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Fluoride and Fluoridation What is Fluoride? Fluoride is a mineral found in water, soil, and plants. It is well known for supporting dental health by strengthening tooth enamel and helping protect teeth from decay. Because of these benefits, fluoride is commonly added to many dental care products like toothpaste and mouth rinses. In addition to its role in oral care, fluoride compounds are used in industries such as aluminum, steel, and glass manufacturing. They can also be released into the environment during the production of phosphate fertilizers, bricks, tiles, and ceramics. “U.S. EPA’s MCL [of 4 mg/L] was set to protect against crippling skeletal fluorosis, with a secondary MCL of 2 mg/L to protect against dental fluorosis (in mild cases, fluorosis is a slight discoloration of teeth, in more severe cases it can lead to pitting and breaking of the teeth). Moderate to severe dental fluorosis is rare when the drinking water fluoride level is in the range of 1 mg/L, but begins to become significant at concentrations close to 2 mg/L” (OEHHA, 1997). What are the Current Fluoride Standards? For community water systems in California that fluoridate their water, the Division of Drinking Water recommends follow the CDC's current recommended optimal fluoride level of 0.7 mg/L. This is recommended over the current California fluoridation regulations of variable optimal fluoride levels based on average air temperature. California’s primary drinking water standard for fluoride can be found at 22 CCR 64431. Additional fluoride standards in 22 CCR 64433.2 have optimal levels and control ranges that depend on daily air temperatures. Fluoride levels in drinking water must be tested daily (22 CCR 64433.3). If more than 20% of the daily samples collected in a month fall outside of the control range, the water system would be out of compliance with the optimal fluoride levels. Standards and Recommendations Concentration (mg/L) California’s Primary Maximum Contaminant Level (MCL) 2 California’s Optimal Fluoride Levels: Temperature dependent - Optimal Fluoride Levels 0.7 to 1.2 - Control Range: Low 0.6 to 1.1 - Control Range: High 1.2 to 1.7 California’s Detection Limit for Purposes of Reporting (DLR) 0.1 U.S. EPA’s Primary MCL 4 U.S. EPA’s Secondary MCL 2 OEHHA’s Public Health Goal (PHG) 1 U.S. Department of Health and Human Services 0.7 What is Fluoridation? Why is Fluoridation Important? Tooth decay is the number one chronic condition for children. It may result in pain, poor nutrition, and dysfunctional speech, as well as a lack of concentration, poor appearance, low self-esteem, and absenteeism. Optimally fluoridated water is the single most cost-effective strategy that a community can take to improve the oral health of its residents. Studies consistently show that water fluoridation reduces tooth decay by 20 to 40 percent. The recommendations of HHS resulted from an updated review of the various current sources of fluoride, including water fluoridation. Providing the optimal level of fluoride protects the dental health of people of all ages, not just children. How is Fluoride and Fluoridation Managed in California? The Division of Drinking Water (DDW) within the State Water Resources Control Board is the regulatory agency responsible for regulating the content of fluoride in water served by California public water systems and assuring drinking water is optimally fluoridated to provide dental health benefits to the public. DDW also provides technical and engineering expertise to water systems for permitting and operating fluoridation systems. DDW is responsible for regulating the activities of fluoridating public water systems in California. This responsibility includes assuring water fluoridation is conducted in a safe and effective manner. Public water systems must obtain a permit from DDW to fluoridate their drinking water supplies and must monitor the fluoride levels in their water system on a daily basis. The Office of Oral Health within CDPH is responsible for securing funds to purchase and install fluoridation equipment for water systems. This office also provides scientific, technical, and health related expertise to communities interested in fluoridating their drinking water. Is there More Related Information?

Fluoridation by Public Water Systems | California State Water Resources Control Board