(NRC) independently reviewed the health effects of ingested fluoride and the scientific basis for EPA’s MCL. It concluded that the MCL was an appropriate interim standard but that further research was needed to fill data gaps on total exposure to fluoride and its toxicity. Because new research on fluoride is now available and because the Safe Drinking Water Act requires periodic reassessment of regulations for drinking-water contaminants, EPA requested that the NRC again evaluate the adequacy of its MCLG and SMCL for fluoride to protect public health.


In response to EPA’s request, the NRC convened the Committee on Fluoride in Drinking Water, which prepared this report. The committee was charged to review toxicologic, epidemiologic, and clinical data on fluoride— particularly data published since the NRC’s previous (1993) report—and exposure data on orally ingested fluoride from drinking water and other sources. On the basis of its review, the committee was asked to evaluate independently the scientific basis of EPA’s MCLG of 4 mg/L and SMCL of 2 mg/L in drinking water and the adequacy of those guidelines to protect children and others from adverse health effects. The committee was asked to consider the relative contribution of various fluoride sources (e.g., drinking water, food, dental-hygiene products) to total exposure. The committee was also asked to identify data gaps and to make recommendations for future research relevant to setting the MCLG and SMCL for fluoride. Addressing questions of artificial fluoridation, economics, risk-benefit assessment, and water-treatment technology was not part of the committee’s charge.


To accomplish its task, the committee reviewed a large body of research on fluoride, focusing primarily on studies generated since the early 1990s, including information on exposure; pharmacokinetics; adverse effects on various organ systems; and genotoxic and carcinogenic potential. The collective evidence from in vitro assays, animal research, human studies, and mechanistic information was used to assess whether multiple lines of evidence indicate human health risks. The committee only considered adverse effects that might result from exposure to fluoride; it did not evaluate health risk from lack of exposure to fluoride or fluoride’s efficacy in preventing dental caries.

After reviewing the collective evidence, including studies conducted since the early 1990s, the committee concluded unanimously that the present MCLG of 4 mg/L for fluoride should be lowered. Exposure at the MCLG clearly puts children at risk of developing severe enamel fluorosis,

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement