Fluoride and Brain Health: What the 2024 NTP Systematic Review Found

Few public health interventions have generated as much sustained scientific and political debate as community water fluoridation. First introduced in Grand Rapids, Michigan, in 1945, the practice of adding fluoride to public water supplies to prevent tooth decay has been endorsed by virtually every major health organization in the world. At the same time, questions about fluoride’s effects on the developing brain have been the subject of scientific investigation for decades — and in August 2024, the National Toxicology Program (NTP) published a systematic review that significantly shifted the terms of that debate.

This article examines what the NTP found, how its conclusions fit within the broader body of fluoride research, what competing studies have reported, how the legal and regulatory landscape has evolved through 2026, and what the current evidence means for consumers and policymakers.

A Brief History of Water Fluoridation

The story of community water fluoridation begins in the early twentieth century, when a dentist named Frederick McKay noticed that residents of Colorado Springs had unusually mottled but remarkably cavity-free teeth. Decades of investigation eventually linked both the mottling (dental fluorosis) and the cavity resistance to naturally occurring fluoride in the local water supply. By the 1940s, public health officials had identified an apparent “sweet spot” — a fluoride concentration high enough to reduce tooth decay but low enough to minimize visible fluorosis.

Grand Rapids became the first city to add fluoride to its water supply in January 1945, followed quickly by other cities in the United States and Canada. By 1960, water fluoridation had become a standard public health measure across much of the English-speaking world. The U.S. Centers for Disease Control and Prevention later named community water fluoridation one of the ten great public health achievements of the twentieth century, alongside vaccination and motor vehicle safety.

Today, approximately 209 million Americans — 72.3% of those on community water systems — receive fluoridated water, according to the CDC’s 2022 National Water Fluoridation Statistics. Globally, however, the practice is far less common. Only about 5% of the world’s population receives artificially fluoridated water, and more people drink fluoridated water in the United States alone than in the rest of the world combined. Most of continental Europe does not fluoridate its water, relying instead on fluoridated salt, fluoride supplements, or topical fluoride products. Only a handful of countries — including Australia (90%), Singapore (100%), Ireland (73%), and New Zealand (52%) — fluoridate more than half their population’s water supply.

What the NTP Systematic Review Found

The NTP’s Monograph on the State of the Science Concerning Fluoride Exposure and Neurodevelopment and Cognition (NTP Monograph 08), published in August 2024, was the most comprehensive review of fluoride’s neurocognitive effects ever conducted by a U.S. government agency. The review was initiated in 2016 and went through multiple rounds of peer review and revision before its final release. It examined human epidemiological studies, experimental animal studies, and mechanistic evidence to assess whether fluoride exposure is associated with adverse neurodevelopmental outcomes.

The central conclusion: the NTP found, with moderate confidence, that higher fluoride exposure is associated with lower IQ in children. This finding was based primarily on the human epidemiological evidence, which the NTP rated as providing the strongest data. The NTP defined “higher exposure” as fluoride levels above 1.5 mg/L in drinking water — more than double the 0.7 mg/L recommended for U.S. community water fluoridation.

The review examined more than 70 epidemiological studies conducted across 12 countries, including several recent prospective cohort studies from Canada, Mexico, and the United States that measured prenatal fluoride exposure and subsequent child IQ. Of these, 22 were assessed as high-quality studies with low risk of bias. The majority of the evidence came from populations exposed to fluoride levels above 1.5 mg/L — concentrations found in endemic fluorosis regions of China, India, Iran, and Mexico. However, some studies in the review did report associations at lower exposure levels, and the NTP stated it could not rule out effects at concentrations relevant to optimally fluoridated water.

The 2025 JAMA Pediatrics Meta-Analysis

In January 2025, members of the NTP review team published a detailed quantitative meta-analysis in JAMA Pediatrics that synthesized the 74 epidemiological studies reviewed in the monograph. The meta-analysis, authored by Taylor, Eftim, Sibrizzi, and colleagues, reported a statistically significant inverse association between fluoride exposure and children’s IQ scores across the full body of evidence. According to the NTP’s own summary, the 74 studies were conducted in 10 countries (Canada, China, Denmark, India, Iran, Mexico, Pakistan, New Zealand, Spain, and Taiwan), and none were conducted in the United States. Exposure was measured through drinking water fluoride concentrations or urinary fluoride levels.

