Fluoride in Drinking Water: The 2026 Debate and What It Means for Your Family

What's Happening with Fluoride in 2026

The fluoride landscape has changed more in the past 18 months than in the previous 30 years. Here are the key developments:

The HHS recommendation ended. In late 2025, the U.S. Department of Health and Human Services officially withdrew its recommendation for community water fluoridation at 0.7 mg/L (parts per million). This didn't ban fluoridation -- it simply removed the federal endorsement that had been in place since 1962. The HHS cited new evidence on total fluoride exposure from multiple sources (toothpaste, dental products, food, beverages) and acknowledged that overexposure concerns warranted a reassessment.

The EPA review raised neurological concerns. A comprehensive EPA-commissioned review by the National Toxicology Program (NTP), finalized after years of litigation, concluded that fluoride exposure at levels commonly found in fluoridated water (0.7 mg/L) is "presumed to be a cognitive neurodevelopmental hazard to humans." The review analyzed over 70 human studies and found consistent associations between fluoride exposure and reduced IQ scores in children, particularly at levels above 1.5 mg/L but with some evidence of effects at lower levels.

State-level action accelerated. By early 2026, at least eight states have passed or introduced legislation requiring voter referendums before municipalities can fluoridate water, and several communities across the country have voted to discontinue fluoridation. In New York State, fluoridation remains a local decision, and Rochester continues to fluoridate.

The dental community is divided. The American Dental Association continues to support fluoridation, citing decades of evidence showing 25% reductions in tooth decay. However, a growing number of dentists and researchers argue that topical fluoride (toothpaste, rinses) provides the same dental benefits without systemic ingestion, and that the risk-benefit calculus has shifted as fluoride exposure from other sources has increased.

The Case for Fluoride: Decades of Dental Evidence

Fluoridation supporters point to a substantial body of evidence:

• Tooth decay reduction. Large-scale studies consistently show that fluoridated communities have 25-30% lower rates of dental cavities compared to non-fluoridated communities. For low-income families with limited access to dental care, this benefit can be significant.
• Cost-effectiveness. Community water fluoridation costs approximately $1 per person per year and prevents an estimated $32 in dental treatment costs per person. It's one of the most cost-effective public health interventions ever implemented.
• Safety at recommended levels. At the recommended concentration of 0.7 mg/L, fluoride has been used for over 75 years with no confirmed acute health effects. The CDC, WHO, and most major dental and medical organizations have historically endorsed it.
• Equity argument. Fluoridation benefits everyone who drinks tap water, regardless of income, insurance status, or access to dental care. Removing it disproportionately affects families who can't afford regular dental visits or prescription fluoride supplements.

The Case Against: Emerging Concerns

Critics cite an accumulating body of research that complicates the picture:

• Neurological effects. The NTP review is the most significant development. Multiple studies, including a major Canadian study published in JAMA Pediatrics in 2019 and subsequent research through 2025, found associations between maternal fluoride exposure during pregnancy and lower IQ scores in children. The effect sizes were modest (approximately 3-5 IQ points) but consistent across different study populations and methodologies.
• Dental fluorosis. Approximately 65% of American adolescents now show some degree of dental fluorosis (white spots or streaks on teeth caused by fluoride overexposure during tooth development). While most cases are mild and cosmetic, this prevalence indicates that total fluoride exposure already exceeds optimal levels for many children.
• Consent and choice. Fluoride is the only chemical added to drinking water for the purpose of treating a medical condition (dental disease) rather than making water safe to drink. Critics argue that mass medication through water supply removes individual choice, especially when topical alternatives exist.
• Thyroid concerns. Some studies have linked fluoride exposure to impaired thyroid function, particularly in individuals with iodine deficiency. A 2018 Canadian study found that fluoridated water was associated with higher rates of hypothyroidism.
• Cumulative exposure. When fluoridation began in the 1940s, drinking water was virtually the only source of fluoride exposure. Today, Americans are exposed through fluoridated toothpaste, dental treatments, processed foods and beverages made with fluoridated water, tea, and other sources. The original risk-benefit analysis didn't account for this cumulative exposure.

Rochester's Fluoride Levels

The City of Rochester fluoridates its water to a target level of 0.7 mg/L (0.7 parts per million), following the concentration recommended by HHS prior to its withdrawal. Based on Rochester Water Authority data, actual measured levels typically range from 0.5 to 0.9 mg/L throughout the distribution system, with some seasonal variation.

