Community Water Fluoridation

To maximize the oral health benefits of community water fluoridation, the U.S. Department of Health and Human Services (HHS) on April 27 standardized the recommended level of fluoride in drinking water nationally to a single level—0.7 milligrams per liter—rather than the range of 0.7 to 1.2 mg/L) that had been in place.

Q. What does the new HHS recommendation mean?

A: This adjustment to a single level has been pending for four years. It is a minimal modification that was expected and does not reflect any change in the accepted body of knowledge regarding the safety of fluoridation. 

Q: Why was the fluoride level adjusted?

A: HHS had previously recommended greater fluoridation in northern regions because research had shown that people in cooler northern climates drank slightly less water than those in warmer southern regions. Recent research from the Centers for Disease Control and Prevention shows that, with more people living and working in climate-controlled environments, regional differences in water consumption have become negligible. 

Another factor considered by HHS is that people today are exposed to more fluoride from other sources, such as beverages, toothpaste, and other oral health products. 

HHS first announced the draft recommendation in 2011. Since then, the agency has reviewed the results of new research from CDC’s National Health and Nutrition Examination Survey and examined thousands of comments submitted by the public. This accumulated information has informed implementation of the fluoridation adjustment.

The decision to adjust the recommended level of fluoride in drinking water incorporates the latest and most accurate research into the policy that benefits the oral health of Americans. Research will continue on the safety and effectiveness of water fluoridation, but after more than  70 years of studies and science, the body of knowledge indicates that fluoride in water adjusted to the optimal level is safe to drink and an effective tool in the fight against tooth decay. 

Q: What are the benefits of fluoride?

A: Water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay across the United States over the past 50 years. In fact, CDC named the fluoridation of drinking water one of 10 great public health achievements of the 20th century. 

Studies show that fluoridation reduces tooth decay by approximately 25 percent for people of all ages. Optimally fluoridated water is the single most cost-effective strategy that a community can use to improve the oral health of its residents.  

Q: Who is affected?

A: Many local water systems already fluoridate their water at the standardized recommended level (0.7 mg/L); 75 percent of Americans who use community water systems have access to this method of protection. CDC has resources on fluoridation levels across the country.