The authors noted that the inverse association was consistent across different study designs, geographic regions, and exposure measurement methods. The publication in one of the most prestigious pediatrics journals in the world gave the NTP’s findings additional visibility and scientific credibility. However, the authors were careful to note that the meta-analysis could not establish causation — it demonstrated a consistent statistical association that warranted further investigation.

NTP’s Response to Key Critiques

Following publication, the NTP authors released a detailed document addressing the most common criticisms of their findings. Among the key points:

On including low-quality studies: The NTP noted that restricting the analysis to the 22 high-quality studies only strengthened the inverse association. The low-quality studies, if anything, diluted the overall effect size rather than inflating it.

On confounding variables: The NTP acknowledged that some studies did not adequately control for all potential confounders, but argued that the consistency of findings across different countries, study designs, and confounding structures made it unlikely that any single unmeasured confounder could explain the entire pattern of results.

On relevance to U.S. water fluoridation levels: The NTP stated that its conclusion applied to fluoride exposures above 1.5 mg/L and noted that the data were insufficient to draw firm conclusions about effects at 0.7 mg/L. However, several of the high-quality studies did report associations at exposures below 1.5 mg/L, and the NTP explicitly stated that it could not rule out effects at lower concentrations.

Competing Studies and Criticisms

The NTP’s conclusions have not gone unchallenged. Two major studies published in 2025 reported findings that appeared to contradict the NTP’s conclusions, at least at the fluoride concentrations used in U.S. community water fluoridation.

The Iowa Fluoride Study (Science Advances, 2025). Warren and colleagues at the University of Iowa published the longest-running prospective study of fluoride exposure and cognitive outcomes, following participants from birth through mid-adulthood (approximately age 30). The study measured fluoride intake from multiple sources — water, diet, supplements, and dental products — and assessed cognitive outcomes at multiple time points using standardized tests. The researchers found no association between childhood fluoride exposure at levels typical of U.S. community water fluoridation and cognitive outcomes later in life. This study was notable for its duration, its comprehensive exposure assessment, and its focus on the specific fluoride concentrations used in American water systems rather than the higher concentrations found in endemic fluorosis regions.

The Australian Longitudinal Study (Journal of Dental Research, 2025). Do and colleagues conducted a population-based longitudinal cohort study in Australia and found no significant relationship between early childhood fluoride exposure and neurodevelopmental outcomes. Australia fluoridates approximately 90% of its population’s water supply at concentrations similar to the U.S. level.

Critics of the NTP review have raised several additional methodological concerns beyond those addressed by the NTP authors.

Exposure levels and dose-response. Most studies showing IQ decrements involved populations exposed to naturally occurring fluoride levels well above 1.5 mg/L — in some cases, 3, 5, or even 10 mg/L. These concentrations are found in parts of China, India, Iran, and Mexico but exceed the 0.7 mg/L used in U.S. community water fluoridation by a factor of five to fifteen. Critics argue that extrapolating results from such high exposures to much lower doses is scientifically inappropriate.

Confounding by co-occurring exposures. In many high-fluoride regions, groundwater also contains elevated levels of arsenic, lead, and other neurotoxicants. Iodine deficiency, which independently affects cognitive development, is also common in some of these regions. Several critics have argued that the observed IQ associations could be partially or entirely explained by these co-occurring exposures rather than by fluoride itself.

Publication bias. Some researchers have noted that small, positive studies (showing an effect) are more likely to be published than small, negative studies (showing no effect), which could inflate the overall estimate in a meta-analysis. However, the NTP authors addressed this in their response, noting that funnel plot analyses did not reveal strong evidence of publication bias in the high-quality study subset.

The Legal and Regulatory Landscape

The scientific debate over fluoride’s neurocognitive effects has played out in parallel in the legal and regulatory arena, with significant developments in 2024, 2025, and 2026.

The District Court Decision (September 2024)

On September 24, 2024, Judge Edward Chen of the U.S. District Court for the Northern District of California issued a landmark ruling in Food & Water Watch v. EPA. The court found that the plaintiffs had established, by a preponderance of the evidence, that fluoride at levels typical of U.S. drinking water (0.7 mg/L) posed an “unreasonable risk of reduced IQ in children.” The court ordered the EPA to “initiate rulemaking pursuant to Subsection 6(a) of TSCA” — the first time a federal court had ordered EPA to regulate fluoride based on neurotoxicity concerns.

