Frequently Asked Questions



Q: What is fluoride and how does it benefit dental health?

A: Fluoride is a mineral that exists naturally in all water supplies. Research proves that fluoride prevents tooth decay, especially at the optimal level of .7 mg/L. This optimal level is reached when a public water system adjusts the level of fluoride.


Q: I recently found the website of a group that opposes fluoridation. This group claims that the connection between fluoridation and cavity prevention isn’t solid. Is that true?

A: No, it is not true. There is solid, consistent evidence supporting fluoride’s role in cavity prevention. Community water fluoridation prevents at least 25 percent of tooth decay in children and adults throughout the lifespan. Two studies released in 2010 strengthened the already substantial evidence that fluoridated water prevents cavities.


Q: Does fluoride in drinking water protect only the teeth of children or does it benefit everyone?

A: People of all ages benefit from drinking water that is optimally fluoridated. Oral health is important throughout a person’s life. In the 1950s, before water fluoridation was common, most people over the age of 65 had lost their teeth. Now, after decades of widespread fluoridation, more seniors are keeping most or all of their teeth. Between 1972 and 2001, the rate of edentulism—losing all of one’s teeth—dropped 26 percent among lower-income seniors and fell 70 percent among upper-income seniors.


Q: What do leading medical and health organizations say about drinking water that is optimally fluoridated?

A: The American Academy of Pediatrics, the American Dental Association, the American Medical Association and many other respected medical or health organizations recognize the health benefits of fluoridation. The U.S. Centers for Disease Control and Prevention called water fluoridation “one of 10 great public health achievements of the 20th century.”


Q: Federal health officials recently recommended that public water systems reduce the level of fluoride in drinking water. What was the recommendation and why was this new level set?

A: In January 2011, the U.S. Department of Health and Human Services (HHS) recommended that the optimal level of fluoride in public water systems should be 0.7 milligrams per liter (mg/L) of water. This is a change from the previous recommendation that the optimal level would vary by a region’s climate (average temperatures) within the range of 0.7 to 1.2 mg/L. This new recommendation by HHS recognizes these scientific findings:

  1. Americans today are getting fluoride from more sources than they were when the original level was set, and
  2. the water intake of children does not vary by climate or region. This new fluoride level demonstrates that federal health officials are periodically reviewing research and relying on the best science to update—if and when appropriate—their recommendations on fluoridated water.


Q: Are many communities planning on completely removing fluoride from water because of the recent federal announcement on the fluoride level?

A: Many communities are reviewing their fluoride levels and planning to adjust those levels to meet the new recommendation. There is no sign that many communities either want or plan to remove fluoride entirely. HHS and leading health experts do not support removing fluoride from water to a level below the recommended level because this would deprive people of cavity protection. In fact, the American Dental Association welcomed HHS’ new fluoride level and said that water fluoridation remains “one of our most potent weapons in disease prevention.” In Grand Rapids, Michigan—the first U.S. city that optimally fluoridated its water system—the city’s daily newspaper wrote an editorial noting that the new HHS recommendation “should not feed the flawed notion … that fluoride must be removed entirely from drinking water.”


Q. What impact will the new fluoride level have on Americans who are served by a public water system that’s fluoridated?

A: The new optimal fluoride level that federal health officials have recommended will have a positive impact. First, it will continue to protect teeth by helping to reduce tooth decay. Second, the new level will continue to minimize the chances of fluorosis, a condition that typically causes faint white lines that appear on teeth, usually visible only to a dentist. The new HHS recommendation reflects the fact that Americans today receive fluoride from more sources (toothpaste, mouth rinses and other products) than they were getting several decades ago.


Q: How many Americans receive water that is optimally fluoridated?

A: Roughly 75 percent of the U.S. population on public water supplies has access to optimally fluoridated water. Some communities have had optimally fluoridated water for over 60 years.


Q: Water fluoridation helps to prevent tooth decay, but is that really a concern in the U.S. anymore?

A: Yes, it remains a concern. Although dental health has improved for many Americans, tooth decay remains the most common chronic childhood disease—five times more prevalent than asthma. Tooth decay causes problems that often last long into adulthood, affecting kids’ schooling and their ability to get jobs as adults.


Q: If I use fluoridated toothpaste, am I getting enough fluoride to protect against decay?

A: No. The benefits from water fluoridation build on those from fluoride in toothpaste. Studies conducted in communities that fluoridated water in the years after fluoride toothpastes were widely used have shown a lower rate of tooth decay than communities without fluoridated water. The author of a 2010 study noted that research has confirmed “the most effective source of fluoride to be water fluoridation.” Water fluoridation provides dental benefits to people of all ages and income groups without requiring them to spend extra money or change their daily routine.


Q: Do any states have laws guaranteeing residents’ access to fluoridated water?

A: Thirteen states* and the District of Columbia have laws designed to ensure access to fluoridated water. Forty-three of the 50 largest cities in the U.S. fluoridate their drinking water. Research shows that every $1 invested in water fluoridation saves $43 in unnecessary dental costs. (The 13 states are Connecticut (1965), Kentucky (1966), Illinois (1967), Minnesota (1967), Ohio (1969), South Dakota (1969), Georgia (1973), Nebraska (1973 and 2008), California (1995), Delaware (1998), Nevada (1999), Louisiana (2008) and Arkansas (2011)).


Q. Why do children need fluoride?

A: Fluoride is an important mineral for young children. As a child’s teeth begin to form, fluoride strengthens the enamel to make it resistant to tooth decay. Later, after teeth are in the mouth, fluoride helps to reverse early signs of decay. This is how children benefit from drinking fluoridated water. Fluoride exists naturally in water, and “fluoridation” is simply adjusting fluoride to the optimal level for preventing tooth decay.


