{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T20:07:04Z","timestamp":1788120424537,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>A National Academies Consensus Study report concluded that the evidence did not support an assessment that fluoride is a neurodevelopmental hazard. However, some researchers have undertaken benchmark dose modelling to determine a safe fluoride concentration level in water. Therefore, the suitability of the data for modelling fluoride concentration in urine and water and cognition response using standard criteria was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data quality was evaluated using a standard tool. A random\u2010effects meta\u2010analysis of standardised mean difference (SMD) and regression coefficients was conducted to assess effect sizes and heterogeneity. The Environmental Protection Agency (EPA) benchmark dose modelling was utilised to determine the association between fluoride concentrations and cognition scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All four maternal urinary fluoride (MUF) studies did not meet the standards for acceptable quality, as identified by the EPA data quality criteria, which are necessary for combining data from different studies for dose\u2013response analysis. The pooled estimate was not statistically significant (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      <jats:sub>MUF<\/jats:sub>\n                      \u2009=\u2009\u22121.06, 95% CI: \u22123.63, 1.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200962%). A meta\u2010analysis of five studies conducted in fluoridated areas showed a pooled SMD effect size of 0.04 (95% CI: \u22120.06, 0.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), favoring higher fluoride. The benchmark dose models did not reveal a functional relationship between MUF or water fluoride concentration and cognitive outcomes (Goodness\u2010of\u2010fit\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The data quality assessment revealed serious flaws that render the maternal urinary studies unacceptable for hazard assessment and benchmark dose modelling. Therefore, more appropriate studies in endemic fluorosis areas are needed to accurately determine whether fluoride is associated with adverse cognitive outcomes in populations with meaningful exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70027","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T05:19:07Z","timestamp":1761974347000},"page":"101-111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fluoride and Neurodevelopmental Hazard Modelling: An Assessment of Concentration\u2010Response Analysis"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8952-3446","authenticated-orcid":false,"given":"Jayanth V.","family":"Kumar","sequence":"first","affiliation":[{"name":"California Department of Public Health (Retired)  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0105-0416","authenticated-orcid":false,"given":"Mark E.","family":"Moss","sequence":"additional","affiliation":[{"name":"East Carolina University School of Dental Medicine  Greenville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghu","family":"Liu","sequence":"additional","affiliation":[{"name":"Pediatrics, School of Medicine, Preventive and Restorative Dental Sciences, School of Dentistry University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Fisher\u2010Owens","sequence":"additional","affiliation":[{"name":"Pediatrics, School of Medicine, Preventive and Restorative Dental Sciences, School of Dentistry University of California  San Francisco California USA"},{"name":"Public &amp; Population Health University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7495-1894","authenticated-orcid":false,"given":"Andrew","family":"Rugg\u2010Gunn","sequence":"additional","affiliation":[{"name":"Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kuring","sequence":"additional","affiliation":[{"name":"School of Psychology Faculty of Health Sciences The University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"United States District Court Northern District of California. Findings of Fact and Conclusions of Law. Food & Water Watch INC \u201cPlaintiffs v. United States Environmental Protection Agency et\u00a0al. Case No. 17\u2010Cv\u201002162\u2010EMC; 2024 \u201d 2025 https:\/\/www.cand.uscourts.gov\/food\u2010and\u2010water\u2010watch\u2010v\u2010us\u2010epa\/."},{"key":"e_1_2_11_3_1","unstructured":"U.S. Environmental Protection Agency Health and Ecological Criteria Division Office of Water \u201cFluoride: Dose\u2010Response Analysis for Non\u2010Cancer Effects \u201d 2010."},{"key":"e_1_2_11_4_1","volume-title":"Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects: A Letter Report (2021)","author":"National Academies of Sciences Engineering and Medicine","year":"2021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201099688\u2010w"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2023.115239"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2023.03.011"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20010022"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00204\u2010020\u201002725\u20102"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2025.01.014"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2024.5542"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckad170"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/risa.13767"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2022.112993"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2019.1729"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.112181"},{"key":"e_1_2_11_17_1","unstructured":"U.S. Environmental Protection Agency Risk Assessment Forum \u201cBenchmark Dose Technical Guidance \u201d 2012."},{"key":"e_1_2_11_18_1","unstructured":"U.S. Environmental Protection Agency Office of Chemical Safety and Pollution Prevention (OCSPP) \u201cApplication of Systematic Review in TSCA Risk Evaluations \u201d 2018."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345241299352"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301857"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2023.164322"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP655"},{"key":"e_1_2_11_23_1","unstructured":"U.S. Department of Environmental Agency \u201cBenchmark Dose (BMDS) Desktop Software \u201d 2024 https:\/\/www.epa.gov\/bmds\/bmds\u2010online\u2010bmds\u2010desktop\u2010and\u2010pybmds#bmdsdesktop."},{"key":"e_1_2_11_24_1","unstructured":"A.Rohatgi \u201cReverse Engineering Chart Data With WebPlotDigitizer \u201d 2024 https:\/\/automeris.io\/."},{"key":"e_1_2_11_25_1","first-page":"23","volume-title":"Fluoride and Dental Health","author":"Dean H. 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