For context:

• The EPA's Maximum Contaminant Level (MCL) for fluoride is 4.0 mg/L -- the enforceable legal limit
• The EPA's secondary standard (for cosmetic effects like dental fluorosis) is 2.0 mg/L
• The former HHS recommended level was 0.7 mg/L
• The NTP review found cognitive concerns beginning at 1.5 mg/L, with some evidence of effects at lower concentrations

Rochester's levels are well below the EPA's enforceable limit and at the former recommended concentration. The question is whether the recommended level itself is appropriate given new research -- a question that's currently unresolved in the scientific community.

Monroe County Water Authority areas receive the same fluoridated supply from Rochester's treatment plant, so suburban homes in Greece, Webster, Penfield, Irondequoit, and other MCWA-served communities have similar fluoride levels. Homes on private wells typically have naturally occurring fluoride at much lower levels (often 0.1-0.3 mg/L), though this varies by geological zone.

Which Filters Remove Fluoride?

If you decide you want to reduce or remove fluoride from your drinking water, it's important to know that most common filters do not remove it:

Reverse Osmosis (RO): Highly Effective. RO systems remove 85-95% of fluoride from water. An under-sink RO unit is the most practical and effective option for fluoride removal in a home setting. These systems cost $300-700 installed and provide fluoride-free drinking and cooking water at the kitchen tap. This is the filtration method we most commonly recommend for families who want to remove fluoride.

Activated Alumina Filters: Effective but Specialized. Activated alumina is a highly porous form of aluminum oxide that adsorbs fluoride effectively. Removal rates of 90-95% are achievable, but the media has a limited capacity and requires regular replacement. Less commonly available than RO for residential use.

Distillation: Effective but Impractical. Distilling water removes virtually all fluoride. However, countertop distillers are slow (producing 1-2 gallons per day), energy-intensive, and impractical for daily family use.

What Does NOT Remove Fluoride:

• Standard activated carbon filters (Brita, PUR, fridge filters) -- do not remove fluoride
• Standard whole-house carbon filters -- do not remove fluoride
• Water softeners -- do not remove fluoride
• Boiling -- actually concentrates fluoride by removing water
• UV treatment -- no effect on fluoride

This is a critical distinction. Many Rochester families assume their pitcher filter or fridge filter removes fluoride. It does not. If fluoride removal is your goal, you need a reverse osmosis system or a specialized fluoride-removal filter.

Making an Informed Decision for Your Family

The fluoride question is genuinely complex, and reasonable people can disagree. Here's a framework for thinking through it:

You may want to keep fluoride in your water if:

• Your family has a history of dental problems and limited access to dental care
• Your children don't consistently use fluoride toothpaste
• You're comfortable with the current fluoride level in Rochester water (0.7 mg/L)
• You weigh the 75-year safety record more heavily than emerging neurological research

You may want to filter fluoride out if:

• You have infants who drink formula mixed with tap water (the ADA recommends using low-fluoride water for infant formula)
• You're pregnant or planning to become pregnant and are concerned about the NTP review findings
• Your children already show signs of dental fluorosis
• You prefer topical fluoride (toothpaste) over systemic ingestion
• You want to minimize total fluoride exposure given multiple sources

A middle-ground approach: Many Rochester families choose to install an RO system for drinking and cooking water while leaving the rest of the home's water fluoridated. This gives you control over fluoride in the water you ingest while maintaining the convenience of municipal water for other uses. If you want your children to receive fluoride's dental benefits, you can use fluoride toothpaste under supervision -- the topical application that most dental researchers agree is effective regardless of their position on water fluoridation.

The Bottom Line

The fluoride debate in 2026 is no longer a fringe concern -- it's a legitimate scientific discussion that has reached the highest levels of federal health policy. Rochester families deserve clear information and the ability to make their own choice.

If you're considering filtering fluoride from your water, the most effective and practical approach is an under-sink reverse osmosis system. Our team can install one at your kitchen sink and show you the before-and-after water quality data. We'll start with a free water test that measures your current fluoride levels along with dozens of other parameters, so you can make a fully informed decision. Schedule a free water test today -- whatever you decide about fluoride, knowing exactly what's in your water is the essential first step.