Letter to Public Water Suppliers Regarding CDCs Revised Fluoride Levels, January 2011

Table of Contents

  1. Letter to Public Water Suppliers
  2. Why is the DHHS proposing to lower the optimal fluoride level?
  3. What is Dental Fluorosis?
  4. Is supplemental fluoridation still effective?
  5. Will the proposed change affect how we operate in New York?
  6. Am I required to lower my fluoride target level now? If I want to do this, will it be accepted?
  7. Does this affect the maximum contaminant level (MCL) for fluoride?

Letter to Public Water Suppliers

January 19, 2011

Dear Public Water Supplier:

On January 7, 2011 the U.S. Department of Health and Human Services (DHHS) proposed a revision to the recommended optimal fluoride level in drinking water to help prevent tooth decay. It is important to know that this does not affect the value of fluoridation as a dental health benefit. The DHHS and New York State continue to support supplemental fluoridation as a significant and cost effective public health measure. Currently about 12.5 million New York State residents receive the benefits of water supplemented with optimal levels of fluoride.

The DHHS is proposing to lower the optimal fluoride target level to a single value of 0.7 milligrams per liter (parts per million, ppm) of fluoride. This would replace the current recommended range of 0.7 to 1.2 ppm fluoride and will be enacted only after reviewing comments submitted by the public and stakeholders. This comment period has begun, and is anticipated to close on February 14, 2011. The proposal would eliminate the range that includes higher target levels for northern states originally set to account for differences in per capita water consumption between warm and cold weather states. In New York State, the long standing optimal target level is 1.0 ppm, with an operating control range of 0.8 to 1.2 ppm.

The New York State Department of Health is evaluating the proposed change and may provide comments to DHHS during the public comment period. Attached is some information to help you understand what the DHHS proposal may mean for your water utility and your customers. Additional information is available online at:


Tooth decay is one of the most common childhood diseases and affects one in three children. In view of the enormous benefit of fluoride in reducing tooth decay for children and adults, the New York State Department of Health recommends that you continue to provide fluoridated water for your customers. When the DHHS proposal becomes final, the Department of Health will provide additional information and training to help public water suppliers implement the recommendations in a timely and effective manner.

If you have any questions at this time, please contact your Local Health Department office. You can also contact the Bureau of Dental Health, Julie Reuther at (518) 474-1961 or the Bureau of Water Supply Protection, John Helmeset at (518) 402-7650.

Rodger C. Sokol, PhD
Acting Director, Bureau of Water Supply Protection

Public Water Suppliers That Provide Fluoride Treatment May Also Want to Know:

Why is the DDHS proposing to lower the optimal fluoride level?

According to DHHS there are several reasons for this change, including an increase in dental fluorosis. Americans now have access to more sources of fluoride than when water fluoridation was first introduced in the United States in the 1950's. The use of fluoride in other products is increasing and now common. These include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals. This has led to a nation wide increase in mild dental fluorosis, especially for individuals using such products.

What is Dental Fluorosis?

Dental fluorosis is a change in the appearance of the tooth enamel. These changes can vary from barely noticeable white spots in mild forms to staining and pitting in the more severe forms. In fluoridated communities, the occurrence of severe dental fluorosis is extremely rare. This can also occur in areas not served by fluoridated water, and is often a result of toothpaste ingestion and inappropriate use of fluoride supplements.

Is supplemental fluoridation still effective?

Yes. The New York State Department of Health has long recognized the benefits of fluoride and the DHHS proposal does not change this. Water fluoridation is considered one of the ten greatest public health achievements and is the primary reason for the vast improvement in oral health among US residents. Research shows that every $1 invested in water fluoridation saves $38 in unnecessary dental treatments. The national average cost of filling one cavity is approximately $145, which is more than twice the cost of providing optimally fluoridated water to one person for a lifetime. Recent studies conducted by the Department of Health for New York State residents confirmed that providing fluoride in drinking water still prevents tooth decay and reduces health care expenditures substantially.

Will the proposed change affect how we operate in New York?

Not immediately, but when the proposed change becomes final it will likely affect fluoridating systems in New York State. If the change is adopted by DHHS, it is likely that New York State will follow suit and revise our recommended optimal fluoride level and the associated operating control range. It is expected that the proposed change will require only a minor reduction in chemical feed rates. One benefit of this would be to lower costs for public water systems that add supplemental fluoride.

Am I required to lower my fluoride target level now? If I want to do this, will it be accepted?

The change is not yet in effect and water suppliers that add fluoride are under no obligation to revise their target fluoride levels. Fluoridating systems are expected to maintain approved fluoride levels unless they have notified their Local Health Department of their intent to alter treatment and have received concurrence. In recognition of the DHHS determination that fluoridation at lower levels will provide effective dental health benefits, your Local Health Department office may consider approving a target level as low as 0.8 ppm, which is within New York State's long standing acceptable control range.

Does this affect the maximum contaminant level (MCL) for fluoride?

No it does not. While the US Environmental Protection Agency (EPA) also announced its intention to reconsider the federal MCL of 4.0 ppm, it will be many months before this process is completed. Meanwhile, New York will continue to enforce its own, lower MCL of 2.2 ppm. While we do not know what revised MCL the EPA may eventually adopt, it seems likely that it will not be much different than New York's current MCL.