Community Water Fluoridation Exposure: A Review of Neurological and Cognitive Effects

( Last Updated : October 23, 2019)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:



  1. What are the neurological or cognitive effects of community water fluoridation, compared with non-fluoridated or different fluoride levels in drinking water, in individuals less than 18 years of age?

Key Message

This review identified one prospective birth cohort study examining the association between fluoride exposure of mothers during pregnancy and subsequent children’s intelligence quotient scores at age 3 to 4 years. Both unadjusted and adjusted estimates showed no significant association between an increase of 1 mg/L in mother urine fluoride and Full Scale intelligence quotient score in the total sample of boys and girls, or in girls. Adjusted estimates also showed no statistically significant association between an increase of 1 mg/L in mother urine fluoride and performance intelligence quotient or verbal intelligence quotient in all children. In boys, every 1 mg/L increased in mothers’ urine fluoride levels was associated with a 4.49 point lower intelligence quotient score. Every 1 mg increase in daily fluoride intake of mothers corresponded with 3.66 points lower in total children’s intelligence quotient score. The interaction between child sex and maternal fluoride intake was not statistically significant. The evidence is weak due to multiple limitations (e.g., non-homogeneous distribution of data, potential errors and biases in the estimation of maternal fluoride exposure and in IQ measurement, uncontrolled potential important confounding factors); therefore, the findings of this study should be interpreted with caution.