This month the EPA and HHS proposed a change that would lower the recommended level of fluoride in drinking water. A small amount of fluoride is good in drinking water because it prevents tooth decay. The idea is to maximize the health benefits of water fluoridation by continuing to prevent tooth decay while reducing the possibility of too much fluoride exposure for children. There are several reasons for the recent change, including new sources of fluoride, like toothpaste, mouth-rinses, prescription fluoride supplements and fluoride applied by health professionals. Water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay over the last few decades.
Water fluoridation is the single most cost-effective strategy that a community can take to improve the oral health of its residents. Research shows that every $1 invested in water fluoridation saves $38 in unnecessary costs for dental treatment. The national average cost of filling one cavity – $145, is more than twice the cost of providing optimally fluoridated water to an individual for a lifetime!
Fluoride at some level is naturally present in water and food. In Arizona, it is not uncommon to have naturally occurring fluoride at 0.2 to 0.5 milligrams per liter of water (mg/L), so all Arizonans get some fluoride. Fluoridation of community drinking water is the adjustment of the existing natural fluoride concentration in drinking water to a level that prevents tooth decay. Currently, ten Arizona communities (Bisbee, Chandler, Gilbert, Glendale, Guadalupe, Mesa, Peoria, Phoenix, Tempe and Yuma) fluoridate their water supply to the optimal level.
The long recognized benefits of community water fluoridation way outweigh any risk, the only known risk is mild enamel discoloration from too much fluoride (from multiple sources). The discoloration has no clinical significance other than that the individual is more resistant to tooth decay.
We recommend that people brush at least twice a day with fluoride toothpaste, when you get up in the morning and before going to bed. For little kids, we recommend monitoring the amount of fluoride during tooth brushing by supervising and discouraging swallowing toothpaste and teaching kids to only place a pea-size amount of toothpaste on the toothbrush. You can read more about community water fluoridation on the CDC’s fluoride website and on EPA’s fluoride website.
A Federal Register notice describing the rationale for the proposed change is available for review. Comments on the proposed change will be accepted for 30 days after publication in the Federal Register, and can be sent to [email protected]. The final guidance for community water fluoridation is expected by spring 2011.