Welcome to the State of California 

Fluoridation by Public Water Systems

Last Update: November 21, 2013  

Is my water supply fluoridated? 

(Click on the link above for a list of systems that provide fluoridated water or have naturally-occurring fluoride at relatively high levels)  

Note:  Information on your drinking water quality (including fluoride levels) is available in the annual Consumer Confidence Report issued by your water provider. 
Contact your water system for a copy of the current report.   

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Background Information on Fluoridation Data

CDPH receives water system fluoride monitoring results from fluoridating water systems each month.  Naturally-fluoridated water systems and systems that purchase fluoridated water are not required to monitor and report the fluoride levels in their water distribution system.  CDPH requests these water systems to monitor and report this information on a voluntary basis.

CDPH maintains a table that identifies public water systems in California that fluoridate their drinking water supplies, are naturally fluoridated, or receive purchased fluoridated water.  The table lists the average monthly fluoride levels in those systems, if the data are available.  Ranges of fluoride levels are provided where monthly data are not available.  Fluoridation level information is also available in Consumer Confidence Reports, provided to you each year by your public water system, or you may contact the public water system directly for the information. 

2011 Fluoridation Data 

Additional Historical Fluoridation Data 

Fluoridation Update – January 14, 2011

Information for Public Water Systems that provide fluoridated water in California.  For a copy of this notice as a PDF file, click here (PDF)Opens in new window..

You may be aware that on January 7, 2011, the U.S. Department of Health and Human Services Agency (HHS) announced a proposal recommending that water systems practicing fluoridation adjust their fluoride content to 0.7 mg/L (parts per million), as opposed to the previous temperature-dependent optimal levels ranging from 0.7 mg/L to 1.2 mg/L.  For more information, please note the following:

1.   The announcement regarding the proposed change was published in the Federal Register on January 13, 2011 (FR Vol. 76, No. 9, beginning on page 2384).  You may view the publication at http://edocket.access.gpo.gov/2011/pdf/2011-637.pdf .  HHS will accept comments from the public and stakeholders on the proposed recommendation for 30 days, beginning January 13, at CWFcomments@cdc.gov.  The announcement also includes a mailing address.

2.  The following information is available via the Centers for Disease Control and Prevention’s (CDC’s) Website at: http://www.cdc.gov/fluoridation/ :

  • U.S. Environmental Protection Agency (EPA) and HHS – January 7, 2011, Joint Press Release
  • Centers for Disease Control and Prevention (CDC) - Community Water Fluoridation:  Questions and Answers

3.   HHS also includes a summary of the announcement and a link the Federal Register publication here:  http://www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html.

In view of this recent development, CDPH offers the following information and recommendations for public water systems:

  • There is no change regarding federal health officials’ strong and long-standing support regarding the value of fluoridation of drinking water.  The proposed change in the optimal levels is a result recent scientific evidence in four areas on the subject:  1) the effectiveness of fluoridation on dental caries prevention and control for all age groups, 2) the availability of fluoride through other sources, 3) trends in the prevalence and severity of dental fluorosis, and 4) fluid intake by children across various ambient air temperatures. 
  • The January 13, 2011, announcement regarding fluoride levels in water is aimed at minimizing the chance that children develop dental fluorosis, a typically mild condition that causes a discoloration of teeth.
  • The CDPH Drinking Water Program and the Office of Oral Health are reviewing the proposed change and will provide comments to HHS.
  • California water systems practicing fluoridation are still required to comply with state fluoridation regulations (Title 22, Chapter 15, Article 4.1, Sections 64433 - 64434, CCR).  Therefore, it is important to continue fluoridation in accordance with your CDPH public water supply permit and state regulations.  However, until further notice, CDPH recommends that water systems practicing fluoridation operate their fluoridation system toward the lower end of their range prescribed in their permit and/or Section 644332.2, yet remain compliant with the requirements in Section 64433.3(b)
  • Please contact your local CDPH District Office if you have any questions regarding the addition of fluoride to the water supply or the maintenance of optimum fluoride concentrations in the water delivered to your customers.
  • Please note that tooth decay is the number one chronic condition for children.  It may result in pain, poor nutrition, and dysfunctional speech, as well as a lack of concentration, poor appearance, low self-esteem and absenteeism. Optimally fluoridated water is the single most cost-effective strategy that a community can take to improve the oral health of its residents.  Studies consistently show that water fluoridation reduces tooth decay by 20 to 40 percent.  The recommendations proposed by HHS resulted from an updated review of the various current sources of fluoride, including water fluoridation. Providing the right level of fluoride protects the dental health of people of all ages, not just children.  

Fluoridation

Fluoride is one of the most plentiful elements on earth, and occurs naturally in water supplies throughout California and elsewhere. When fluoride is present in drinking water at optimal levels, it has been shown to promote oral health by preventing tooth decay. Water systems are considered naturally fluoridated when the natural level of fluoride is greater than 0.7 parts per million (ppm). When a water system adjusts the level of fluoride to 0.7–1.2 ppm it is referred to as water fluoridation.  Today, about 67 percent of the U.S. population on public water supplies has access to fluoridated water.  Additional information on water fluoridation and oral health is available at the following locations:

Fluoridation and Infant Formula 

Concerns have been raised about the use of fluoridated drinking water in infant formula.  For more information on this topic, click on the links below.

