NORTHEAST WIS. – Ten years after asking the U.S. Environmental Protection Agency (EPA) to review its maximum contaminant levels for fluoride in drinking water, Green Bay resident and Peshtigo native Brenda Staudenmaier continues to believe fluoridated water is harmful, particularly for children, but persuading the government to act on scientific evidence to set a lower maximum contaminant level for fluoride has proven to be a larger task than she imagined.
On May 21, a U.S. Appeals Court vacated a September 2024 U.S. District Court judgment that sided with Staudenmaier and other plaintiffs in the Food and Water Watch v U.S. Environmental Protection Agency lawsuit and remanded the case to the U.S. District Court, where Judge Edward Chen is expected to consider only scientific research available at an initial trial held in 2020.
Staudenmaier doesn’t expect a different outcome, as research from 2019 and 2020 supports the allegations of fluoride’s neurological health effects on infants and small children who consume fluoride in baby formula and some foods.
“This verdict doesn’t change the science, it only delays protection of the developing fetus and bottle fed infant,” Staudenmaier said.
The EPA isn’t overlooking the most recent science, however. It announced in January it was accelerating a review of fluoride, using the Safe Drinking Water Act, following a large body of scientific research discussed in the National Toxicology Program’s 2024 “Monograph on the state of the science concerning fluoride exposure and neurodevelopment and cognition.” NTP’s systemic review indicated that, with moderate confidence, fluoride exposure at 1.5 mg/liter was associated with lower Intelligence Quotient (IQ) in children.
A 2025 assessment of fluoride’s health effects, based on the European Food Safety Authority’s literature review of fluoride research, indicated bone health, skeletal fluorosis and thyroid effects also were associated with fluoride consumption. It also supported the NTP’s finding on neurotoxicity in children.
The EPA Office of Water’s fluoride review, which is expected to take several years, has a different purpose than the Food and Water Watch lawsuit Staudenmaier is a plaintiff in. Her focus is on the maximum contaminant levels allowed for fluoride in drinking water, which is enforceable, while the Office of Water’s research could result in a new advisory level for fluoride in community drinking water systems. The current advisory level is 0.7 mg/liter, while the MCL is 4 mg/liter.
In its appeal filing in the Food and Water Watch case, the. EPA said the district judge’s decision to consider more recent research on the health effects of fluoridated water was an abuse of the court’s discretion, and the appeals court agreed.
“It is when the stakes are highest that a court must be most diligent in recognizing the limits on its powers under the relevant statutes and in our adversarial system,” the EPA said.
“The court’s open-ended and extensive demand for the most up-to-date evidence exceeded the limits on its authority,” the agency said.
In September 2024, Chen agreed with Staudenmaier and other plaintiffs in the Food and Water Watch v U.S. EPA case and ordered the EPA to conduct a review of MCLs for fluoride, while most community water systems have been using 0.7 mg per liter as the upper limit.
The EPA’s attorneys, however, weren’t willing to concede that a review of its MCLs was necessary and appealed the U.S. District Court’s decision by filing with the U.S. Court of Appeals.
The EPA’s Office of Water’s review uses a different federal statute than the Toxic Substances Control Act Staudenmaier relied on when she petitioned the EPA to review its MCL. The Office of Water’s scientific review isn’t expected to examine the dental benefits of fluoride but instead focus on fluoride’s health effects, the EPA said, suggesting Staudenmaier’s influence has been heard in Washington, D.C. in a different way than she imagined.
“The EPA is acknowledging that its role is not to justify fluoridation, but to evaluate risk,” Staudenmaier said.
Advocating for continued fluoridation is the American Dental Association and many public health departments supporting fluoridated community water as an effective way to prevent tooth decay.
The Office of Water’s upcoming review represents a shift for the agency away from its previous stance of putting cavity prevention above other health considerations. Proponents of fluoride tend to focus on the benefits to teeth, but Staudenmaier said those “benefits” also have been questioned.
The EPA’s responsibility “is to determine whether a substance poses a risk to human health,” Staudenmaier said.
The Office of Water’s review also raises questions for Staudenmaier about why the EPA didn’t re-examine the fluoride MCLs a decade ago.
“In my opinion, EPA routinely wastes millions of taxpayer dollars in each case, defending polluters in court and delaying meaningful regulatory action even when credible evidence of harm exists,” Staudenmaier said.
The latest delay stems from the 9th U.S. Circuit Court of Appeals’ order to remand the Food and Water Watch case, which is based on the Toxic Substances Control Act and fluoride’s MCLs, to the U.S. District Court where Chen is expected to reconsider it using only research that was available for an initial trial. Chen would subsequently consider more recent research before he ordered the EPA to conduct a fluoride review.
Chen’s September 2024 judgment stated the current level of fluoride posed an “unreasonable risk” of health effects. He ordered the EPA to commence a review of the MCLs considered safe for community water supplies, but the EPA balked at the more recent research Chen relied on and appealed.
It said the U.S. District Court had “abused its discretion” through a takeover of the case when it allowed new research to be considered that wasn’t available when the original petition was filed in 2016.
“If new evidence arises that is relevant, persons may always file a new petition, triggering a new 90-day review window by EPA,” the appeal said.
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