According to the Centers for Disease Control and Prevention (CDC), a division of the U.S. Department of Health and Human Services (HHS), “For 70 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay. The CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.”
Greenville Water also acknowledges the recommendations of the World Health Organization (WHO), American Medical Association (AMA), Canadian Medical Association (CMA), Center for Disease Control (CDC), American Dental Association (ADA), Canadian Dental Association (CDA), American Water Works Association (AWWA) and other professional organizations in the medical community, for the fluoridation of public water supplies as a significant public health benefit.
Greenville Water supports the use of fluoride in a safe, effective, and reliable manner that includes adequate monitoring and control of fluoride levels within limits mandated by local, state, and federal laws and that is subject to community acceptance through applicable local decision-making processes.
Health Benefits & Social Equity
According to 2012 data from the Centers for Disease Control and Prevention, more than 210 million or nearly 75% of the US population served by public water supplies, drank water with optimal fluoride levels to prevent tooth decay.
Water fluoridation prevents tooth decay mainly by providing teeth with frequent contact of low levels of fluoride throughout each day and throughout life. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25 percent over a person’s lifetime.
Community water fluoridation is not only safe and effective, but it is also the least expensive way to deliver the benefits of fluoride to all residents of a community. For larger communities of more than 20,000 people, it costs about 50 cents per person to fluoridate the water. It is also cost-effective because every $1 invested in this preventive measure yields approximately $38 savings in dental treatment costs.
This method of fluoride delivery benefits all people―regardless of age, income, education, or socioeconomic status. A person’s income and ability to get routine dental care are not barriers since all residents of a community can enjoy fluoride’s protective benefits just by drinking tap water and consuming foods and beverages prepared with it.
Fluoride from other sources prevents tooth decay as well, whether from toothpaste, mouth rinses, professionally applied fluoride treatments, or prescription fluoride supplements. These methods of delivering fluoride, however, are more costly than water fluoridation and require a conscious decision to use them.
Source: Centers for Disease Control and Prevention
Recent Changes to Recommended Levels Reflect Ongoing Assessment and Review
On April 27, 2015, the U.S. Department of Health and Human Services (HHS) released the final Public Health Service recommendation for the optimal fluoride level in drinking water to prevent tooth decay.
The new HHS recommendation of 0.7 milligrams of fluoride per liter of water replaces the former recommended range of 0.7 to 1.2 milligrams. HHS moved away from a range for fluoridation to a single number in recognition of two factors: people now get fluoride from other sources, and regional differences in water consumption have evened out in recent decades.
Greenville Water follows the recommended dosage of 0.7 milligrams per liter.
It is acknowledged that there are possible negative impacts from excessive fluoride exposure. Since fluoridation of water began in the 1940s, sources of fluoride have increased. Other sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and professionally applied fluoride products such as varnish and gels.
The EPA’s recent assessments of fluoride were undertaken in response to findings of the National Academies of Science (NAS), which in 2006 recommended that in developing regulatory standards for high levels of fluoride in drinking water, adverse health effects warrant consideration. Such evidence is the foundation for the recommended fluoride levels for public water systems to prevent tooth decay.
Opponents frequently cite the fact that public water fluoridation is not mandated in Europe. According to the American Dental Association (ADA), “European countries construct their own water quality regulations within the framework of the 1980 European Water Quality Directive…The Directive does not require or prohibit fluoridation, it merely requires that the fluoride concentration in water does not exceed the maximum permissible concentration.”
The ADA report goes on to state, “Water fluoridation is not practical in many European countries because of complex water systems with numerous water sources. As an alternative to water fluoridation, many European countries have opted for salt fluoridation, in addition to the use of fluoride toothpaste for topical benefits, as a means of bringing the protective benefits of fluoride to the public.”
According to the American Public Health Association, “the base of scientific evidence continues to support Fluoridation as a safe and effective public health measure. Reviews of the scientific literature on the health effects of fluoride over more than 20 years have been conducted by the National Health and Medical Research Council; National Research Council (NRC), USA (1993, 2006); World Health Organization (WHO) (1994, 1996, 2006); US Agency for Toxic Substances and Disease Registry (2003); International Programme on Chemical Safety; WHO (2002); Forum on Fluoridation, Ireland (2002); Medical Research Council, UK (2002); University of York, UK (2000); Institute of Medicine, USA (1999); Health Canada (1999); US Public Health Service (1991); and Kaminsky et al., New York State Department of Health (1990). All of these reviews have found fluoride to be safe and effective.”
Opponents have claimed potential toxicity from fluoridated water, but none of these claims has been supported by studies of scientific merit, which is reflected in a statement from the American Dental Association:
“The American Dental Association continues to endorse fluoridation of community water supplies as safe and effective for preventing tooth decay. This support has been the Association’s position since the policy was first adopted in 1950. The ADA’s policies regarding community water fluoridation are based on the overwhelming weight of peer-reviewed, credible scientific evidence. The ADA, along with state and local dental societies, continues to work with federal, state, and local agencies to increase the number of communities benefiting from water fluoridation.”
Financial considerations are a factor in many cases related to community debates about fluoridation. Some water systems and municipalities cite prohibitive costs and a lack of funds to implement or sustain the practice. At this time, financial considerations for fluoridation are not an issue for Greenville Water. The associated costs are budgeted, and the necessary systems are in place.
Regarding health concerns, Greenville Water believes there is a limited amount of peer-reviewed research and information to support fluoride opponents. Many of the sources cited often distort the facts and do not accurately represent the information.
In conclusion, Greenville Water supports fluoridation due to the preponderance of evidence in favor of the practice, including recommendations set forth by leading health agencies, non-governmental organizations and industry associations based on decades of science and research.
Resources on Fluoridation as Noted in Greenville Water July 2018 Position Statement
Centers for Disease Control and Prevention: