectiveness of fluoride alternatives.