What is community water fluoridation?

Most water supplies and soils contain trace amounts of fluoride. Water systems are considered naturally fluoridated when the natural level of fluoride is greater than 0.7 parts per million (ppm). When a water system adjusts the level of fluoride to 0.7-1.2 ppm, it is referred to as community water fluoridation. For more than 60 years communities around the nation and in most of the developed world have fluoridated community water supplies as a simple, safe and effective way to prevent cavities and dental disease. Today, more than 67% of the U.S. population on public water supplies has access to fluoridated water. But only about 36% of Louisiana citizens have access to fluoridated water supplies in their communities.
 

What is fluoride?

Fluoride is the name given to a group of compounds that are composed of the naturally occurring element fluorine and one or more other elements. Fluorides are present naturally in water and soil.
 

How does fluoride work?

Tooth decay is an infectious and transmissible bacterial disease. When a person eats sugar, or other refined carbohydrates, some oral bacteria produce acid that removes minerals from the surface of the tooth, a process that is known as demineralization. If the demineralization process continues for a period of time, a cavity is formed. If fluoride is available, the demineralization process can be reversed, thereby preventing the cavity. In addition, fluoride reduces the ability of the oral bacteria to produce acid.
 

Why fluoridate water?

 In the early 1940s, scientists discovered that people who lived where drinking water supplies had naturally occurring fluoride levels of approximately 1.0 ppm (1 part fluoride per million parts of water) had fewer dental caries (cavities). More than 60 years of research and practical experience has shown fluoridation is safe and beneficial for everyone, especially children and seniors. Fluoride can prevent and even reverse tooth decay by enhancing re-mineralization, the process by which fluoride “rebuilds” tooth enamel that is beginning to decay.

Today, more than 67% of the U.S. population on public water supplies has access to fluoridated water. But only about 36% of Louisianans have access to fluoridated water supplies in their communities. The Centers for Disease Control and Prevention (CDC) considers fluoridation of water one of the 10 great achievements in public health in the 20th century.
 

Is tooth decay still a serious problem?

Yes. By age 19, more than two-thirds of U.S. children and adolescents, 91% of U.S. adults, and 93% of Americans 60 years of age and older have experienced tooth decay. 

Has the prevalence of tooth decay decreased since water fluoridation began?

Yes. Independent studies initiated in 1945 and 1946 followed four communities and assessed the value of water fluoridation. By 1960, tooth decay rates in these communities declined, on average, 56% more than in demographically similar communities whose water supplies were not fluoridated. More recent studies show that water fluoridation will reduce tooth decay in permanent teeth by approximately 18-40%. Although this reduction in decay is not as dramatic as it was in the 1950s and 1960s, it is significant when compared to tooth decay in non-fluoridated communities.
 

Will community water fluoridation benefit my family?

It has been demonstrated that fluoride's action in preventing tooth decay provides a benefit to both children and adults throughout their lives. The health benefits of fluoridation include a reduction in the frequency and severity of tooth decay, a decrease in the need for fillings and tooth extractions, a reduction in pain and suffering associated with tooth decay, and the obvious elevation of self-esteem that goes with improved oral functioning and appearance. Community water fluoridation is especially important for children who have limited access to dental care.
 

Is community water fluoridation safe?

Yes. Extensive research conducted over the past 60 years (and the practical experience of millions who have benefited from access to fluoridated water supplies) has shown that fluoridation of public water supplies is a safe and effective way to reduce tooth decay for all community residents. It is especially beneficial for children and seniors. More recent reviews of the safety of water fluoridation include a comprehensive review of the scientific literature by the U.S. Public Health Service in 1991 and the University of York in 2000. The overall value and safety of community water fluoridation has been endorsed by the Centers for Disease Control and Prevention, by the U.S. Surgeon General's report Oral Health in America (May 2000), and by the U.S. Task Force on Community Preventive Services in 2001. Community water fluoridation also has been endorsed by numerous public health and professional organizations, including the American Dental Association, the American Medical Association, the American Association of Public Health, U.S. Public Health Service and the World Health Organization.
 

Is it true that the American Dental Association recently warned parents not to feed babies infant formula mixed with fluoridated water?

