The EPA water fluoridation appeal will proceed to the 9th Circuit Court of Appeals, following the agency’s decision to challenge a 2024 federal court ruling that found current fluoride levels in drinking water pose health risks. The decision, announced by plaintiffs’ attorney Michael Connett, marks a significant turn in a legal battle that began in 2017 under the Toxic Substances Control Act (TSCA).
In September 2024, U.S. District Judge Edward Chen ruled that the EPA must take regulatory action, citing scientific evidence that fluoride at current levels could impair children’s cognitive development. Rather than accept the ruling as a regulatory directive, the EPA water fluoridation appeal will now be reviewed by a three-judge panel, with arguments expected to focus on regulatory obligations and scientific standards.
The case stems from a lawsuit filed by several advocacy organizations, including the Fluoride Action Network (FAN), Moms Against Fluoridation, and Food & Water Watch, who argued that fluoridated water poses risks not sufficiently addressed by current EPA standards. Plaintiffs submitted peer-reviewed studies and expert testimony that led Judge Chen to conclude fluoride poses “an unreasonable risk” to public health, especially for pregnant women and young children.
Since the ruling, new scientific studies have reinforced the concerns outlined in court. A 2025 meta-analysis published in JAMA Pediatrics linked fluoridated water with measurable reductions in childhood IQ. Additional studies in JAMA Open Network and from the National Toxicology Program have echoed similar concerns.
Despite the growing body of evidence, the EPA water fluoridation appeal has garnered support from the American Chemistry Council, the American Dental Association, and the American Fluoridation Society, all of whom intend to submit amicus briefs. These groups maintain that water fluoridation is a safe and cost-effective public health strategy, although recent reviews, including a 2024 Cochrane Review, have cast doubt on the effectiveness of ingested fluoride for cavity prevention.
Under the Safe Drinking Water Act, the EPA currently allows a maximum fluoride concentration of 4.0 mg/L, while the U.S. Public Health Service recommends a lower “optimal” level of 0.7 mg/L. Judge Chen’s decision found that even this lower dosage presents risks based on a preponderance of current scientific data.
Plaintiffs have expressed concern that the decision to appeal was made not by health officials but by the Solicitor General at the U.S. Department of Justice, potentially reflecting institutional reluctance to reverse long-standing federal endorsements of fluoridation. Health Secretary Robert F. Kennedy Jr., a vocal critic of water fluoridation, has no authority to enforce regulatory changes within the EPA.
Environmental groups argue the appeal is a missed opportunity. “From day one, the EPA treated fluoridation chemicals as a protected pollutant,” said FAN Executive Director Stuart Cooper. “This case could set a precedent for how citizens can use TSCA to hold federal agencies accountable.”
In the months following the ruling, more than 60 communities, counties, and two states — Utah and Florida — have voted to end water fluoridation. Meanwhile, the American Dental Association and allied organizations have launched public messaging efforts asserting the safety and necessity of fluoride, often without acknowledging the distinction between naturally occurring calcium fluoride and industrial-grade additives like hydrofluorosilicic acid.
As the EPA water fluoridation appeal moves forward, the outcome could influence future regulation of drinking water additives and clarify the role of citizen-led litigation in shaping environmental health standards.
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Author: Sean Probber
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