However, the court’s order was carefully circumscribed. It did not ban water fluoridation, did not order the EPA to set a specific fluoride standard, and did not dictate what regulatory action the EPA must take. It left the door open for EPA to “conduct additional analysis or seek additional information to put a finer point on the risk posed by the condition of use before taking regulatory action.”

The Biden Administration’s Appeal (January 2025)

On January 17, 2025, in one of the final actions of the Biden administration, the EPA filed a notice of appeal of the district court’s ruling to the U.S. Court of Appeals for the Ninth Circuit. The appeal was continued by the incoming Trump administration, which presented legal grounds for reversal.

The Ninth Circuit Decision (May 2026)

On May 21, 2026, the Ninth Circuit filed a memorandum of disposition vacating the district court’s September 2024 decision and remanding the case for further consideration. This means the district court’s finding that fluoride at 0.7 mg/L poses an “unreasonable risk” no longer stands as binding precedent. The case has been sent back to the district court for further proceedings, and the ultimate regulatory outcome remains uncertain as of September 2026.

State-Level Actions

Regardless of the federal litigation, the fluoride debate has prompted action at the state and local level. Several U.S. municipalities have voted to discontinue water fluoridation in 2025 and 2026, citing the NTP report and the district court ruling (even though the latter was subsequently vacated). These decisions have been criticized by dental and public health organizations as premature and not supported by the weight of the evidence at concentrations used in community water fluoridation.

Mechanistic Evidence: How Fluoride Could Affect the Brain

Understanding why fluoride might affect neurodevelopment requires looking at the mechanistic evidence — the laboratory studies that examine how fluoride interacts with brain cells and biological systems at the molecular level.

The NTP review identified several plausible biological mechanisms through which fluoride could affect neurodevelopment. Animal studies have demonstrated that fluoride can cross the blood-brain barrier and accumulate in brain tissue, particularly in the hippocampus (a region critical for learning and memory). At high doses, fluoride has been shown to trigger oxidative stress in brain cells, disrupt neurotransmitter systems, induce neuroinflammation, and activate apoptotic (cell death) pathways. Research published in Environmental Pollution by Niu and colleagues has documented that excessive endoplasmic reticulum stress and resulting autophagic flux dysfunction contribute to fluoride-induced neurotoxicity in experimental models.

However, a crucial limitation applies: most mechanistic studies have used fluoride concentrations far exceeding what human brain tissue would be exposed to from drinking fluoridated water at 0.7 mg/L. The dose at which cellular effects are observed in a petri dish or in rodent models does not necessarily translate to the exposures experienced by humans drinking optimally fluoridated water. This dose-relevance question remains one of the most contested aspects of the scientific debate.

The developing fetal brain may be more vulnerable to fluoride exposure than the adult brain. Several prospective cohort studies have measured fluoride concentrations in maternal urine during pregnancy and then assessed the children’s IQ at school age. The ELEMENT cohort in Mexico City and the MIREC cohort in Canada both reported inverse associations between prenatal fluoride exposure (as measured by maternal urinary fluoride) and children’s IQ scores. These prenatal exposure studies are considered particularly important because the fetal blood-brain barrier is less fully developed than the adult version, potentially allowing greater fluoride transfer to the developing brain.

The Role of Total Fluoride Exposure

One often-overlooked aspect of the fluoride debate is that drinking water is only one source of total fluoride intake. Other significant sources include toothpaste (which children may inadvertently swallow), mouthwash, tea (the tea plant is a natural fluoride accumulator), processed foods and beverages made with fluoridated water, certain pesticides (such as cryolite), and in some countries, fluoridated salt or milk.

A person’s total fluoride exposure depends not only on their water fluoride concentration but also on how much water they drink, what they eat, what dental products they use, and their individual kidney function (since the kidneys are the primary route of fluoride excretion). This variability in total exposure is one reason why setting a single “optimal” water fluoride concentration is inherently imprecise — the same water concentration will produce different total exposures in different individuals.

The U.S. Public Health Service lowered its recommended fluoride concentration from the previous range of 0.7–1.2 mg/L to a single recommendation of 0.7 mg/L in 2015, specifically because of concerns about increasing total fluoride exposure from multiple sources. The reduction was based primarily on rising rates of dental fluorosis (cosmetic changes to tooth enamel caused by excess fluoride during tooth development), not on neurotoxicity concerns, which were less prominent at that time.

International Perspective: How Other Countries Handle Fluoride

The United States and its English-speaking allies (Australia, New Zealand, Ireland, Canada, and the United Kingdom) are unusual in their reliance on water fluoridation. Most of the rest of the world has chosen different approaches to preventing tooth decay.

Continental Europe largely rejected water fluoridation decades ago. Germany discontinued fluoridation in 1971, the Netherlands in 1976, Finland in 1993, and Switzerland ended its only fluoridation program (in Basel) in 2003. Most European countries have instead adopted fluoridated salt, fluoridated milk programs (notably in Bulgaria and the United Kingdom), school-based fluoride rinse programs, or reliance on fluoridated toothpaste as the primary vehicle for topical fluoride delivery. Despite not fluoridating their water, many European countries have experienced declining rates of tooth decay comparable to those seen in fluoridated countries, leading some researchers to question whether water fluoridation provides meaningful additional benefit beyond what is achieved through fluoride toothpaste alone.

Japan fluoridates less than 1% of its population’s water. China does not practice community water fluoridation, though many regions have naturally occurring fluoride in groundwater at levels that cause endemic fluorosis. India faces significant endemic fluorosis in several states and has national programs aimed at reducing fluoride exposure rather than adding it.

Dental Health Considerations

Any discussion of fluoride and brain health must be balanced against fluoride’s well-documented benefits for dental health. The evidence that fluoride prevents tooth decay is supported by decades of research and is not seriously contested in the dental science community. The relevant question is not whether fluoride protects teeth but whether the benefit comes primarily from topical exposure (fluoride applied directly to the tooth surface through toothpaste or dental treatments) or from systemic exposure (fluoride ingested through water or supplements).

This distinction matters because the neurodevelopmental concerns center on systemic fluoride exposure — fluoride that is swallowed and enters the bloodstream. If the dental benefits come primarily from topical application, then it may be possible to achieve the same cavity prevention without systemic ingestion, reducing potential neurodevelopmental risks while preserving dental benefits.

The American Dental Association and most dental organizations note that fluoride provides benefits through both topical and systemic mechanisms, though they acknowledge that topical application is the primary mechanism of action for caries prevention in erupted teeth. Community water fluoridation provides a continuous low-level topical exposure through drinking, cooking, and food preparation, in addition to any systemic effects.

The equity argument for community water fluoridation is particularly important. Water fluoridation is often described as one of the few public health interventions that reaches everyone in a community regardless of income, education, dental insurance status, or access to dental care. Low-income children, who are disproportionately affected by tooth decay and least likely to receive regular dental treatment, benefit the most from the passive protection that fluoridated water provides. A Cochrane systematic review published in 2015 estimated that community water fluoridation reduces the proportion of children with cavities by approximately 15 percentage points and reduces the average number of decayed, missing, or filled teeth by 1.16 in primary teeth and 1.68 in permanent teeth. Critics of this review noted that the included studies were generally of low quality and that most were conducted before the widespread adoption of fluoride toothpaste, raising questions about whether the same magnitude of benefit would be observed in modern populations with access to multiple fluoride sources.

A 2018 Cochrane review update found insufficient evidence to determine whether water fluoridation reduces dental caries in adults. The evidence base for fluoridation’s benefits in adults is considerably weaker than for children, and some researchers have argued that the primary justification for community water fluoridation rests on its benefits for children’s dental health — a benefit that must now be weighed against the NTP’s findings regarding potential neurodevelopmental effects on the same population.

Vulnerable Populations and Differential Risk

Not all individuals face the same level of risk from a given fluoride concentration in drinking water. Several population subgroups have been identified as potentially more vulnerable to fluoride’s effects.

Infants fed formula mixed with fluoridated water. Infants who are exclusively formula-fed receive substantially higher fluoride doses per kilogram of body weight than breastfed infants, because breast milk contains very little fluoride regardless of the mother’s water supply. A 2019 analysis estimated that formula-fed infants in fluoridated communities may receive 100 to 200 times more fluoride per kilogram than breastfed infants. The American Dental Association has recommended that parents concerned about fluorosis (though not neurotoxicity) can use low-fluoride or unfluoridated water to prepare infant formula.

