CDC does not mandate community water fluoridation. The U.S. Public Health Service (USPHS) recommended fluoride level is not an enforceable standard.
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State and local governments decide whether to implement water fluoridation. Often, voters themselves make the decision to adjust water fluoride to improve public health. Some states have laws that require water systems of a certain size to provide fluoridated water. In some areas, the level of naturally occurring fluoride in water is already at a level proven to prevent cavities.
The best source of information on the fluoride level of your drinking water is your local water provider.
The fluoride content of well water can be determined only through laboratory analysis. Your local public health department can tell you where to have your home well water tested.
The U.S. Environmental Protection Agency (EPA) recommends that drinking water contain no more than 2.0 mg/L of fluoride. This is a non-enforceable guideline and is intended to help children avoid dental fluorosis. This condition only develops in children while teeth are developing under the gums (up until about age 8).
When water fluoride levels exceed 2.0 mg/L, water systems are required to notify customers of the increased potential for dental fluorosis. Less than 1% of the U.S. population has water from private wells or drinking systems with fluoride higher than 2.0 mg/L.
EPA recommends that children 8 years and younger be provided with alternative sources of drinking water if their main source of water contains more than 2.0 mg/L of fluoride. Pregnant women or parents of children who live in areas with higher fluoride concentrations can use low-fluoride bottled water, for instance to mix infant formula.
If your water has a fluoride content of 4.0 mg/L or higher, contact your public health department for specific steps to follow. Consider using a filter that removes fluoride from water used for drinking or cooking. Fluoride is not absorbed through skin, so water with too much fluoride can still be used for cleaning and bathing.
Some, but not all, bottled water contains fluoride. Bottled water may come from a public water system that adds fluoride to improve oral health. It may also come from springs or aquifers where fluoride is naturally present.
Bottled water labeled as de-ionized, purified, demineralized, or distilled contain no or only trace amounts of fluoride, unless they specifically list fluoride as an added ingredient. Contact the bottled water’s manufacturer to ask about the fluoride content of a particular brand.
Getting enough water every day is important for your health. It prevents dehydration, a condition that can cause unclear thinking, result in mood change, cause your body to overheat, and lead to constipation and kidney stones.
If you drink mostly bottled water you may not get an optimal amount of fluoride to prevent cavities and promote oral health. Tell your dental provider if you drink mostly bottled water so they can help you find the best way to prevent cavities.
If your child is only consuming infant formula mixed with fluoridated water, there may be an increased chance for mild dental fluorosis. Bottled water labeled as de-ionized, purified, demineralized, or distilled contains no or only trace amounts of fluoride, unless they specifically list fluoride as an added ingredient.
Parents can use low-fluoride bottled water some of the time to mix infant formula to lessen this risk. Look for bottles labeled as de-ionized, purified, demineralized, or distilled. Additionally, some bottled waters are marketed for infants and for the purpose of mixing with formula.
For more information, see the U.S. Food and Drug Administration's general Q&A about bottled water and infant formula.
Fluoride benefits both children and adults. Here's how:
Before teeth break through the gums (erupt), the fluoride taken in from foods, beverages and dietary supplements makes tooth enamel (the hard surface of the tooth) stronger, making it easier to resist tooth decay. This provides what is called a "systemic" benefit.
After teeth erupt, fluoride helps rebuild (remineralize) weakened tooth enamel and reverses early signs of tooth decay. When you brush your teeth with fluoride toothpaste, or use other fluoride dental products, the fluoride is applied to the surface of your teeth. This provides what is called a "topical" benefit.
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In addition, the fluoride you take in from foods and beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth with tiny amounts of fluoride that help rebuild weakened tooth enamel.
Communities fluoridate their water supply because it is a cost-effective public health method that helps prevent cavities. The average cost per year for U.S. communities to fluoridate the water ranges from $.50 per person for large communities to $3.00 per person for small communities.
Cavities are caused by a disease called "caries," which is five times more common than asthma and seven times more common than hayfever in 5-to-17-year-olds. The pain from untreated cavities can cause people to lose sleep, have trouble eating, speaking and paying attention at school or work.
A report from the U.S. Surgeon General in estimated that 51 million school hours are lost per year because of dental-related illness. Without water fluoridation, that number would likely be much higher.
The American Dental Association (ADA) supports community water fluoridation as the single most effective public health measure to prevent tooth decay. Studies prove water fluoridation continues to be effective in reducing dental decay by at least 25% in children and adults, even in the of era widespread availability of fluoride from other sources, such as fluoride toothpaste.
The ADA, the American Medical Association, the World Health Organization and many others support fluoridation of community water supplies. The U.S. Centers for Disease Control and Prevention (CDC) has cited community water fluoridation as one of 10 great public health achievements of the 20th century (along with vaccinations, infectious disease control and motor vehicle safety).
So, by simply drinking fluoridated water, you are doing something good for your oral health.
No. Fluoride in water at the recommended level is not toxic according to the best available scientific evidence.
Toxicity is related to dose. While large doses of fluoride could be toxic, it is important to recognize the difference between the effect of a massive dose of an extremely high level of fluoride versus the fluoride level currently recommended for public water systems. Like many common substances essential to life and good health - salt, iron, vitamins A and D, chlorine, oxygen and even water itself - fluoride can be toxic in massive quantities.
Fluoride at the much lower recommended concentrations (0.7 mg/L) used in community water fluoridation is not harmful or toxic.
The single dose (consumed at one time) of fluoride that could cause acute fluoride toxicity is 5 mg/kg of body weight (11mg/kg of body weight of sodium fluoride). This dose is considered the probably toxic dose (PTD) which "is defined as the minimum dose that could cause serious or life-threatening systemic signs and symptoms and that should trigger immediate therapeutic intervention and hospitalization." Acute fluoride toxicity occurring from the ingestion of optimally fluoridated water is impossible. With water fluoridated at 1 mg/L, an individual would need to drink five (5) liters of water for every kilogram of body weight. For example, an adult male (155 pound/70.3 kilogram man), it would require that he consume more than 350 liters (nearly 93 gallons) of water at one time to reach an acute fluoride dose. With optimally water now set at 0.7 mg/L, it would take almost 30% more, or nearly 120 gallons (more than 1,900 eight ounce glasses) of water at one time to reach the acute dose.
Sources:
U.S. Department of Health and Human Services. Federal Panel on Community Water Fluoridation. U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Rep ; 130(4):318-331. Article at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC. Accessed August 9, .
Whitford GM. Acute toxicity of ingested fluoride. In Buzalaf MAR (ed): Fluoride and the Oral Environment. Monogar Oral Sci. Basel, Karger. ; 22:66-80. Abstract at: https://www.ncbi.nlm.nih.gov/pubmed/. Accessed August 9, .
For children younger than 3 years, parents and caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than a smear or the size of a grain of rice.
For children 3 to 6 years of age, parents and caregivers should dispense no more than a pea-sized amount of fluoride toothpaste.
Teeth should be brushed thoroughly twice a day (morning and night) or as directed by a dentist or physician. Children’s brushing should be supervised to ensure that they use the appropriate amount of toothpaste.
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