The AAP is continuing to speak out in support of using fluoride to prevent dental caries, as federal officials take steps to remove prescription fluoride supplements for children from the market.
“If we are going to promote the health and well-being of children, fluoride is an important part of that work,” said AAP President Susan J. Kressly, M.D., FAAP. “We need policymakers to join us in following the science to make sure that every child has the opportunity to thrive.”
The Food and Drug Administration (FDA) announced Tuesday it will conduct a review of evidence on concentrated ingestible fluoride prescription products for children with the goal of taking action by Oct. 31. However, manufacturers would have to remove the products voluntarily for the FDA to avoid a long rulemaking process, according to the Associated Press.
Prescription supplements come in the form of liquids, tablets and lozenges. FDA Commissioner Marty Makary, M.D., M.P.H., claimed in a press release the supplements alter the gut microbiome and that fluoride is linked to thyroid disorders, weight gain and possible decreased IQ.
The AAP has repeatedly debunked claims about negative health impacts of fluoride. Evidence shows it is safe when used at recommended levels.
“We must follow good science and the evidence,” Dr. Kressly said. “Poorly constructed studies and possible associations proposing negative impacts of fluoride, which cannot be replicated and are not based on fact, cause unnecessary concern and anxiety for families. Rigorous reviews of fluoride safety have consistently found no credible evidence linking it to systemic or adverse health issues.”
Dental caries is one of the most common chronic diseases in children and can have lifelong consequences. Tooth decay can be painful and disabling and lead to costly health conditions that impact children’s ability to eat, sleep, focus and attend school. It disproportionately impacts Black and Hispanic children, children who live in underserved communities or in families with low incomes, and children with special needs.
The AAP recommends children use age-appropriate amounts of fluoride toothpaste and drink optimally fluoridated water to protect their teeth. Families of children ages 6 months to 16 years whose primary water source does not have sufficient fluoride should discuss oral fluoride supplementation with their pediatrician or dentist. Fluoride varnish should be applied to children’s teeth as recommended by the U.S. Preventive Services Task Force. Children get optimal protection with a combination of topical and systemic exposure.
“Strategies around fluoride in toothpaste, fluoride in the water supply, fluoride supplements and application of topical fluoride treatments have been instrumental in reducing the health implications of caries,” Dr. Kressly said. “Many people don't realize how dental caries impact overall health and can lead to significant complications, including brain abscesses and heart infections.”
Water fluoridation reduces tooth decay by about 25%. It has been recognized as one of the 10 great public health interventions of the 20th century by the Centers for Disease Control and Prevention (CDC).
The plan to remove fluoride supplements from the market is the latest attack on fluoride led by Health and Human Services Secretary Robert F. Kennedy Jr. Last month, Kennedy said he wanted the CDC to stop recommending community water fluoridation and praised Utah for banning it, according to news reports.
The AAP was one of 250 health professional organizations that sent a letter to Congress supporting the continued use of water fluoridation and asserting that it is safe and effective despite pervasive misinformation.
“With an abrupt departure from water fluoridation, our nation would undoubtedly experience a rapidly rising incidence of decay,” they wrote. “The U.S. does not have capacity in the oral health workforce to support the emergency, surgical, and restorative dental needs that would result. There would be increased pain and suffering, and more missed school and work. None of this is necessary.”
Resources
- AAP clinical report Fluoride Use in Caries Prevention in the Primary Care Setting
- AAP Campaign for Dental Health
- AAP Fact Checked article “Fluoride is a Powerful Tool for Preventing Tooth Decay”
- Information for parents from HealthyChildren.org on fluoride supplementation and fluoride FAQ
- AAP’s 2025 Recommendations for Preventive Pediatric Health Care (Periodicity Schedule)