The American Dental Association (ADA) issued interim guidance last year on infant formula and fluoride while more research is conducted in response to two developments: 1) The U.S. Food and Drug Administration’s Oct. 14, 2006 health claim notification allowing bottlers to claim that fluoridated water may reduce the risk of dental cavities or tooth decay, but not make the claim for bottled water products specifically marketed for use by infants; and 2) the March 22, 2006 release of the National Research Council (NCR) Report: "Fluoride in Drinking Water: A Scientific Review of EPA's Standards."

Studies cited in the NCR Report have raised the possibility that infants could receive a greater than optimal amount of fluoride through liquid concentrate or powdered baby formula that has been mixed with water containing fluoride during a time when their developing teeth may be susceptible to mild enamel fluorosis.

 

Is the risk of fluorisis in infants a reason to be cautious about water fluoridation?

No. The small potential of very mild to mild fluorisis from a child consuming more than an optimal amount of fluoride means there is a chance a child might develop a cosmetic condition that appears as a cloudy white area on teeth after they have erupted (see photo below). It doesn't affect the function of the teeth and poses no health risk.



Dental caries or cavities, on the other hand, ARE a disease – the most prevalent chronic disease among children nation wide - seven times more common than asthma. Dental disease can lead to other, more serious health problems. The photos below show children's mouths with mild, moderate severe dental disease. This is the disease that children who don't receive an optimal amount of fluoride are at risk of developing.

 

Can fluoridated water cause cancer?

In the scientific and health care community, the issue isn't in doubt. Fluoride has clearly proven to be safe and effective. The American Cancer Society, which carefully reviews all research related to increased cancer risks, strongly supports community water fluoridation. The possible relationship between fluoridated water and cancer has been extensively studied and debated.

Opponents of fluoridation have made much of a preliminary research study by Elise B. Bassin as part of her doctoral thesis for the Harvard School of Dental Medicine. Her study suggested a possible association between osteosarcomas (bone tumors) in young males and residence in an area of fluoridated water. An accompanying letter by a Harvard School of Dental medicine faculty member cautioned readers against using the results of this preliminary study in formulating public policy about fluoridation because his larger study, with a more direct measure of biologic exposure, failed to confirm the finding.

In a February 1991 Public Health Service (PHS) report, the agency said it found no evidence of an association between fluoride and cancer in humans. The report, based on a review of more than 50 human epidemiological (population) studies produced over the previous 40 years, concluded that optimal fluoridation of drinking water “does not pose a detectable cancer risk to humans” as evidenced by extensive human epidemiological data reported to date.

In one of the studies reviewed for the PHS report, scientists at the National Cancer Institute evaluated the relationship between the fluoridation of drinking water and the number of deaths due to cancer in the United States during a 36-year period, and the relationship between water fluoridation and number of new cases of cancer during a 15-year period. After examining more than 2.2 million cancer death records and 125,000 cancer case records in counties using fluoridated water, the researchers found no indication of increased cancer risk associated with fluoridated drinking water.

In 1993, the Subcommittee on Health Effects of Ingested Fluoride of the National Research Council, part of the National Academy of Sciences, conducted an extensive literature review concerning the association between fluoridated drinking water and increased cancer risk. The review included data from more than 50 human epidemiological studies and six animal studies. The Subcommittee concluded that none of the data demonstrated an association between fluoridated drinking water and cancer. A 1999 report by the CDC supported these findings. The report concluded that studies to date have produced “no credible evidence” of an association between fluoridated drinking water and an increased risk for cancer.
 

Is there any risk to fish or wildlife from the addition of fluoride to drinking water?

No. While some studies have shown that very high levels of fluoride may be detrimental to fish (and must be removed to meet EPA drinking water standards), those studies examined exposures to fluoride levels 500% or more above levels recommended for community water fluoridation. Fluoride entering waterways from fluoridated drinking water supplies adds, at most, only a tiny fraction to the background levels of fluoride found naturally in the receiving waters.
 

How much does it cost the community to fluoridate the water?

The per-person cost of fluoridation varies by the size of the community population. The average cost of providing fluoridated water to communities with more than 20,000 residents is about 50 cents per year. For communities of 10,000–20,000 residents, the cost is about $1.
 

Is community water fluoridation a cost-effective method for disease prevention?

Yes. In 2004, an estimated $78 billion was spent on dental services, representing about 5% of all expenditures for personal health care in the United States. A CDC study estimated that every $1 invested in community water fluoridation saved $38 in avoided costs for dental treatment. 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.