Overview

Community water fluoridation is a safe, effective and inexpensive way to prevent tooth decay.  The 2,900 members of the WDA represent the vast majority of the state's practicing dentists who are committed to promoting quality oral health care and support community water fluoridation. 

Fluoride has significant benefits for children and adults. In children, fluoride works with plaque and saliva to protect the tooth enamel and make it more resistant to the acid and bacteria that cause tooth decay.  For adults, fluoride can effectively reduce problems with dental caries (cavities).

Fluoride is a mineral that forms naturally in the earth's crust and there are traces of fluoride in virtually all water. However, sometimes that amount is not enough to prevent tooth decay, so communities adjust the level of fluoride in their public water supplies to achieve a safe and effective amount (this is called optimal fluoridation). 

Learn more about how community water fluoridation is a cornerstone to good overall health.

Supporters of community water fluoridation

Oral health is critical to overall health. Numerous organizations have hailed community water fluoridation as safe and effective and a significant public health achievement.  They include (but are not limited to):

*Note: This is not a complete listing of organizations that support fluoridation. Ask your doctor or dentist for others.

HHS revises recommended levels for community water fluoridation

The U.S. Department of Health and Human Services announced on Jan. 7, 2011 that it is revising the recommended level for optimally fluoridating community water systems from 0.7 – 1.2 parts per million to 0.7 ppm

The ADA commends the federal agency for recalibrating the ratio of fluoride to water that they consider optimal based on scientific evaluation and the full appreciation of fluoride received from all sources.

As a science-based organization, the ADA supports the recommendation to set the level for optimally fluoridated water at 0.7 ppm. This adjustment will provide an effective level of fluoride for reducing the incidence of tooth decay while minimizing the rate of fluorosis (a non-harmful, cosmetic condition that appears as white lines or spots on the teeth) in the general population.

The federal government recommends communities continue adding fluoride to drinking water due to its public health benefits. The decrease in the recommended level is not related to any health concern, but simply minimizes individuals’ chances of developing cosmetic white lines or streaks on the teeth.

Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the United States. The new guidance updates and replaces original recommendations provided in 1962 by the U.S. Public Health Service.

At the same time, the Environmental Protection Agency  announced it will study the issue of fluoride in water, based on a 2006 report from the National Academy of Sciences that questioned whether the EPA's current maximum allowable level of fluoride in water — 4 ppm —should be reduced. The EPA announcement does not in any way question the safety of optimal water fluoridation.

• Visit the HHS website for more information

Wisconsin fluoridation plan

The WDA continues to work collaboratively with Wisconsin’s Division of Public Health and American Dental Association to counter objections to water fluoridation with strong public health messages.

A WDA dentist leader and staff member worked with dental, drinking water and fluoridation experts on the Wisconsin Fluoridation Plan Advisory Committee. This group provided guidance and advice for a statewide fluoridation plan issued in fall 2010.

• Click here to view the Wisconsin Fluoridation Plan

Frequently asked questions

How is fluoride good for my teeth?

Products such as toothpaste and mouth rinse that contain fluoride protect tooth enamel and can prevent cavities from forming on the surface and roots of the teeth. Tooth decay can affect a person's self-esteem and can cause significant pain and tooth loss.

In fact, Antigo, Wis. was the focal point of a landmark study. As part of the study, Antigo ceased fluoridating its public water supply in 1960. After only five years, second graders had 200 percent more tooth decay.  In light of the results, Antigo promptly resumed fluoridating its public water supply and rates of tooth decay significantly decreased.

What is the safe amount of fluoride in drinking water?

There is a difference between natural and optimal fluoride. Fluoride is found naturally in most water sources. The U.S. Department of Health and Human Services announced Jan. 7, 2011 that it is revising its recommended levels for optimally fluoridating community water systems from 0.7 to 1.2 parts per million to a new recommended level of 0.7 ppm.

At the same time, the Environmental Protection Agency announced it will study the issue of fluoride in water, based on a 2006 report from the National Academy of Sciences that questioned whether the EPA's current maximum allowable level of 4 ppm fluoride in water should be reduced. The EPA announcement does not question the safety of optimal water fluoridation.

How does fluoride benefit children and adults?

Fluoride has significant health benefits for children and adults. Tooth decay is often problematic for middle-aged and older adults, especially decay around the roots resulting from a receding gumline.

Dental caries (cavities) is a disease that can be acquired at any point in a person’s life.  Early studies showed that water fluoridation reduced the amount of cavities children get in their baby teeth by as much as 60 percent and reduced tooth decay in permanent adult teeth nearly 35 percent.  Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20-40 percent, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.

When ingested, fluoride is incorporated into the enamel of developing teeth before they erupt, making them more resistant to decay.  After teeth erupt, topical fluoride continues to strengthen the tooth structure to further prevent decay by reversing the early stages of decay and promoting the remineralization of enamel.  Fluoride also can markedly reduce decay occurring along the gum line and on root surfaces, which often occurs in older patients.

How does fluoride contribute to good health?

The U.S. Centers for Disease Control and Prevention proclaimed community water fluoridation one of the 10 greatest public health achievements of the 20th century. Numerous reports have documented that exposure to fluoridated water supplies, particularly during adolescence, reduces cavity rates. It can also reduce the amount of dental plaque bacteria which can lead to tooth decay and other oral health ailments. 

Numerous studies published in respected and peer-reviewed scientific journals conclude that community water fluoridation has no ill effects on health.

Is there a connection between fluoride and bone cancer?

The National Cancer Institute has repeatedly stated that fluoridated water does not pose a detectable risk of cancer in humans. Researchers studied this relationship in the United States during a 36-year period. They examined millions of patient records and found no relationship between the two.

