Abstract
We recently completed a comprehensive systematic review of the literature on fluoride exposure and neurodevelopment and cognition, resulting in two publications. The 2024 National Toxicology Program Monograph concluded—with moderate confidence—that higher fluoride exposure is associated with lower IQ in children. The 2025 meta‑analysis, published in JAMA Pediatrics, quantitatively synthesized over 70 epidemiological studies and likewise reported an inverse association between fluoride exposure and children’s IQ. This inverse association persisted when analyses were restricted to the best evidence, the high‑quality studies, and was consistent across subgroups defined by sex, age, country, outcome assessment method, timing of exposure, and exposure matrix (e.g., urine or drinking water). Notably, among the high‑quality evidence, inverse associations were still observed at fluoride exposure levels below 1.5 mg/L, based on both urinary and drinking‑water measurements. These publications have received considerable public and media attention, prompted healthy scientific discourse, and have been cited by public health decision‑makers. Many scientific comments were carefully considered and resolved during development and peer review, which contributed to the rigor of the final documents. However, some recurrent critiques continue to be raised. This viewpoint provides a high‑level summary of these key critiques and corresponding responses to help the public, media, and the scientific community better understand the strength and implications of the scientific evidence on fluoride exposures and neurodevelopment and cognition.