Fluoridation Management

CDPH oversees the fluoridation of public water systems in California through two of its organizations:

  • the Drinking Water Program of the Division of Drinking Water and Environmental Management (DDWEM), which provides technical and engineering expertise to public water systems for permitting and operating fluoridation systems.  DDWEM is the regulatory agency and responsible for assuring fluoridation systems are optimally fluoridating the water supplies to provide dental health benefits.
  • the Office of Oral Health (OOH) within the Chronic Disease Control Branch, provides scientific, technical, and health related expertise to communities interested in fluoridating their drinking water supplies.  OOH is also responsible for securing funds to purchase and install fluoridation equipment for public water systems.

California Water Fluoridation Standards

CDPH's precursor--the Department of Health Services--adopted regulations in 1998 that establish standards for the addition of fluoride to drinking water.  The regulations are located in Title 22 of the California Code of Regulations (CCR), Sections 64433, et. seq.  (see the Drinking Water "Lawbook"). The standards require fluoridating public water systems to maintain fluoride levels within the control range that has been established for its climate. This is based on the concept that people in cooler climates typically drink less water per day than people in warmer climates.  Therefore, in coolers areas, a higher fluoride level is required to provide the same dental health benefits.  The regulations include the table below listing the optimal fluoride levels and the fluoride control ranges for a given average high temperature range.

 

Optimal Fluoride Levels 
(22 CCR §64433.2, Table 64433.2-A)   

Average Daily 
Air Temperature 
(F°)

 

Optimal Fluoride 
Level (ppm)

Control Range 
(ppm)

 

50.0 to 53.7 

1.2 

1.1 to 1.7

53.8 to 58.3 

1.1 

1.0 to 1.6

58.4 to 63.8

1.0 

0.9 to 1.5

63.9 to 70.6

0.9 

0.8 to 1.4

70.7 to 79.2

0.8 

0.7 to 1.3 

79.3 to 90.5 

0.7

0.6 to 1.2

 

Fluoridation Monitoring and Reporting

CDPH is responsible for regulating the activities of fluoridating public water systems in California.  This responsibility includes assuring water fluoridation is conducted in a safe and effective manner.  Public water systems must obtain a permit from the CDPH to fluoridate their drinking water supplies and must monitor the fluoride levels in their water system on a daily basis.  The operational and monitoring information is also reported to the CDPH.  For copies of the reporting requirements and reporting forms, click on the links below. 

   

 

 

Required Reporting

Where there are two,

choose the correct report form to use

 

Monthly Distribution Monitoring 

Monthly Distribution Monitoring – Single Fluoridation Treatment System

OR

Monthly Distribution Monitoring – Two or more Fluoridation Treatment Systems   

Year-to-Date Distribution Summary 

Year-to-Date Distribution– All Fluoridation Treatment Systems 

 

 

Monthly Treatment Summary  

Monthly Treatment Monitoring

OR

Monthly Treatment Monitoring – SATURATOR Systems only  

Yearly Treatment Summary 

Yearly Treatment Summary Report – All Fluoridation Treatment Systems 

 

Optimal Fluoride Control Range Calculation

(Done Annually) 

Optimal Fluoride Control Range Worksheet (PDF)

Annual Cost Summary 

Annual Cost Summary Report – All Fluoridation

Treatment Systems 

Voluntary Fluoridation

 (Only for systems that purchase fluoridated water but do not supplement with additional fluoride) 

Voluntary Distribution Monthly Monitoring Report

 AND

Voluntary Year-To-Date Distribution Monitoring Report 

 

  

References for Fluoridation Treatment Facility Design

Three references often used for design purposes are from the Centers for Disease Control and Prevention (CDC) and the American Water Works Association (AWWA):

1. Engineering and Administrative Recommendations for Water Fluoridation, 1995. MMWR, September 29, 1995;44(RR–13):1–40.  A PDF fileOpens new browser window.is also available. 

2. Reeve, T.G.,  Water Fluoridation, A Manual for Engineers and Technicians (PDF)Opens new browser window., Atlanta, US Department of Health and Human Services, Public Health Service, CDC, 1986.

3. Water Fluoridation Principals and Practices, William C. Lauer, Fredrick Rubel, Jr., 5th ed., (AWWA manual M4).

Contact Information

For detailed information on your drinking water supply, please contact your local water supplier.  A contact number for your water supplier should be included on your water bill.

For further information concerning

  • fluoride and oral health, please contact OOH at (916) 552-9947.
  • fluoridation, please contact Mark Bartson at DDWEM at (916) 449-5600 or by email at Mark.Bartson@cdph.ca.gov.

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*NOTE: Links to non-Government organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDPH or the State of California, and none should be inferred. CDPH is not responsible for the content of the individual organization Web pages found at this link. 

 
 
Last modified on: 11/21/2013 1:28 PM