What is dental fluorosis?

Dental fluorosis is generally a mild, non-harmful cosmetic condition characterized by white lines or specks on the teeth.  It is also referred to as mottling of the tooth enamel.  It comes from sources of fluoride that are not intended to be consumed in conjunction with fluoridated water, such as dietary fluoride supplements or swallowing more than a minimal amount of fluoride toothpaste.

Fluorosis is associated with ingesting fluoride during children's tooth-forming years.  It can occur when the natural fluoride content is too high and children drink the water or ingest fluoride toothpaste while their permanent teeth are still forming. The risk period may extend to ages six or seven.

Dental fluorosis can be avoided by parents of children aged two to six applying only a pea-sized amount of toothpaste to the child’s toothbrush and teach their children not to swallow toothpaste. Parents of children 2 and younger should consult with their family dentist about appropriate fluoride use.

The Wisconsin Department of Health Services provides more information about dental fluorosis and specific information about the appropriate amount of fluoride for specific ages.

Can there be too much fluoride in water?

The National Research Council released a statement in March 2006 that addressed the levels of naturally occurring fluoride in drinking water. The report does NOT call into question the safety of community water fluoridation at appropriate levels.

The report concludes the EPA's maximum natural fluoride goal of 4 ppm be lowered to protect the public’s health.  

The EPA is reviewing the new assessment of fluoride along with other information (e.g. analytical methods and treatment feasibility, occurrence and exposure, etc.) to determine whether it is appropriate to revise the drinking water standard.

Does fluoride occur naturally in water? What if my water system has naturally-occurring fluoride above 4.0 mg/L?

Fluoride can occur in drinking water naturally as a result of the geological composition of soils and bedrock.

Community water systems are required to ensure that levels of fluoride in their drinking water are less than 4.0 ppm in order to be in compliance with EPA drinking water regulations. If your water system has naturally-occurring fluoride above this level, the EPA requires systems to take action to reduce it.

Visit the CDC’s website “My Water's Fluoride” section, to find information on your water system’s fluoridation status.

Another way to find the fluoride level of your local public water system is to contact your water utility provider for more information. Consumers can find the name and contact information of the water utility on their water bill.

Do the benefits of fluoride outweigh any possible risks?

Yes. The most significant benefit is the prevention of dental disease that would occur if people don’t get the right amount of fluoride. Optimally fluoridated water is a significant health benefit and federal government agencies agree.

Dentistry, in advocating for water fluoridation and use of fluoride supplements when needed, has succeeded in preventing vast amounts of dental disease and saving families money! Dentists want as many people as possible to enjoy the health benefits of this simple, safe, inexpensive and proven disease-fighting public health measure.

How much does community water fluoridation cost?

According to the ADA, the average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities. 

The CDC also concluded every $1 spent on water fluoridation saves $7-$42 in oral health treatment costs, depending on the size of the community. 

An article in the February 2008 Journal of the American Dental Association cites the work of dental colleagues at the Indiana University School of Dentistry who investigated whether access to fluoridated community water reduces the number of restorations placed and the associated costs incurred for children, adults and older adults. All three groups benefited, with older adults benefiting the most.

Additional resources

American Dental Association. ADA President Raymond Gist, DDS, Comments on Harvard Study Examining Fluoride Levels in Bone. July 28, 2011. http://www.ada.org/6064.aspx

American Dental Association. Scientific Panels Issue Evidence-Based Clinical Recommendations on Use of Fluoridated Water with Infant Formula, Prescribing Fluoride Supplements. Press release, January 2011. http://www.ada.org/5199.aspx.

American Dental Association. ADA Applauds HHS Action on Recommended Fluoride Level in Drinking Water. Press release, January 2011. http://www.ada.org/5194.aspx.

American Dental Association. ADA Statement on Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Press Release, March 2006.

American Dental Association. Exposure to Several Fluoride Sources May Explain Increase in Enamel Fluorosis, Journal Article Says. Press Release, Feb. 2002.

American Dental Association. "Older adults benefit most from fluoridation" (2008). Journal of the American Dental Association, 139, 133.

American Dental Association. "Water Fluoridation and Alleged Risk of Bone Cancer" (2005).

Centers for Disease Control. "Fact Sheet: Preventing Dental Caries with Community Programs" 2010. www.cdc.gov/oralhealth/publications/factsheets/dental_caries.htm.

Environmental Protection Agency. “Questions and Answers on Fluoride” 2011

Griffin, S.O., Jones, K. & S.L. Tomar (2001). An economic evaluation of community water fluoridation. Journal of Public Health Dentistry, 61, 78-86.

Lemke, C., Doherty, J. & M. Arra (1970). Controlled fluoridation: The dental effects of discontinuation in Antigo, Wisconsin. Journal of the American Dental Association, 80, 782-786.

National Research Council. Carcinogenicity of fluoride. In: Subcommittee on Health Effects of Ingested Fluoride, editor. Health Effects of Ingested Fluoride. Washington DC: National Academy Press, 1993.

Wisconsin Department of Health Services. "Dental Health Fact Sheet: Fluoride" 2001. http://www.dhs.wisconsin.gov/publications/P4/P44532.pdf.

For more information, visit the following websites:

• American Academy of Family Physicians
• American Dental Association
• U.S. Centers for Disease Control & Prevention
• Wisconsin Department of Health Services
• Environmental Protection Agency

Contact

For more information on community water fluoridation and/or if you are involved with a local task force to improve the oral health of local residents, contact the Wisconsin Dental Association Executive Office at 414-276-4520.