What is drinking water fluoridation?
Drinking water fluoridation is the adjustment of fluoride to an optimal level in accordance with scientific and dental guidelines. The US Public Health Service (PHS) has determined a fluoride concentration of 0.7 mg/L as the optimal concentration of fluoride in drinking water that maximizes fluoride’s oral health benefits while minimizing potential harms, such as dental fluorosis. Fluoride is a naturally occurring mineral present in varying amounts in almost all soil, water, plants and animals and a normal constituent of many diets. Naturally occurring levels of fluoride in drinking water sources are often too low for the benefit of cavity prevention and so water systems have the choice to add fluoride to the recommended optimal level. Water fluoridation is practical, cost-effective, and equitable for all members of the community. For every $1 invested by water systems in water fluoridation, Coloradans save an estimated $61 per person per year in dental care costs. Fluoride improves oral health by helping to prevent tooth decay through strengthening the tooth enamel and helping to remineralize tooth enamel lost to the acids in food and beverages. Fluoride also makes it harder for harmful bacteria to adhere to the teeth. Good oral health is an important part of good overall health and an essential part of our everyday lives. Diet, sleep, psychological status, social interaction, school and work are all affected by impaired oral health.
What is CDPHE’s role in water fluoridation?
The Colorado Department of Public Health and the Environment’s (CDPHE) Water Quality Control Division (WQCD) provides technical support to systems that add fluoride as part of their treatment process. WQCD also performs inspections of the fluoride treatment system as part of the sanitary survey process for regulated public water systems. WQCD performs these inspections under a “Memorandum of Understanding” with CDPHE’s Oral Health Unit (OHU) in the Prevention Services Division (PSD). Much like the monthly operating reports (MOR) surface water systems submit to show compliance with the Surface Water Treatment Rule, participating water fluoridating systems submit a monthly fluoride report to OHU for tracking optimal fluoride levels. CDPHE follows the PHS recommendation of 0.7 mg/L for the optimal fluoride level in drinking water. While water fluoridation in the state of Colorado is voluntary, the decision to add fluoride is held to the same drinking water standards; additives must meet NSF/ANSI standards, fluoride levels are monitored daily and reported monthly to OHU.
The Environmental Protection Agency (EPA), through the Safe Drinking Water Act, has established national drinking water standards for public water systems. The EPA requires public water systems to comply with the maximum contaminant level (MCL) of 4.0 mg/L for fluoride in drinking water, with a secondary MCL of 2.0 mg/L. Public water systems that exceed the secondary MCL but are below the MCL are required to distribute public notice regarding the health effects of the elevated levels of fluoride. Recommended fluoride levels for the efficacy of cavity prevention are well below the EPA’s secondary MCL. A recent District Court case out of Northern California ordered the EPA to evaluate the public health risk of fluoride in drinking water under the amended Toxic Substances Control Act. Following the announcement of the Court’s opinion, the American Water Works Association, the American Dental Association, the American Academy of Pediatrics and the American Fluoridation Society have each reaffirmed support for optimal water fluoridation as safe, effective, and essential to the protection of the public’s health. CDPHE issued its own statement on October 14, 2024 in support of water fluoridation and will continue to review new and emerging research on water fluoridation.
For additional information about water fluoridation or further inquiries on the Court ruling, please reach out to the CDPHE OHU community water fluoridation program at cdphe.psfluoridationsmf@state.co.us.
➽ Aspen Coombs, P.E. WQCD Fluoride Liaison
