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ADA supports proposed control range for fluoride in water

By Jennifer Garvin

Washington — The ADA supports the proposed operational control range of 0.6 mg/L to 1.0 mg/L for the target fluoride level of 0.7mg/L recommended by the U.S. Public Health Service.

In comments filed Oct. 11, the Association said the low end of the range, 0.6 mg/L, will “allow for the public to enjoy the decay preventive effect of fluoridated water” and the high end, 1.0 mg/L, will help reduce dental fluorosis. 

“This range is feasible and practical for water systems based on historical studies and most recently a 2017 study that looked at data from 34 states,” wrote ADA President Joseph P. Crowley and Executive Director Kathleen T. O’Loughlin, citing the American Water Works Association’s 2017 study.

“We appreciate that even the best managed water system cannot maintain a perfect level of 0.7 mg/L 24/7/365.  The operational control range of 0.4 mg/L allows for maintenance of a therapeutic average over time.”

The ADA said that some water systems have “mistakenly interpreted” that the U.S. Public Health Service target of 0.7 mg/L is the highest level of fluoride to be allowed in drinking water at any given time but noted, these systems have set their target level at 0.5/L as a matter of preference.

“The finalization of this recommended operational control range will help to clarify expectations of fluoride level management and will aid in states setting regulations for the management of their water systems,” Drs. Crowley and O’Loughlin said.

With the finalization of the recommended operational control range, the ADA leaders said they look forward to the Centers for Disease Control and Prevention revising the 1995 Engineering and Administrative Recommendation for Water Fluoridation as well as increased educational opportunities for water system personnel and regulators.

“Fluoridation of community water supplies is the single most effective public health measure to prevent tooth decay,” Drs. Crowley and O’Loughlin concluded. “The ADA continues efforts to expand access to fluoridation as it works to meet the Healthy People 2020 goal of providing fluoridated water to 79.6 percent of the U.S. population on public water systems.”

For more information on community water fluoridation, visit