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ECU dentist urges caution but endorses continued community water fluoridation
Summary
Dr. Mark Moss reviewed evidence on community water fluoridation, saying benefits for preventing tooth decay — especially among lower‑income children — remain robust while recent studies linking fluoride at high levels to lower IQ are inconclusive for U.S. exposure levels.
Dr. Mark Moss, a Greenville resident and faculty member at East Carolina University School of Dental Medicine, reviewed the scientific evidence on community water fluoridation and its safety during the Pitt County Board of Health meeting in May.
Moss told the board that community water fluoridation continues to reduce tooth decay and is particularly helpful for children in lower‑income families. "The benefits of fluoride are greater in low income families," he said, and noted that fluoridation helps narrow the social gradient in tooth decay seen in communities without fluoridated water.
Moss summarized recent safety debates, including work by the National Toxicology Program and a systematic review published in JAMA that prompted public concern about links between fluoride and child IQ. He said those analyses mainly identify risks at concentrations substantially above the U.S. recommended level and that the available studies from U.S.‑like exposure ranges do not show a consistent IQ effect. "The levels that we are exposed to are probably not there," he said, while also calling for more high‑quality research and controlled toxicology studies.
He described dental fluorosis — staining of developing teeth resulting from excess fluoride exposure — as the clearest adverse effect to watch and emphasized parental guidance about toothpaste dosing: a smear for children under 3 and a pea‑size amount for ages 3–6. He advised that water systems are engineered to hold fluoride near the U.S. optimal level of 0.7 milligrams per liter and noted that North Carolina currently has a high percentage of public water supplies at optimal levels.
Board members asked about local and statewide political interest in ending fluoridation and how long it would take to see changes if a community ceased fluoridation. Moss said it can take five to seven years to detect an increase in tooth decay after cessation and that policy debates have been active in other parts of the state. He declined to recommend immediate elimination and said he would not support stopping at this time.
The presentation included references to CDC guidance on community water fluoridation, the National Toxicology Program review, and recent peer‑reviewed analyses; Moss recommended monitoring evidence as new research emerges.
For now, the board received the presentation as information and did not take formal action on fluoridation policy.
