Fluoridation by Public Water Systems
Last Update: June 12, 2008
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 Current Issues
Concerns have been raised over the use of fluoridated drinking water about its use in infant formula, and about the possible risks of bone cancer. For more information on these topics, 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. (also, 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)
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.
Fluoride Levels in Public Water Systems
CDPH receives water system fluoride monitoring results from fluoridating water systems each month. Currently, natural fluoridated water systems and systems that purchase fluoridated water (but do not add fluoride themselves) are not required to monitor and report the fluoride levels in their water distribution systems to CDPH. CDPH requests these water systems to monitor and report this information on a voluntary basis.
CDPH maintains a table (last updated December 6, 2007) that identifies public water systems in California that fluoridate (Excel)
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.
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 fileis also available.
2. Reeve, T.G., Water Fluoridation, A Manual for Engineers and Technicians (PDF), 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.