Lincoln’s response to CWF risks, where is the benefit in the risk?

Related topics:

• The dose matters. What are CWF risks to infants?
• Fluorosis, where is the benefit in the risk?
• LB147 Removing the fluoride mandate – watch the HHS Committee hearing
• Federal Court Rules Fluoridation Poses An “Unreasonable Risk”
• Community water fluoridation news and links
• Community Water Fluoridation in Nebraska

City of Lincoln drinking water update

“Regarding the cautionary statement, we did seek guidance from the Lincoln-Lancaster County Board of Health on this item which was discussed at their February 11^th meeting.  At that meeting, it was recommended that a statement was not necessary based on the most current research and fluoride policy recommendations by the American Academy of Pediatric Dentistry and the American Academy of Pediatric Physicians.  Accordingly, this statement was not included in the 2024 water quality report.” This was the response I received from the City of Lincoln Transportation and Utilities, last Friday, to my request to add a cautionary note to the annual water quality report addressing fluoride risks to infants from community water fluoridation (CWF). The Health Department provided references for their recommendation.(2)(4)

The Health Board’s decision came after several requests were denied for the City and County to reduce the drinking water fluoride treatment level. Unlike MUD-Omaha, Lincoln had been treating its water to a fluoride level of 0.88 parts per million (ppm or mg/L) for years without regard to Nebraska Department of Environment & Energy (NDEE) guidance.

NDEE provided fluoride level guidance because the Nebraska Department of Health and Human Services (DHHS) hadn’t updated its fluoride dosing regulation since 1983 despite the 2011 draft and 2015 final US Public Health Service (USPHS & CDC) recommendation to lower the fluoride level to 0.7 ppm due to rising fluorosis concerns, from 40% to 70%. The DHHS regulation remained between 0.8 and 1.5 ppm until January of this year. DHHS fluoride treatment revisions followed a 2024 petition to update the regulation. In comparison, 68% of water systems nation-wide using systemic dosing reduced fluoride to 0.7 ppm within six months of the 2011 draft issue.

Lincoln’s naturally occurring fluoride level is 0.4 ppm. Lincoln will spend $116,000 this year adding approximately 0.3 ppm of the cheapest fluoride additive, hydro-fluorosilicic acid, a pollution collection byproduct, that offsets industry hazardous waste disposal costs.

What are CWF risks to infants?

“Remember the dose matters…“

Dr. Ann Anderson Berry, MD, LB147 testimony

According to the CDC, infants are particularly vulnerable to chemical exposure because they consume more food and water relative to their body weight compared to adults, leading to higher absorption rates of toxicants. This increased vulnerability is especially critical during the first few months of life when their growth and development are rapid. According to the American Dental Association (ADA), “Reducing fluoride intake from reconstituted infant formula alone will not eliminate the risk of fluorosis development.”(1)

Lincoln’s 2024 Annual Drinking Water Quality Report cautions that, “Some people may be more vulnerable to contaminants in drinking water. This includes… infants. …caregivers should seek advice about drinking water from their health care providers.”

The American Academy of Pediatrics (AAP) recommends no fluoride supplement for infants 0 to 6 months old (Table 2) and advocates for breast milk, as it has consistently low fluoride levels (0.005-0.01 ppm).(1)(2)

“We don’t think that infants between 0 and 6 months of age need extra [fluoride] outside of what they would get in breast milk“

Ann Anderson Berry, MD

The American Academy of Pediatrics also provides risk information on their website HealthyChildren.org saying, “Babies under 6 months old should not get fluoride supplements. After that time, however, breastfed and formula-fed infants need appropriate fluoride supplementation if local drinking water contains less than 0.3 parts per million (ppm) of fluoride.”(5)

Fluorosis, where is the benefit in the risk?

Fluorosis is one of the first visible signs of fluoride toxicity. It is a condition where fluoride causes discoloration of teeth, ranging from white spots to brown stains. Fluoride weakens tooth enamel beginning with very minor changes and progressing to brittleness and pitting with increased and/or prolonged exposure.

Stages of fluorosis

Paradoxically, the ADA claims that mild to moderate fluorosis is merely cosmetic and that fluoride helps rebuild (remineralize) weakened tooth enamel and can reverse early signs of tooth decay. However, the 2024 Cochrane Review found fluoride may reduce decay by only a negligible amount.(3) Where is the benefit in the risk?

References

(1)Berg J, et al. Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2011;142:79-87.

(2) Clark MB, Slayton RL, AAP SECTION ON ORAL HEALTH. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics. 2020;146(6):e2020034637

(3) Iheozor-Ejiofor Z, Walsh T, Lewis SR, Riley P, Boyers D, Clarkson JE, Worthington HV, Glenny AM, O’Malley L. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2024 Oct 4;10(10):CD010856. doi: 10.1002/14651858.CD010856.pub3. PMID: 39362658; PMCID: PMC11449566.

(4) American Academy of Pediatric Dentistry. Policy on
use of fluoride. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2024:101-3

(5) American Academy of Pediatrics. Where We Stand: Fluoride Supplements. Retrieved 3/28/2025