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Frequently Asked Questions About Fluoridation

Fact Sheet
on
Drinking Water Fluoridation

Since 1945, many American water systems have adjusted the amount of natural fluoride concentration of a community’s water supply to a level that is best for the prevention of dental decay. This process is known as "drinking water fluoridation".

Fluoride is a naturally occurring ion found in varying amounts in water, air and soil.

Fluoride at optimal concentrations for oral health is safe and effective in reducing tooth decay by 20%-40%.

Drinking water fluoridation is beneficial to adults as well as children in preventing tooth decay.

The American Dental Association (ADA), the American Medical Association, the Centers for Disease Control and Prevention (CDC), the U.S. Public Health Service (USPHS), the World Health Organization (WHO), the American Water Works Association (AWWA) and many other public health and professional organizations recognize the public health benefits of drinking fluoridated water.

The three primary agents used in drinking water fluoridation are sodium fluoride, sodium fluorosilicate and fluorosilicic acid.

Drinking water's fluoride content is limited under federal and state regulations. The U.S. Environmental Protection Agency (USEPA) has established a Maximum Contaminant Level of 4 mg/L for fluoride, a Maximum Contaminant Level Goal of 4 mg/L, and a Secondary Maximum Contaminant Level of 2 mg/L to avoid cosmetic staining of teeth for children less than age 9. EPA considers all water with fluoride content less than 4 mg/L to be safe for consumption. California has a standard of 2 mg/L for fluoride.

Consumption of water with a fluoride level above 2 mg/L increases the risk for dental fluorosis in developing teeth. The vast majority of dental fluorosis is a whitening of the biting edges of the teeth, and are considered a minor cosmetic effect. Consumption over long periods to excessively high levels of fluoride can cause moderate or severe forms, which is a staining of the permanent teeth. To minimize the risk of fluorosis, children under age 9 should not drink water that has more than 2 mg/L of fluoride.

A detailed review by the National Research Council in 1993 found finds no links between low-level fluoride ingestion and occurrences of cancer, kidney disease, gastrointestinal disorders, immunological disorders, reproductive effects, genetic disorders, or bone fractures.

As part of “Healthy People 2010” the U.S. Department of Health and Human Services set a goal of increasing the proportion of the American population served by community water systems with optimally fluoridated water to 75% by the year 2010.

In 2000, the CDC estimated that 66% of people using community water systems, or 162 million people, had access to fluoridated water.

Water plant personnel perform a valuable public service by carefully adjusting the level of fluoride in water to improve the dental health of the community.

 

Does the Contra Costa Water District fluoridate its drinking water?

Yes, the State of California requires all water agencies that serve more than 10,000 homes and businesses to fluoridate their water. The Contra Costa Water District (CCWD) fluoridates drinking water at its two treatment plants. The Randall-Bold Water Treatment Plant located in Oakley serves Diablo Water District (Oakley) and parts of Antioch and Brentwood. The Bollman Water Treatment Plant located in Concord serves Clayton, Clyde, Concord, Pacheco, Port Costa, and parts of Martinez, Pleasant Hill and Walnut Creek.

Do the cities and agencies that purchase untreated water from CCWD also fluoridate the water when they treat it?

The cities of Antioch, Martinez, Pittsburg, and Diablo Water District (Oakley) fluoridate their water. The California Cities Water Company (now known as the Golden State Water Company) that serves Bay Point, does not fluoridate its drinking water.

Where can I find data on the levels of fluoride in CCWD service area drinking water?

Every year water providers are mandated to mail out an Annual Water Quality Report to all of their customers. Each year, CCWD, Diablo Water District, and the cities of Antioch, Martinez, and Pittsburg prepare a joint report that lists data for each water agency. You can obtain a copy of the report on line or call and request a report from these agencies at:

CCWD - (925) 688-8024

Martinez – 9925) 372-3512

Pittsburg – (925) 252-4850

Antioch - (925) 779-7009

Diablo Water District - (925) 625-3798

The Golden State Water Company produces a separate report for Bay Point. Golden State Water Company (Bay Point) - 1-800-999-4033

Why fluoridate the water?

