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ADA supports new government fluoride recommendation

April 27, 2015

By Craig Palmer

Washington – The Association commended the U.S. Public Health Service for issuing a final recommendation April 27 for the optimal level of fluoride for community water systems and said the ADA supports the new target. The recommended ratio of fluoride to water is newly calibrated at 0.7 milligrams of fluoride per liter of water from what was a recommended optimal range.

The newly recommended ratio results from years of scientifically rigorous analysis of the amount of fluoride people receive from all sources, the Association said. The new recommendation will help ensure an effective level of fluoride to reduce the incidence of tooth decay while minimizing the risk of cosmetic fluorosis in the general population, the ADA said.

"Water fluoridation is effective and safe," Dr. Maxine Feinberg, ADA president, said in a media statement posted at ADA.org. "It has now been 70 years since Grand Rapids, Mich., became the first U.S. city to begin adding fluoride to its water system. Since then, decades of studies and the experience of tens of millions of people have affirmed that water fluoridation helps prevent cavities in both children and adults. Today's [HHS] announcement is based on solid science."

"This is an important public health measure," U.S. Deputy Surgeon General Rear Admiral Boris Lushniak, M.D., told reporters in a pre-release media briefing. It replaces and updates the recommended range of 0.7 to 1.2 milligrams per liter, which was issued in 1962. It is a recommendation and not a regulation, Dr. Lushniak said. The new recommended level will maintain the protective decay prevention benefits of water fluoridation and reduce the occurrence of dental fluorosis, the Department of Health and Human Services said in a news release.

"While additional sources of fluoride are more widely used that they were in 1962, the need for community water fluoridation still continues," Dr. Lushniak said. "Community water fluoridation continues to reduce tooth decay in children and adults beyond that provided by using only toothpaste and other fluoride-containing products."

Dr. Kathleen O'Loughlin, ADA executive director, participated in the pre-release media briefing, telling reporters that the Association "applauds" the new measure and the U.S. Public Health Service for "this tremendous success story" of community water fluoridation. Dr. O'Loughlin urged extension of water fluoridation to communities not currently fluoridated and maintenance "of what we have" going forward.

The USPHS Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries was published in Public Health Reports.

The HHS Centers for Disease Control and Prevention issued a Statement on the Evidence Supporting the Safety and Effectiveness of Community Water Fluoridation, which is posted in a PDF version at cdc.gov. The statement cited evidence that community water fluoridation is "an effective intervention," "a cost-saving intervention" and "a safe intervention."

"The CDC leads national efforts to improve oral health by using proven strategies such as community water fluoridation and school-based dental sealant programs that prevent oral diseases," said the statement signed by Dr. Katherine Weno, director of the agency's Division of Oral Health. "Because of its contribution to the dramatic decline in tooth decay over the past 70 years, CDC named community water fluoridation 1 of 10 great public health achievements of the 20th century."

The CDC received 19,000 comments on the recommendation after its release four years ago for public comment. Health officials said that some 700 were "unique" comments and the rest echoed those comments. "We did due diligence" in reviewing and responding to public comments, said Dr. Lushniak. But there were no changes made in the final recommendation on the basis of those comments, he said.  

"Dentistry is proud of its record in preventing disease," said Dr. Feinberg, ADA president. "The ADA and other health organizations in the U.S. and around the world understand that community water fluoridation is one of the safest, most effective and least costly ways to do so.

"The recommended level is now officially set at 0.7 parts per million, but the health benefits have not changed and neither has the ADA's commitment to bringing optimally fluoridated water to the greatest number of people," Dr. Feinberg said.

Extending the availability of optimally fluoridated water is one of the Association's eight Action for Dental Health initiatives. The ADA and state dental societies have set a goal to bring fluoridated water to 80 percent of the population served by public water systems by 2020, using a baseline level of 74 percent in 2010.

The Association urges communities to continue fluoridating water at levels the government recommends. People in what the Association said is a "dwindling number of non-fluoridated communities should help educate their state and local officials about the need to fluoridate," the ADA statement said. "They should also talk to their dentists about other ways to ensure that they are receiving the right amount of fluoride, through such means as supplements or topical applications."

Visit ADA.org for more information on the recommendation and for more ADA resources on fluoride.