Facts: Fluoride Contamination.
The U.S. Department of Health and Human Services is proposing a change to the recommendation for the optimal fluoride level in drinking water to prevent tooth decay. The new recommendation, 0.7 milligrams of fluoride per liter of water, replaces the previous recommended range of 0.7 to 1.2 milligrams per liter. There are several reasons for this change, including that Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the United States. The new guidance will update and replace original recommendations provided in 1962 by the U.S. Public Health Service.
This fact sheet provides information on community water fluoridation, as well as current federal activities to update guidance and regulations on community water fluoridation.
What is fluoride?
Fluoride is a naturally occurring mineral that is proven to protect against tooth decay.
Why is fluoride added to water and toothpaste?
Fluoride’s action in preventing tooth decay benefits both children and adults throughout their lives. The health benefits of fluoridation are—
- Fewer cavities and less severe cavities.
- Less need for fillings and tooth extractions.
- Less pain and suffering associated with tooth decay.
How does fluoride work to prevent tooth decay?
Fluoride works by stopping or even reversing the tooth decay process. It keeps tooth enamel strong and solid. Tooth decay is caused by certain bacteria in the mouth. When a person eats sugar and other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth. Fluoride helps to remineralize tooth surfaces and prevents cavities from continuing to form.
What is community water fluoridation?
Almost all water contains some naturally occurring fluoride, but usually at levels too low to prevent tooth decay. 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 60 years, the Centers for Disease Control and Prevention (CDC) named water fluoridation one of Ten Great Public Health Interventions of the 20th Century.
Why is the Department of Health and Human Services (HHS) developing new recommendations 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 set out to develop new recommendations for community water fluoridation.
How is HHS developing new recommendations?
In September 2010, the Department of Health and Human Services convened a panel of scientists from the across the U.S. government to review new information related to fluoride intake and to develop new recommendations for community water fluoridation.
The scientists reviewed the best available information on: the prevalence and trends in dental caries, water intake in children in relation to outdoor air temperature, changes in the percentage of U.S. children and adults with dental fluorosis, and the U.S. Environmental Protection Agency’s (EPA) new assessments of cumulative sources of fluoride exposure and risks of children developing severe dental fluorosis.
This new information led HHS to propose changing the recommended level for community water systems to 0.7 milligrams per liter. The current recommended level is a range of 0.7 to 1.2 milligrams per liter. An announcement about the proposed change was published in the Federal Register. Public comment on the new proposed optimal fluoridation level is being sought and may be provided for 30 days. Comments will be considered by HHS in finalizing a new recommendation for community water fluoridation in the United States.
How were the recommended levels previously set for fluoride in drinking water?
In 1962, based on scientific studies showing that fluoride reduces tooth decay, the U.S. Public Health Service recommended the amount of fluoride in drinking water range from 0.7 to 1.2 milligrams per liter. Scientists set the range by taking into account different levels of children’s fluid intake according to the average annual temperature in different regions of the United States—less fluoride was added in warmer, southern climates where it was believed that people drank more water, and more was added in cooler, northern climates where it was believed that people drank less. Over the past several decades, many factors, including the advent of air conditioning, have reduced geographical differences in water intake.
- How does fluoride get into tap water?
- Does my public water system add fluoride to the water?
- Why is EPA’s drinking water standard (referred to as the MCL or MCLG) different than HHS’ recommended optimal fluoridation level for community drinking water systems?
- What is dental fluorosis?
- Since the optimal level of 0.7 milligrams per liter of fluoride is a “recommended” level (i.e., not a nationwide level or EPA enforceable level) in community drinking water systems, how do I know whether my community has or will reduce the level of fluoride in my drinking water? Does it have to?
- Why has exposure to fluoride increased?
- In addition to water, what are other specific sources of fluoride?
- Given that we get fluoride from other sources, is it still beneficial to fluoridate drinking water?
- Why does HHS think that .7 milligrams of fluoride per liter of water is appropriate?
Potential adverse health effects from overexposure:
- What are the adverse health effects of excessive fluoride exposure?
- Are children or adults exposed to too much fluoride?
- Who is at risk for excessive fluoride exposure?
- What are the effects of excess levels of fluoride and why are they different for children and adults?
- Is my child getting an appropriate amount of fluoride from drinking water and tooth brushing?
- What are the drinking water standards for maximum levels of fluoride? What do you mean by an MCL, an MCLG, and a secondary standard for fluoride? What is the difference?
- Has the safety of fluoridation been evaluated?
What people can do:
- What should I do to limit my exposure to fluoride?
- Should my children stop brushing their teeth with fluoride toothpaste?
- Should I reduce the number of times I brush my teeth daily?
- Should I refuse fluoride treatments at the dentist?
- If I am drinking water with fluoride, why do I also need to brush with toothpaste that contains fluoride?
- If they both contain fluoride, how can they work differently?
- Does toothpaste contain too much fluoride to be recommended for children?
- Are there methods I can use to remove fluoride from my drinking water at home? For example, boiling or use of commercially available water filters and units?
- Is there fluoride in infant formula? Should I try to remove fluoride from infant formula?
- Is fluoride present in mouthwash and dental whitening products?
- Does bottled water contain fluoride?