Frequently Asked Questions

We frequently receive the same question when we share our knowledge with others. This page offers a brief collection of the most popular questions we are asked.

What is Fluoride?

Fluoride is a mineral that exists naturally in water supplies. Fluoride has been shown to reduce the rate of tooth decay when added to toothpaste or water.

What is water fluoridation?

Water fluoridation is the simple adjustment of existing fluoride in water to a level that helps prevent dental decay. Local water systems typically choose from one of three forms of fluoride to engage in fluoridation, and the Centers for Disease Control and Prevention (CDC) provides detailed information on these types of fluoride.

How does fluoride get into our water?

As groundwater flows over rocks, it picks up fluoride ions which originate from those rocks. These fluoride ions are what is commonly referred to as being “naturally occurring” fluoride. The fluoride ions added during fluoridation are identical to these “naturally occurring” fluoride ions.

What are the benefits and risks of fluoridated water?

Benefits: The benefits of fluoridated water have been shown to reduce dental decay by 25% over a person’s lifetime. This includes both adults and children.

Risks: There are no valid, peer-reviewed scientific evidence of any adverse health effects of optimally fluoridated water.

What is the optimal level of fluoride?

The optimal level of fluoride in drinking water is that recommended level at which maximum dental decay prevention will occur, with no adverse effects. This optimal level was originally set by the US Public Health Service in 1962, as a range of 0.7 ppm to 1.2 ppm. It was set as a range in order to allow for different amounts of water consumption between different climates.

 

Recent scientific evidence has demonstrated that, due to air-conditioning and other modern amenities, there no longer exist any significant difference in water consumption due to climate differences. Thus, there is no longer a need for a range. In recognition of this fact and of the greater availability of fluoride now, than when the optimal was originally established, the CDC, in 2011, recommended that the optimal range be consolidated into simply the low end of that range, 0.7 ppm. After several years of careful study and consideration as to whether this consolidation would impact the dental decay prevention of fluoridated water, the US DHHS concluded that it would not.

Thus, in keeping with the original goal of providing maximum dental decay protection while minimizing any risk of mild dental fluorosis, the US DHHS recently announced that the optimal recommendation had been officially consolidated into the low end of the previous optimum range. The current optimal level is 0.7 ppm, the level at which most water systems have been fluoridating for years, anyway.

Can I use fluoridated water to reconstitute (mix) powered or concentrated liquid infant formula?

Yes

What do the leading health and medical organizations say about community water fluoridation?

Fluoridation is recommended by the leading health, medical and dental organizations, including the American Academy of Pediatrics, the American Dental Association, the Centers for Disease Control and Prevention, the American Public Health Association, the Mayo Clinic, and the Institute of Medicine.

Is water fluoridation cost-effective?

Yes.

 

Numerous peer-reviewed scientific studies clearly demonstrate the cost-effectiveness of this public health initiative.

Is there any requirement or need for FDA approval of optimal level fluoride in drinking water?

The FDA is just one of several regulatory agencies that ensure public safety.  The FDA’s authority is limited to products sold to the public and fluoride has been approved for use in toothpastes, mouth rinses and even bottled water. The FDA has no role in approving drinking water additives  pursuant to their agreement with the EPA in the early 1980’s.  Additives are covered by state regulations.  It should be noted that the FDA does not have the authority to approve many of the products we use every day.  For more information on what the FDA regulates, visit https://www.fda.gov/AboutFDA/Transparency/Basics/ucm194879.htm.

The Safe Drinking Water Act (SDWA) of 1974 confers the authority for ensuring the safety of public drinking water to the Environmental Protection Agency (EPA).  The EPA is responsible for setting drinking water standards and has the authority to regulate the addition of fluoride to the public drinking water.

California Department of Public Health

Reference

Fluoridation opponents cite data from the World Health Organization (WHO) and claim that Europe’s dental decay rates have fallen as much as the U.S.’s without using water fluoridation. What about this claim?

 

This claim is based on a skewed misrepresentation of WHO data by the “Fluoride Action Action Network”.  As part of a review located on Fluoride Science, Vinicius N Tavares, DDS, MPH & Adeyemi Jolaoso, BDS, MPH, explain how WHO data is misrepresented by the selective use of data points.  This may be viewed here.

Another excellent explanation of this misrepresentation is provided by New Zealand biochemist Ken Perrott here.

It’s also important to note that nearly every country in Europe has large-scale strategies for providing fluoride’s cavity-prevention benefits. These strategies include adding fluoride to salt, water and milk.

Are there more effective programs, such as Scotland’s “Childsmile”, to prevent dental decay than water fluoridation?

Given the following facts, the answer is: No.

1. Fluoride at the optimal level at which water is fluoridated is odorless, colorless, and tasteless.

2. Countless peer-reviewed scientific studies clearly demonstrate the effectiveness of fluoridation in the prevention of dental decay in entire populations.

3. With the extremely low per person cost of fluoridation, there is no other dental decay preventive measure which even approaches the cost-effectiveness of this public health initiative.

4. Peer-reviewed science has demonstrated there to be no adverse effect on the environment from fluoridation.

Regarding “Childsmile”, the following is from the British Fluoridation Society:

The Scottish ChildSmile Program, while a good initiative, is saving no money. This program involves a supervised toothbrushing program in schools, twice yearly fluoride varnish applications in selected areas, and various education initiatives. The total number of children involved is 120,000. The total annual cost of the program is £15 million. This equals £125 per child per year.

By contrast, the entire fluoridation programme currently serving 6 million people in England is costing around £2.1 million a year and is benefiting everyone with natural teeth, regardless of age, education or socio-economic status. Importantly, it is benefiting all children. The cost per person of fluoridation in England is therefore around 35 pence per annum.

The fact that the British Dental Association in Scotland has recently come out publicly to call for Scottish communities to move towards introducing water fluoridation undermines the arguments of anti-fluoridation groups, whether in the United States or in the UK, that Childsmile is an adequate substitute for water fluoridation. The professional body representing dentists in Scotland does not see it that way.

Childsmile is drastically more expensive than fluoridation, restricted to 120,000 school children, is dependent upon compliance of those children, has decay reduction no greater than fluoridation, and does not appear to have reduced SES inequalities.

Childsmile is a helpful program but not a substitute for fluoridation.

What evidence is there of the effectiveness of fluoridation?

 

A large volume of peer-reviewed science clearly demonstrates the effectiveness of fluoridation in the prevention of dental decay in entire populations. A number of these studies may be found here.

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