Water Fluoridation 

Fluoride is a naturally occurring mineral that is an effective way to prevent and protect teeth from tooth decay.  Fluoride stops or can even reverse the tooth decay process, keeping tooth enamel strong for both children and adults. All drinking water naturally contains some fluoride.  Community water fluoridation is the process of adjusting the naturally occurring fluoride level to the optimum level for preventing tooth decay.  In 2018,  more than 22 million people in California or 58.3% of the population served by community water systems received fluoridated water. 

Community water fluoridation has the endorsement of every major health organization in the United States and many other countries, as well as every Surgeon General for the past 50 years. The Centers for Disease Control and Prevention (CDC) has named community water fluoridation as one of 10 great public health achievements of the 20th century. 

The concentration of fluoride in community drinking water is maintained at 0.7 parts per million and represents no health hazards. An economic analysis found that individuals in communities that fluoridate water save an average of $32 per person by avoiding treatment for tooth decay. The Community Preventive Services Task Force (CPSTF) recommends community water fluoridation to reduce tooth decay.  

Guidelines and Literature

• The Community Preventive Services Task Force (CPSTF) recommends community water fluoridation to reduce tooth decay. The CPSTF is an independent, nonfederal panel of public health and prevention experts. It provides evidence-based findings and recommendations about community preventive services, programs, and other interventions aimed at improving population health. These findings are listed on The Community Guide.
  

• U.S. Department of Health and Human Services Recommendation: In 2015, the U.S. Department of Health and Human Services published recommendation for fluoride concentration in drinking water for the prevention of dental caries. 

• Statement on the Evidence Supporting the Safety and Effectiveness of Community Water Fluoridation (PDF): The Centers for Disease Control and Prevention (CDC) and Department of Health and Human Services (DHHS) published this statement on the evidence regarding the safety and benefits of community water fluoridation. 
  

• Engineering and Administrative Recommendations for Water Fluoridation: This report delineates specific recommendations related to the engineering aspects of water fluoridation, including administration, monitoring and surveillance, technical requirements, and safety procedures. The recommendations address water fluoridation for both community public water supply systems and school public water supply systems.
  

Resources

• California Fluoridation Manual (PDF): This manual provides guidance for local health jurisdictions in California in the promotion of community water fluoridation for oral health based on generally accepted, peer-reviewed, scientific evidence and experience.
  

• Centers for Disease Control and Prevention: The CDC provides information on the benefits of water fluoridation, as well as recommendations and guidance for water engineers and operators. This webpage also outlines scientific statements, statements of support from federal, state, and local agencies, basic information and safety information for everyone, and information for professionals such as the water fluoridation training program. 
  

• American Dental Association’s Fluoridation Facts: Information from over 350 scientific references in an easy-to-use question and answer format on the topics of effectiveness, safety, practice, and cost-effectiveness of fluoridation.

• California Environmental Protection Agency State Water Resources Control Board: Overview of fluoridation by public water systems, including background information on fluoridation data, most recent and historic fluoridation data, and fluoridation management and reporting.
  

• Association of State and Territorial Dental Directors (ASTDD) Best Practice Approach (PDF): Community Water Fluoridation: Describes strategies, assesses the strength of evidence on the effectiveness of the strategies, and uses practice examples to illustrate successful/innovative implementation.  
  

• CDC’s Community Water Fluoridation Fact Sheet (PDF): An evidence-based fact sheet outlining why community water fluoridation is safe, effective, reduces disparities, saves money, and is a public health achievement.
  

• I Like My Teeth: A Campaign for Dental Health by the AAP provides information on fluoridated water to ensure that people of all ages have access to the most effective, affordable, and equitable way to protect teeth from decay.​​