A U.S. government report expected to stir debate concluded that fluoride in drinking water at twice the recommended limit is linked with lower IQ in children.

The report, based on an analysis of previously published research, marks the first time a federal agency has determined — “with moderate confidence” — that there is a link between higher levels of fluoride exposure and lower IQ in kids. While the report was not designed to evaluate the health effects of fluoride in drinking water alone, it is a striking acknowledgment of a potential neurological risk from high levels of fluoride.

Fluoride strengthens teeth and reduces cavities by replacing minerals lost during normal wear and tear, according to the U.S. Centers for Disease Control and Prevention. The addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century.

“I think this (report) is crucial in our understanding” of this risk, said Ashley Malin, a University of Florida researcher who has studied the affect of higher fluoride levels in pregnant women on their children. She called it the most rigorously conducted report of its kind.