In 1995, the State of California passed legislation that requires water systems with 10,000 or more connections to fluoridate the water. According to the U.S. Centers for Disease Control (CDC), over 84 percent of U.S. children, 96 percent of U.S. adults, and 99.5 percent of Americans 65 years of age and older have experienced tooth decay. Fluoride works by stopping or even reversing the tooth decay process.

North American water systems have added fluoride to their water supplies since 1945. Since that time, tooth decay has been reduced by 20%-40% where fluoridation has been implemented. The CDC has proclaimed water fluoridation to be one of the top ten greatest public health achievements of the past century. It is an effective, safe, and inexpensive way to prevent tooth decay and benefits Americans of all ages and socioeconomic status. Research indicates that frequent exposure to small amounts of fluoride is the best way to prevent tooth decay, and this is best gained by drinking fluoridated water and using a fluoride toothpaste twice daily.

What is water fluoridation? How does it prevent tooth decay?

Fluoride is a naturally occurring element that is present in water. Utilities add fluoride to adjust the natural concentration of the water supply to the level recommended for optimal dental health. The three primary agents used in drinking water fluoridation are sodium fluoride, sodium fluorosilicate and fluorosilicic acid.

Fluoride's effect is topical. When small amounts of fluoride are maintained in the mouth in saliva and dental plaque (the film that adheres to tooth enamel), it keeps the tooth enamel strong by preventing the loss of important minerals.

Is fluoridation safe?

Yes. Extensive research conducted over the past 50 years has demonstrated that fluoridation of public water supplies is a safe and effective way to reduce the incidence of tooth decay in a community. A detailed review by the National Research Council in 1993 found no links between low-level fluoride ingestion and occurrences of cancer, kidney disease, gastrointestinal disorders, immunological disorders, reproductive effects, genetic disorders, or bone fractures.

Exposure to high levels of fluoride over a long time can cause dental fluorosis, a condition that leads to mottled tooth enamel, discoloration, and in some cases erosion of the gum line. Drinking water's fluoride content is limited under federal law and the levels are very low. The maximum level of fluoride deemed acceptable by the US Environmental Protection Agency is 4 milligrams per liter (mg/L). In California, the Department of Health Services has set a maximum contaminant level (MCL) of 2.0 mg/L.

The American Dental Association (ADA), the American Medical Association, the Centers for Disease Control and Prevention (CDC), the U.S. Public Health Service (USPHS), the World Health Organization (WHO), and many other public health and professional organizations recognize the public health benefits of drinking water fluoridation. These policies are based on the overwhelming weight of credible scientific evidence.

What about recent reports linking fluoridation to bone cancer?

Recent media coverage has indicated the Harvard School of Medicine is investigating whether a professor downplayed a former student’s research suggesting a link between fluoridated tap water and a rare form of bone cancer in adolescent boys. In a statement, the ADA “cautions the dental profession, public health officials and the public against drawing conclusions based on a lone researcher’s unpublished study. Indeed, the student notes in her thesis that there are several limitations to her study and recommends that the findings be confirmed using data from other studies. For example, she notes that the study may not accurately reflect the actual amount of fluoride consumed by study subjects.”

How popular is fluoridated water?

Fluoridation of drinking water has been used successfully in the United States for more than 50 years. In 2000, the CDC estimated that 66% of residents using community water systems, or 162 million people, had access to fluoridated tap water. Of the 50 largest cities in the United States, 43 have community water fluoridation.

As part of its “Health People 2010” campaign, the U.S. Department of Health and Human Services set a goal of increasing the proportion of the American population served by community water systems with optimally fluoridated water to 75% by the year 2010.

Is water fluoridation the best and most cost-effective method for disease prevention?

Yes. In 1999, an estimated $56 billion was spent on dental services, representing about 5.6 percent of all expenditures for personal health care in the United States. The national average cost to restore one cavity with dental amalgam is approximately $65 - the approximate cost of providing fluoridation to an individual for a lifetime.

Fluoridation Research

The dental, public health and water communities have been studying fluoridation for many years.

For more information on fluoride and fluoridation, visit::

American Dental Association: http://www.ada.org/public/topics/fluoride/index.asp

 
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