HHS issues recommendation for community water fluoridation

The U.S. Department of Health and Human Services released its final Public Health Service (PHS) recommendation for the optimal fluoride level in drinking water to prevent tooth decay.

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The U.S. Department of Health and Human Services released its final Public Health Service (PHS) recommendation for the optimal fluoride level in drinking water to prevent tooth decay. The new recommendation is for a single level of 0.7 milligrams of fluoride per liter of water. It updates and replaces the previous recommended range (0.7 to 1.2 milligrams per liter) issued in 1962.

How was the updated recommendation developed?
In September 2010, the Department of Health and Human Services convened a panel of scientists from across the U.S. government to review new information related to fluoride intake and to consider a new recommendation for community water fluoridation. The federal panel reviewed the best available information, including changes in the occurrence and severity of tooth decay and of dental fluorosis in U.S. children and adults. The panel also studied the U.S. Environmental Protection Agency's (EPA) scientific assessments of the major sources of fluoride intake and risk of severe dental fluorosis among children. Severe dental fluorosis is rare in the United States. Based on this review, the federal panel proposed changing the recommended level for community water systems to 0.7 milligrams per liter (the low end of the prior recommended range of 0.7 to 1.2 milligrams per liter). The proposed change was published in the Federal Register. Public comment on the proposed new level was sought—and considered carefully by the Panel—before finalizing the new recommendation. In addition, the proposed recommendation was submitted to a Peer Review Process, a step required by the federal government for influential scientific information.

The change was recommended because Americans now have access to more sources of fluoride, such as toothpaste and mouth rinses than they did when water fluoridation was first introduced in the United States. As a result, there has been an increase in fluorosis, which, in most cases, manifests as barely visible lacy white marking or spots on the tooth enamel. The new recommended level will maintain the protective decay prevention benefits of water fluoridation and reduce the occurrence of dental fluorosis.

To download a fact sheet on community water fluoridation, click here.

“While additional sources of fluoride are more widely used than they were in 1962, the need for community water fluoridation still continues,” said U.S. Deputy Surgeon General Rear Admiral Boris D. Lushniak, MD, MPH. “Community water fluoridation continues to reduce tooth decay in children and adults beyond that provided by using only toothpaste and other fluoride-containing products.”

Fluoride occurs naturally in most water systems, but often at levels too low to prevent tooth decay. The practice of adding fluoride to a community’s water system to reach the optimal level for preventing tooth decay has grown steadily over the years. Nearly 75 percent of Americans who are served by public water systems receive fluoridated water.

Why does HHS recommend 0.7 milligrams per liter?
An optimal level of fluoride in drinking water provides enough fluoride to prevent tooth decay in children and adults while limiting the risk of dental fluorosis, which is the only unwanted health effect of community water fluoridation. Dental fluorosis is a change in the appearance of the dental enamel that occurs in children whose teeth are forming under the gums. The risk of dental fluorosis increases as children ingest higher levels of fluoride. The most common impact of fluorosis is faint white spots on teeth that usually only a dental professional would notice. National survey data show that prevention of tooth decay can be maintained at the recommended level of 0.7 milligrams of fluoride per liter of drinking water. This recommended level updates and replaces the previously recommended range of 0.7 to 1.2 milligrams per liter.

Community water fluoridation has led to dramatic declines in both the prevalence and severity of tooth decay. As a result, the Centers for Disease Control and Prevention named it one of 10 great public health achievements of the 20th century.

“Community water fluoridation is effective, inexpensive and does not depend on access or availability of professional services. It has been the basis for the primary prevention of tooth decay for nearly 70 years,” said Dr. Lushniak.

The U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries was published today in Public Health Reports.

For more information about community water fluoridation, as well as information for health care providers and individuals on how to prevent tooth decay and reduce the chance of developing dental fluorosis: http://www.cdc.gov/fluoridation.

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