Individuals with impaired kidney function. The kidneys are the primary route of fluoride excretion. Individuals with chronic kidney disease, including the elderly and those with diabetes-related kidney damage, excrete fluoride less efficiently and may accumulate higher body fluoride levels from the same water concentration. A 2018 study in the Journal of Clinical and Diagnostic Research found significantly higher serum fluoride levels in patients with chronic kidney disease compared to age-matched controls drinking the same water.

Individuals with high water intake. People who drink significantly more water than average — including manual laborers, outdoor workers in hot climates, athletes, and individuals with polydipsia (excessive thirst, often associated with diabetes) — will consume proportionally more fluoride from the same water concentration. The original Coordinated Framework for fluoride in drinking water set a range (0.7–1.2 mg/L) to account for climate-related differences in water consumption, with the lower end recommended for warmer climates. The 2015 decision to adopt a single recommendation of 0.7 mg/L for all climates reflected, in part, recognition that total fluoride intake from all sources had increased since the original recommendation was established.

Genetic variability. Emerging research suggests that genetic polymorphisms in genes related to fluoride metabolism and excretion may influence individual susceptibility to fluoride’s effects. Several studies have identified variants in genes encoding renal transporters and enzymes involved in fluoride metabolism that are associated with differences in urinary fluoride excretion efficiency. This area of research is still in its early stages, but it suggests that population-level averages may mask significant individual variability in fluoride susceptibility.

Environmental Sources Beyond Drinking Water

The debate over community water fluoridation sometimes obscures the fact that fluoride is ubiquitous in the environment. Fluorine is the thirteenth most abundant element in the Earth’s crust, and fluoride ions are naturally present in virtually all soils, rocks, and water sources at varying concentrations.

Tea is one of the most significant dietary sources of fluoride. The Camellia sinensis plant is a hyperaccumulator of fluoride, absorbing it from the soil and concentrating it in its leaves. Brewed tea can contain 1 to 6 mg/L of fluoride depending on the variety, growing conditions, and brewing method — with older leaves (used in lower-grade teas) containing significantly more fluoride than young leaves. Brick tea, commonly consumed in parts of China, Tibet, and Central Asia, can contain fluoride levels exceeding 10 mg/L and has been associated with skeletal fluorosis in heavy consumers.

Processed foods and beverages manufactured in fluoridated communities contain fluoride from the water used in processing. Carbonated soft drinks, juices, soups, and processed cereals can all contribute to total fluoride intake. Fluoridated dental products (toothpaste, mouthwash, prescription fluoride treatments) provide topical exposure that also contributes to systemic intake when inadvertently swallowed — a particular concern for young children who have not yet mastered the spit-and-rinse technique.

Certain agricultural chemicals also contribute to environmental fluoride exposure. Cryolite (sodium hexafluoroaluminate) is a fluoride-containing pesticide approved for use on grapes and other crops. Phosphate fertilizers, derived from phosphate rock, contain fluoride as a natural impurity and can contribute to fluoride levels in both soil and groundwater.

Understanding total fluoride exposure from all sources is essential for evaluating the significance of any single source, including community water fluoridation. A comprehensive exposure assessment that accounts for water, diet, dental products, and environmental sources provides a more complete picture than focusing on water fluoride concentration alone.

What This Means for Consumers

For individuals seeking to make informed decisions about fluoride exposure, several practical steps are available.

Check local water fluoride levels. The CDC’s My Water’s Fluoride database allows U.S. residents to look up whether their community water system adds fluoride and at what concentration. Annual Consumer Confidence Reports published by every public water system also include fluoride levels. Residents of areas with naturally high fluoride levels (above 2 mg/L) face a different risk profile than those in areas with adjusted fluoride at 0.7 mg/L.

Water treatment options. Reverse osmosis systems, activated alumina filters, and distillation units are the three main consumer-grade technologies that effectively remove fluoride from drinking water. Standard activated carbon filters, including Brita and PUR pitchers, do not remove fluoride. Bone char filters can reduce fluoride but are less commonly available.

Dental health alternatives. Fluoride toothpaste remains the most widely recommended source of topical fluoride for dental health. Most dental organizations recommend using a rice-grain-sized amount of fluoride toothpaste for children under three and a pea-sized amount for children three to six. Prescription fluoride varnishes and gels applied by dental professionals provide targeted topical fluoride at higher concentrations for individuals at elevated risk of tooth decay.