Q. I read something on the Internet suggesting that infants shouldn’t be exposed to fluoride. What’s this all about?

A: In recent years, questions have been raised about the use of fluoridated water to prepare infant formula. Some of these questions have come from groups like the Fluoride Action Network, which has a much broader agenda—to prevent Americans of all ages from having access to fluoridated water through their public water systems. The Fluoride Action Network wrongly claimed that the American Dental Association (ADA) recommends “that children under 12 months of age should not consume fluoridated water.” In fact, the ADA concludes that “it is safe to use fluoridated water to mix infant formula” and encourages parents to discuss any questions they may have with their dentists and pediatricians.


Q. What options do parents have if they prefer not to use fluoridated water for infant formula?

A: Parents or caregivers have three simple alternatives for feeding an infant. First, they can breast-feed their infants, which is what the American Academy of Pediatrics generally recommends. Second, they can use bottled or purified water that contains no fluoride. Third, they can use a ready-to-feed formula that does not require water to be added.


Q. What is dental fluorosis and will fluoridated water increase the odds that an infant will later develop this condition?

A: Although using fluoridated water to prepare infant formula might increase the chance that a child develops dental fluorosis, nearly all instances of fluorosis are a mild, cosmetic condition. Fluorosis usually appears as very faint white streaks on teeth. For examples of what mild fluorosis looks like, click here.  In fact, the ADA reports that often “the effect is so subtle that, usually only a dental expert would notice it during an examination.” It does not cause pain, nor does it affect the function or health of the teeth. And once a child reaches age 8, they cannot develop dental fluorosis.


Q. Is fluoridated water the reason why the rate of dental fluorosis among children has increased?

A: Experts point to a different reason. Officials at the Centers for Disease Control and Prevention believe the rise in fluorosis is due mainly to children who swallow fluoride-containing toothpaste when they brush their teeth. Researchers at Oregon State University also point to the swallowing of fluoride toothpaste as a key factor in excess fluoride intake by kids. This is why parents are advised to supervise their kids’ tooth-brushing and apply only a recommended amount of fluoridated toothpaste to the toothbrush (no more than a smear the size of a grain of rice for children younger than 3 years old, or a pea-sized amount for children 3-6 years old, according to the American Dental Association).


Q:  Why don’t many European countries fluoridate their water?

A: Many European countries provide the cavity-fighting benefits of fluoridation in other ways.   Europe has used a variety of programs to provide fluoride’s benefits to the public. Water fluoridation is one of these programs. Fluoridated water reaches 12 million Europeans, mostly residents of Great Britain, Ireland and Spain. Fluoridated milk programs reach millions of additional Europeans, mostly in Eastern Europe. Salt fluoridation is the most widely used approach in Europe. In fact, at least 70 million Europeans consume fluoridated salt, and this method of fluoridation reaches most of the population in Germany and Switzerland. These two countries have among the lowest rates of tooth decay in all of Europe. A wide spectrum of health-related organizations, including the health advisory committee of the European Union, and numerous national health authorities in Europe have supported fluoridation for decay prevention.


Q. What does fluoride actually do in the body and is there a cumulative effect?

A: When fluoride is ingested, it is rapidly absorbed from the gastrointestinal tract and distributed throughout the body via plasma and blood cells, with plasma levels being twice as high as blood cell levels. Approximately 50 percent of the fluoride is excreted through the kidneys, with the rest being retained and stored within teeth and bones.  Although the retention within the teeth and bones is cumulative, it does not simply continue to accumulate without variation.  As the fluoride level of plasma decreases through decreased fluoride intake, fluoride stored in teeth and bones is released back into the plasma where it is then excreted through the kidneys until the equilibrium is once again attained.


When high levels of fluoride (4.0 mg/L or greater) are chronically ingested over time, adverse effects on the teeth and bones can occur. The most common are moderate/severe dental fluorosis, skeletal fluorosis, and bone fracture.  When water is optimally fluoridated at 0.7 mg/L, it is well below the level where there is a risk of adverse effects.


It is important to note that approximately 75 percent of the U.S. population served by community systems receives the benefits of fluoridated water. Over the decades, hundreds of millions of people have chronically ingested optimally fluoridated water over the past 70 years. If skeletal fluorosis was a consequence of water fluoridation, this disorder would be rampant in the U.S. by now.  Skeletal fluorosis is so rare in the U.S. that it is deemed as nearly non-existent, with the few cases that have occurred being attributable to chronic industrial exposure, not fluoridated water.


Q: Is fluoridation mass medication without consent?

A: Fluoridation is not medication; it is the adjustment of a naturally occurring element found in water in order to prevent dental decay. Courts have consistently ruled that water fluoridation is not a form of compulsory mass medication or socialized medicine.  Local officials are not required to have informed consent from anyone prior to approving the addition of chlorine, fluoride, ammonia or any of the 40+ additives routinely applied to water supplies. There have been numerous court challenges through the decades, but no court of last resort has ever ruled in favor of the argument that the optimal level fluoride in drinking water is a drug.


Q: Why doesn’t FDA approve community water fluoridation?

A: The Food and Drug Administration (FDA) does not oversee fluoride in tap water/community water.  Community water, including routine additives, is under the jurisdiction of the Environmental Protection Agency (EPA).  Fluoride is simply a mineral that has naturally existed in water forever. The fluoride that is added to achieve the optimal level of fluoridation, is identical to the fluoride that naturally occurs.  A fluoride ion is a fluoride ion, regardless of the source from which it is released into water.

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