- Recommended levels for community water fluoridation
- Wisconsin fluoridation plan
- Fluoride Myth vs. Facts
For more than 68 years, community water fluoridation has proven to be a safe, effective and economical way to prevent tooth decay.
The Wisconsin Dental Association and its more than 3,000 dentist and dental hygiene members are committed to promoting quality oral health care and support community water fluoridation.
Fluoride is a naturally occurring mineral that is proven to protect against tooth decay in children and adults.
However, sometimes the naturally-occurring 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). The U.S. Department of Health and Human Services has recommended that the level for community water systems be 0.7 milligrams per liter of water.
Learn more about how community water fluoridation is a cornerstone to good overall health and see a list of the largest cities in the United States that fluoridate their water systems.
The U.S. Department of Health and Human Services announced on Jan. 7, 2011 that it’s proposing revising the recommended level for optimally fluoridating community water systems. Until HHS releases the final optimal fluoride recommendations, Wisconsin communities are encouraged to continue fluoridating at the optimal level of 1.0 ppm.
The American Dental Association 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 proposed 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 proposed 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.
In September 2010, HHS convened a panel of scientists to review new information related to fluoride intake and to develop new recommendations. 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.
The WDA continues to work collaboratively with Wisconsin’s Division of Public Health, the Wisconsin Oral Health Coalition and the 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.
Fluoride's preventive effect acts in three main ways:
- It reduces the amount of acid produced by bacteria that can decay teeth.
- It makes tooth enamel less susceptible to acid by chemically strengthening it.
- It promotes the repair of tooth enamel in areas that have been affected by acid.
Fluoride is present to some extent in all water, food and beverages, but the concentrations of natural fluoride in water vary widely from community to community.
Many communities choose to adjust the fluoride concentration in the water supply to a level beneficial to reduce tooth decay and promote good oral health. This practice is known as community water fluoridation. Given the dramatic decline in tooth decay during the past 65 years, the Centers for Disease Control and Prevention named water fluoridation one of 10 Great Public Health Interventions of the 20th Century.
The latest data show that in 2008, 72 percent of the U.S. population on public water systems, or 195 million people, had access to optimally fluoridated water. Approximately 89 percent of the population in Wisconsin on public water supplies receives the benefit of appropriate levels of fluoride.
▶ Why did the U.S. Department of Health and Human Services recommend a new level for community water fluoridation?
Sources of fluoride have increased since the early 1960s. At that time, drinking water and food and beverages prepared with fluoridated water accounted for nearly all of an individual’s fluoride intake.
Today, water is just one of several sources of fluoride. Other sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and professionally applied fluoride products such as varnish and gels.
Recognizing that it is now possible to receive enough fluoride with slightly lower levels of fluoride in water, the HHS recommended changing the level for community water systems to 0.7 milligrams per liter.
Many studies over time have proved the effectiveness of water fluoridation.
The city of Antigo became the focus of a state study to test fluoride as a preventive of dental decay after residents pushed through a 1960 referendum repealing fluoridation and removing it from the public water supply.
After only four years, cavities had increased a jarring 92 percent among kindergarten children, 183 percent among second-graders and 41 percent among fourth-graders.
In light of the results, Antigo promptly resumed fluoridating its public water supply and rates of tooth decay significantly decreased.
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.
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 eight or nine.
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.
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 4.0 milligrams per liter 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.
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.
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.
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.
All formulas, either concentrates or ready-to-feed, have some fluoride, but most infant formula manufacturers develop their products to ensure low levels of fluoride.
A study by the ADA confirmed that fluoride concentrations in commercially available infant formulas are very low.
It is not possible to remove this small amount of fluoride by filtering or boiling the formula; however, at normal consumption amounts, infant formula alone does not contain fluoride at levels that would be higher than the daily upper limit established by the Institute of Medicine. In liquid or powdered infant formula concentrate, the majority of fluoride comes from the water used to mix the formula. Some parents may choose to use bottled water.
According to the CDC, bottled water products labeled as de-ionized, purified or distilled have been treated in such a way that they contain no or only trace amounts of fluoride, unless they specifically list fluoride as an added ingredient.
Other bottled water products (such as spring water) can contain fluoride that is added or naturally present in the original source of the water.
Food and Drug Administration sets limits for fluoride in bottled water based on several factors, including the source of the water. These limits range from 0.8 to 2.4 milligrams per liter.
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, (2011). www.ada.org/5199.aspx.
American Dental Association. ADA Applauds HHS Action on Recommended Fluoride Level in Drinking Water. Press release (2011). www.ada.org/5194.aspx.
American Dental Association. ADA Statement on Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. Press Release (2006).
American Dental Association. Exposure to Several Fluoride Sources May Explain Increase in Enamel Fluorosis, Journal Article Says. Press Release (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.
Centers for Disease Control and Prevention. “Community Water Fluoridation: Questions and Answers” (2012). www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#4
Centers for Disease Control and Prevention, Public Health Grand Rounds archives, “Community Water Fluoridation: A Vital 21st Century Public Health Intervention”, recorded Dec. 17, 2013.
Environmental Protection Agency. “Questions and Answers on Fluoride” (2011) http://water.epa.gov/lawsregs/rulesregs/regulatingcontaminants/sixyearreview/upload/2011_Fluoride_QuestionsAnswers.pdf
Griffin, S.O., Jones, K. & S.L. Tomar. An economic evaluation of community water fluoridation. (2001) 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. (1993) Washington DC: National Academy Press.
Wisconsin Department of Health Services. “Dental Health Fact Sheet: Fluoride” 2001. www.dhs.wisconsin.gov/publications/P4/P44532.pdf.
Wisconsin Department of Health Services. “Wisconsin Public Water Supply Fluoridated Census” 2012. www.dhs.wisconsin.gov/publications/p0/p00103.pdf.
- American Academy of Family Physicians
- American Dental Association
- Campaign for Dental Health
- Centers for Disease Control & Prevention
- Environmental Protection Agency
- Healthy Kids, Healthy Portland
- The Center for Fluoride Research Analysis (Fluoride Science)
- Wisconsin Department of Health Services
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 WDA Legislative Office at 888-538-8932.