6. What further investigations are needed to improve assessment of exposure and of the health effects of fluoride?
The SCHER opinion states:
Fluoride in drinking water has been shown to have a beneficial effect on caries prevention, but could also induce enamel fluorosis within a very narrow margin of exposure, and the adverse effect depends on the period of exposure – windows of susceptibility.
Several other adverse health effects have been postulated to be due to fluoride exposure, i.e. osteosarcoma, developmental neurotoxicity, and reproductive toxicity. However, most of the information on these endpoints is of limited quality with inaccurate exposure information, and the observed effects occur only at high exposure levels not relevant for the European situation.
Additional research on potential adverse health effects at realistic EU exposure levels may provide new data to support the risk assessment process.
Exposure assessment is the critical step for health effect studies, thus it is recommended to:
1) Develop and validate new biomarkers for long-term fluoride exposure.
2) Develop standardized methods for exposure assessment integrating all routes of exposure.
3) Collect information on fluoride in food and bioavailability of fluoride.
4) Conduct epidemiological studies, taking advantage of the existing mother-child cohorts to investigate the role of fluoride intake on incidence of dental fluorosis and dental health.