From fluoride to “forever chemicals,” drinking water has been in the spotlight this year. In a Q&A, Yale epidemiologist Nicole Deziel discusses the water we drink today — and what’s on tap for the future.
New Heaven, Aug 18, 2025.- In 1945, Grand Rapids, Michigan, made history — as the first city in the world to add small amounts of fluoride to its public water supply. At the time, studies showed communities with higher levels of natural fluoride in water had better dental health. Water fluoridation is now practiced in about 25 countries around the world, including Spain, Malaysia, and the United States. In the U.S., approximately 63% of the population drinks fluoridated water.
Low levels of fluoride, a naturally occurring mineral, can be found in many sources of drinking water due to natural processes like the weathering of rocks and human activities like manufacturing. However, there’s growing debate over whether additional fluoride should be introduced to drinking water. This year, states including Utah and Florida have banned the use of fluoride in public water systems, and federal officials have called for more states to follow suit.
Nicole Deziel is an associate professor of epidemiology (environmental health sciences) and co-director of the Yale Center for Perinatal, Pediatric and Environmental Epidemiology at the Yale School of Public Health. In an interview, she explains the benefits and risks of fluoride, how “forever chemicals” and climate change impact water quality, and how we can monitor the water we drink.
What are the benefits of fluoride? Are there any potential risks?
Nicole Deziel: Fluoride can strengthen our bones and teeth enamel, and the strengthening of the enamel prevents cavities. But too much of it can damage our bones and enamel in a process called fluorosis, and it can potentially have neurological effects as well.
Finding the right amount where the benefits outweigh the risks is key. The U.S. Public Health Service recommends a fluoride concentration of 0.7 mg/L [parts per million] in drinking water. The World Health Organization recommends a limit of 1.5 mg/L, while the U.S. Environmental Protection Agency sets a limit of 4 mg/L. Newer evidence of more subtle neurological effects is prompting reexamination of these target levels and limits.
Why are we seeing some states ban the use of fluoride in public water systems? Why are some people suspicious of it?
Deziel: There’s a long history of controversy about fluoride, including urban legends and conspiracy theories. For some people, it may seem counterintuitive to add a chemical that may have some toxic properties to make our water safer. However, we do this with chlorine as well. Chlorine is toxic at high levels and can form harmful byproducts, but we add it to drinking water to disinfect it and kill bacteria and pathogens to make our water safe to drink. We’re often doing these kinds of tradeoffs in environmental health and public health. In addition, misinformation and distrust of science could all be contributing to us revisiting this [the fluoridation of water].
However, there’s been some new data that should prompt us to reexamine fluoride. There have been a few recent studies that have shown that fluoride exposure is linked to lower IQ levels in children where fluoride levels are above some of the target levels. That’s something that should be considered when thinking about these tradeoffs with fluoride.
Let’s move from fluoride to so-called “forever chemicals,” also known as PFAS. What are PFAS, and why are they called “forever chemicals”?
Deziel: PFAS, or per- and polyfluoroalkyl substances, are commonly referred to as “forever chemicals” due to their persistence in the environment as well as human bodies. They’re molecules that have chains of carbon and fluorine, and the carbon-fluorine bond is the strongest chemical bond known.
Their properties have made PFAS very desirable in many consumer products like Teflon pans, stain-resistant and water-resistant clothing and textiles, food packaging, and more. They’re also in firefighting foam.
According to some estimates, 90% of drinking water in the U.S. contains PFAS. How did happen, and what impact do PFAS have on our health?
Deziel: This happens for a few reasons, such as improper disposal of PFAS at manufacturing sites and the use of firefighting foams at airports and military bases. But PFAS are also in household products, many of which can go down the drain and be introduced into our environment.
PFAS have been linked to a variety of adverse health problems, including endocrine disruption, cancer, reproductive effects, decreased effects on our immune system, decreased efficacy of vaccines, and more.
Last year, the U.S. set the first-ever national limits on PFAS. Now, some of those regulations are being delayed or reconsidered. How are limits set for contaminants like PFAS?
Deziel: The Environmental Protection Agency sets maximum contaminant levels for drinking water under the Safe Drinking Water Act. When they set them, they’re allowed to consider not just public health but technological or economic feasibility. It took about 20 years just to get the PFAS standards passed, even though we’ve known about these issues for decades. This is a very slow and inefficient process, and the standards are not keeping pace with the science. So, it’s frustrating that the few new standards set may not even move forward.
In recent years, we’ve also seen several extreme weather events, from wildfires and floods to intense heat and droughts. How does climate change threaten the safety of our drinking water?
Deziel: Climate change can impact our drinking water in many ways. First, increasing intense droughts can affect our water supplies and lead to water scarcity. With wildfires, we often focus on the smoke and the immediate damage, but once the fires have been addressed, there are concerns about all the fire-retardant chemicals that are deposited into our soils and waterways. Plus, wildfires require a lot of water. Rising sea levels can create saltwater intrusion into freshwater sources. Floods and storms can release chemicals into our waterways and impact our water infrastructure overall. So there are many ways our changing climate and extreme weather can affect drinking water.
What can people like you and me do to monitor — and even improve — the quality of the water we drink?
Deziel: In public health, we talk about a hierarchy of controls. So, the best would be to have evidence-based drinking water standards that reflect the best science, and that would be because not everybody has the time and resources to research different strategies or purchase different filters.
However, if someone wanted to reduce their exposures to chemicals, there are several different filtering devices that are available. The most common is the charcoal, or activated carbon, filter. These can remove some chemicals including chlorine, some metals, some organic contaminants, and some but not all PFAS. They can be installed for the whole house, under the sink, or directly on the faucet. Reverse osmosis filters, which push water through a special membrane, are more effective at removing a much wider range of chemicals, but they’re more expensive. Countertop and pitcher-style filters are other options. They use gravity to pass water through a carbon cartridge. They’re generally more affordable, and while they don’t remove as many contaminants as in-line systems, they offer some protection and may be a good starting point for some households.
People may be tempted to turn to bottled water. However, many brands of bottled water are just tap water that’s been run through extra purification steps (spring water and mineral water are exceptions). This additional treatment can mean the water is very clean, but bottled water comes with significant downsides. In the U.S., only a tiny fraction of the millions of plastic bottles we use actually get recycled, with most polluting streets, rivers, and oceans. Producing those bottles uses petroleum and releases greenhouse gases, adding to climate change. Moreover, single-use plastic bottles can release endocrine-disrupting chemicals called phthalates as well as tiny plastic particles known as microplastics, especially if left in sunlight and heat.