Water Fluoridation


For almost 70 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 member dentist and dental hygienists are committed to promoting quality oral health care and support community water fluoridation.

Fluoride is a naturally-occurring mineral present in all water. Community water fluoridation is the adjustment of the natural fluoride level in public water systems to an optimal level to prevent tooth decay in children and adults.

In Wisconsin, the optimal level for fluoridated systems is 0.7 part per million (ppm) of fluoride.

U.S. Department of Health and Human Services announced April 27, 2015 the final recommendation that the optimal fluoride level in community water systems is 0.7 parts per million. The ADA supports the recommendation, which was released for comment four years ago. The new recommendation will help ensure an effective level of fluoride to reduce the incidence of tooth decay, while minimizing the risk of cosmetic fluorosis.

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


Status of community water fluoridation in Wisconsin

Approximately 89.4 percent of Wisconsin residents or about 4 million persons are served by public water supplies. Of those, 3.5 million are on systems with adequate fluoride levels. About 500,000 Wisconsin residents on public water systems do not receive fluoridated water.

Nationally, Wisconsin ranks 17th in the percentage of persons on public water systems receiving fluoridated water.


Recommended levels for community water fluoridation

In January 2011, the U.S. Department of Health and Human Services proposed new recommendations for the level of fluoride in community water systems.

HHS recommended the optimum level be set at 0.7 ppm which had previously been a range of 0.7 ppm to 1.2 ppm.

The recommendation is meant to ensure children and adults receive the best protection against tooth decay, while reducing the possibility of fluorosis (a harmless cosmetic condition that appears as white lines or spots on the teeth) in the general population.

Today, fluoride is available in many dental products such as toothpaste, mouth rinses and fluoride applied by dental professionals.

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.

Health officials and dental professionals reaffirm that community water fluoridation is safe and effective, and improves the oral health of people of all ages.  It remains one of the nation’s 10 most effective public health achievements of the 20th century.

For more information, visit the following:


Wisconsin fluoridation plan

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 members worked with dental, drinking water and fluoridation experts on the Wisconsin Advisory on Fluoridation Committee. This group provided guidance and advice for a statewide fluoridation plan issued in fall 2010. The plan is currently in the review process for updates if needed for this coming year.

Contact the DHS sealant and fluoridation program coordinator at 608-266-0876 for more information.



Should dietary fluoride supplements still be prescribed?

Research has consistently shown fluoride helps prevent dental caries. This naturally-occurring mineral has a systemic and topical effect that remineralizes enamel and has some anti-bacterial properties.

Unfortunately, not all Wisconsin residents live in areas where the public water supply is fluoridated.

The American Dental Association continues to support the use of dietary fluoride supplements for children from six months to 16 years old who live in areas not optimally fluoridated and at high-risk for dental caries.

In 2012, the American Academy of Pediatric Dentistry revised  fluoride supplement dose guidelines and recommends fluoride supplements for children drinking water with fluoride levels less than 0.6 parts per million.

Talk with your dentist to determine if fluoride supplements are needed for your child and what the correct dose should be based on the child’s age and the natural fluoride concentration in your local drinking water.

If needed, the Wisconsin State Laboratory of Hygiene provides test kits to analyze

home water fluoride content for those not on a fluoridated water system. Call 800-443-4618 to order a sampling kit.

Is fluoridated water still needed?

Yes, tooth decay still remains a widespread problem, affecting more than 90 percent of Americans by the time they reach their adult years.

In fact, 53 percent of Wisconsin third graders have at least one cavity, according to the state Department of Health Services’ report “Healthy Smiles/Healthy Growth Wisconsin’s Third Grade Children” released in 2013.

Fluoridation offers an easy, inexpensive preventive strategy that everyone benefits from simply by turning on their water faucet.

Does fluoridated water prevent tooth decay?

Yes, research proves drinking fluoridated water reduces tooth decay by about 25 percent over a lifetime.

As community water fluoridation increased in the U.S. between 1966 and 1994, the average number of decayed, filled or missing teeth among 12-yearolds fell 68 percent

Evidence supporting fluoridated water’s effectiveness has been building for almost 70 years, even during an era with widespread availability of fluoride from other sources, such as fluoridated toothpaste.

How much fluoride is added to the water?

At 1 ppm, fluoride is diluted in a million parts of water.

So, 1 ppm can be represented as:

  • 1 inch in 16 miles
  • 1 minute in two years
  • 1 cent in $10,000

With the new HHS recommendation of 0.7 ppm, even less fluoride is actually present in the water, but still is sufficient for oral health benefits.

How does fluoride work to prevent tooth decay?

Fluoride’s prevents cavities 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.

What is community water fluoridation?

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, HHS recommends changing the level for community water systems to 0.7 ppm.

How effective is fluoridated water?

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.

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.

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.) This usually is caused by taking dietary fluoride supplements or swallowing more than a minimal amount of fluoride toothpaste in addition to drinking and cooking with fluoridated water.

Dental fluorosis can be avoided by parents of children aged 2 to 6 by applying only a pea-sized amount of toothpaste to a child’s toothbrush and teaching 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.

Learn more about fluorosis on the ADA’s public MouthHealthy.org website: http://www.mouthhealthy.org/en/az-topics/f/fluorosis

Can there be too much fluoride in water?

The National Research Council released a statement in March 2006 addressing the levels of naturally-occurring fluoride in drinking water. 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) to determine whether it is appropriate to revise the drinking water standard.

The NRC report does NOT call into question the safety of community water fluoridation at appropriate levels.

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 which has saved children and adults pain and families and communities dental care costs!

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?

The ADA estimates the average cost for a community to fluoridate its water ranges from 50 cents per year per person in large communities to $3 per year per person in small communities.

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

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.

Is there fluoride in infant formula? Should I try to remove fluoride from infant formula?

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.

Does bottled water contain fluoride?

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. 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://1.usa.gov/1hWGfoI.

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.

Other websites



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 Erika Valadez with the WDA Legislative Office at evaladez@wda.org or 888-538-8932.