Pregnancy considerations. The evidence suggesting that prenatal fluoride exposure may affect fetal brain development has led some researchers to recommend that pregnant women in fluoridated communities consider using filtered water as a precautionary measure. This recommendation is not endorsed by major medical organizations, which continue to regard community water fluoridation as safe during pregnancy. However, the precautionary principle suggests that individuals who are concerned about this issue have reasonable options for reducing exposure without abandoning fluoride’s dental benefits.

The Bottom Line

The fluoride-and-brain-health debate sits at a genuinely uncertain point in the science. The NTP has identified a consistent epidemiological association between higher fluoride exposure and lower IQ in children, based on the most comprehensive systematic review any government agency has conducted on this topic. At the same time, the evidence most directly relevant to U.S. community water fluoridation — studies conducted at or near 0.7 mg/L in North American and Australian populations — has generally not found statistically significant associations with cognitive outcomes. The Ninth Circuit’s vacatur of the district court’s ruling in May 2026 leaves the regulatory question unresolved.

What is clear is that the scientific understanding of fluoride’s neurocognitive effects has changed significantly since the NTP began its review in 2016, and the body of evidence continues to grow. Major studies are ongoing in multiple countries, and additional prospective cohort data from North American populations are expected in the coming years.

The disagreement is partly about the level of evidence required to justify policy change. Proponents of the precautionary principle argue that a consistent association across 70+ studies in 12 countries, combined with plausible biological mechanisms, is sufficient reason to reconsider a practice that exposes hundreds of millions of people — including pregnant women, infants, and individuals who cannot control their exposure — to a substance that may carry neurological risks. Defenders of the current policy argue that the most directly relevant studies (those conducted in communities with fluoride levels at or near 0.7 mg/L) have not confirmed a neurocognitive risk, that the dental health benefits are well-documented and disproportionately benefit disadvantaged communities, and that abandoning fluoridation based on studies conducted at much higher exposure levels would be a net public health loss.

Both positions can be held in good faith, and the resolution will ultimately depend on additional high-quality research conducted at fluoride exposure levels directly relevant to community water fluoridation. In the meantime, individuals and policymakers must navigate genuine scientific uncertainty — a situation that is uncomfortable but not uncommon in public health, where perfect evidence rarely arrives before decisions must be made.

The debate is far from settled, and the policy implications of whatever scientific consensus eventually emerges will be significant for the more than 200 million Americans who currently drink fluoridated water.

References

1. National Toxicology Program. NTP Monograph on the State of the Science Concerning Fluoride Exposure and Neurodevelopment and Cognition: A Systematic Review. NTP Monograph 08, August 2024. ntp.niehs.nih.gov
2. Taylor KW, Eftim SE, Sibrizzi CA, et al. Fluoride Exposure and Children’s IQ Scores: A Systematic Review and Meta-Analysis. JAMA Pediatrics. 2025;179:282–292. PubMed
3. Warren J, Rumore G, Kim S, et al. Childhood Fluoride Exposure and Cognition Across the Life Course. Science Advances. 2025;11:eadz0757.
4. Do LG, Sawyer A, Spencer AJ, et al. Early Childhood Exposures to Fluorides and Cognitive Neurodevelopment: A Population-Based Longitudinal Study. Journal of Dental Research. 2025;104:243–250.
5. Food & Water Watch v. EPA. No. 3:17-cv-02162-EMC. U.S. District Court for the Northern District of California. September 24, 2024. networkforphl.org
6. U.S. Court of Appeals for the Ninth Circuit. Memorandum of Disposition, Food & Water Watch v. EPA, No. 25-384. May 21, 2026. lawbc.com
7. CDC. 2022 National Water Fluoridation Statistics. cdc.gov
8. U.S. Public Health Service. Recommendation for Fluoride Concentration in Drinking Water. Public Health Reports. 2015;130(4):318–331.
9. National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. Washington, DC: National Academies Press; 2006.
10. Choi AL, Sun G, Zhang Y, Grandjean P. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives. 2012;120(10):1362–1368.
11. Niu Q, Chen J, Xia T, et al. Excessive ER Stress and the Resulting Autophagic Flux Dysfunction Contribute to Fluoride-Induced Neurotoxicity. Environmental Pollution. 2018;233:889–899.
12. NTP Division of Translational Toxicology. Addressing Critiques of the Evidence Linking Fluoride and Children’s IQ. Environmental Health Perspectives. 2025. PMC

Last updated: September 26, 2026