Water Fluoridation FAQs

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What is community water fluoridation?
Most water supplies contain trace amounts of fluoride. Water systems are considered naturally fluoridated when the natural level of fluoride is greater than 0.7 parts per million (ppm). When a water system adjusts the level of fluoride to 0.7-1.2 ppm, it is referred to as community water fluoridation. Today, approximately 67.3 percent of the U.S. population on public water supplies has access to fluoridated water. (Please see list of Nebraska communities that have fluoridated water systems)

How does fluoride work?
Tooth decay is an infectious and transmissible bacterial disease. When a person eats sugar or other refined carbohydrates, some oral bacteria produce acid that removes minerals from the surface of the tooth, a process that is known as demineralization. If the demineralization continues for a period of time, a cavity is formed. If fluoride is available, the demineralization process can be reversed, thereby, preventing the cavity. In addition, fluoride reduces the ability of the oral bacteria to produce acid.

Is tooth decay still a serious problem?
Yes. By age 19, more than 66% of U.S. children and adolescents, 91% of U.S. adults and 93% of Americans 60 years of age and older have experienced tooth decay.

Will community water fluoridation benefit my family?
Fluoride's action in preventing tooth decay provides a benefit to both children and adults throughout their lives. The health benefits of fluoridation include a reduction in the frequency and severity of tooth decay, a decrease in the need for fillings and tooth extractions, a reduction in pain and suffering associated with tooth decay, and the obvious elevation of self-esteem that goes with improved oral functioning and appearance.

Has the prevalence of tooth decay decreased since water fluoridation began?
Yes. Independent studies initiated in 1945 and 1946 followed four communities and assessed the value of water fluoridation. By 1960, tooth decay rates in these communities declined, on average, 56% more than in demographically similar communities whose water supplies were not fluoridated. More recent studies show that water fluoridation will reduce tooth decay in permanent teeth by approximately 18 to 40%.

Is community water fluoridation safe?
Yes. Extensive research conducted over the past 60 years has shown that fluoridation of public water supplies is a safe and effective way to reduce tooth decay for all community residents. More recent reviews of the safety of water fluoridation include a comprehensive review of the scientific literature by the U.S. Public Health Service in 1991 and the University of York in 2000. The overall value and safety of community water fluoridation has been endorsed by the CDC, by the U.S. Surgeon General's report Oral Health in America (May 2000), and by the U.S. Task Force on Community Preventive Services in 2001. Community water fluoridation has also been endorsed by the American Dental Association, the American Medical Association, the American Association of Public Health, U.S. Public Health Service, the World Health Organization and others.

Does the U.S. Food and Drug Administration (FDA) or Environmental Protection Agency (EPA) regulate fluoride added to drinking water?
Neither the FDA nor the EPA publish standards for drinking water additives. A 1979 Memorandum of Agreement between the FDA and EPA establishes that the FDA has regulatory responsibility for beverages, and the EPA has regulatory responsibility for drinking water by community water systems. The EPA additives program was discontinued in 1984 and replaced by the American National Standards Institute program for drinking water additives. The FDA does not regulate community drinking water but does regulate bottled water because commercial bottled water is considered to be a beverage (food).

What standards for levels of fluoride in water are set by the EPA?
Under the Safe Drinking Water Act and its amendments (1974, 1986 and 1996), the EPA establishes criteria for safe drinking water. These standards include the maximum contaminant level goal (MCLG), the maximum contaminant level (MCL), and the secondary maximum contaminant level (SMCL). The MCLG is a nonenforceable health goal set at a concentration to minimize adverse health effects and serves as an advisory to the states. The MCL is an enforceable regulatory standard that is set as close to the MCLG as practical, taking into consideration other factors such as treatment technology and costs. The SMCL is a nonenforceable secondary standard providing guidance on cosmetic or aesthetic considerations. In 1986, EPA established an MCLG and MCL for fluoride at a concentration of 4 milligrams per liter (mg/L) and an SMCL of 2 mg/L. The Safe Drinking Water Act requires periodic reassessment of regulations for drinking water contaminants.

How does the release of the 2006 National Research Council report affect the standards set by the EPA and national recommendations for community water fluoridation?
As part of its normal regulatory process, the Environmental Protection Agency (EPA) periodically reviews the scientific basis for its regulatory criteria. In 2003, the EPA sponsored the National Research Council to evaluate the scientific basis of the EPA's maximum contaminant level goal (MCLG) and secondary contaminant level (SMCL) for fluoride. This review was conducted by the NRC's Committee on Fluoride in Drinking Water. The committee was asked to review the adequacy of the EPA's guidelines to protect children and others from adverse health effects. The committee was asked to consider the relative contribution of various fluoride sources (e.g., drinking water, food, dental hygiene products) to total exposure. In addition, the committee was asked to identify gaps in research data and to make recommendations for future research relevant for setting the MCLG and SMCL for fluoride. On March 22, 2006, the committee's report, Fluoride in Drinking Water: A Scientific Review of EPA's Standards, was issued by the National Research Council. * The report addresses the safety of high levels of fluoride in water that occur naturally, and does not question the use of lower levels of fluoride to prevent tooth decay. The committee concluded that the current MCLG of 4 mg/L should be lowered to better protect people from the health risks associated with high natural fluoride levels. The NRC committee's conclusions concerning the potential for adverse health effects were focused on exposure to fluoride at levels of 2 mg/L and higher. The findings are consistent with CDC's assessment that water is safe and healthy at the levels used for water fluoridation (0.7 mg/L-1.2 mg/L). The recommendations from CDC remain the same--that community water fluoridation is safe and effective for preventing tooth decay. CDC continues to recommend steps to prevent moderate and severe enamel fluorosis; these recommendations were made in the August 17, 2001, MMWR report, Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. These steps include using an alternate water source for children age 8 and younger if the primary drinking water source has naturally occurring fluoride above 2 mg/L, and supervising the use of toothpaste by children younger than 6 years to prevent swallowing excess toothpaste. Parents should place only a pea-sized amount of toothpaste on the child's brush.

How much does it cost the community to fluoridate the water?
The per person cost of fluoridation varies by size of the community population. The average cost of providing fluoridated water to communities with more than 20,000 residents is about 50 cents per year. For communities of 10,000-20,000 residents, the cost is about $1, and for those living in communities of less than 5,000, the cost is about $3 per year.

Is community water fluoridation a cost-effective method for disease prevention?
Yes. In 2004, an estimated $78 billion was spent on dental services, representing about 5% of all expenditures for personal health care in the United States. A CDC study estimated that every $1 invested in community water fluoridation saved $38 in avoided costs for dental treatment. The national average cost to restore one cavity with dental amalgam is approximately $65--the approximate cost of providing fluoridation to an individual for a lifetime.

Does bottled water have fluoride?
It depends on the particular brand. Fluoride can occur naturally in source waters used for bottling or be added. Most bottled waters contain fluoride at levels that are less than optimal for oral health. To find out the fluoride content of a particular brand of bottled water, you must contact the manufacturer.

Water Fluoridation Letter

Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion
http://www.nedental.org/Public/Fluoridation.htm