Letter to Public Water Suppliers Regarding CDCs Revised Fluoride Levels, May 2015

Table of Contents

  1. Letter to Public Water Suppliers
  2. Why has the DHHS lowered the optimal fluoride level?
  3. What is Dental Fluorosis?
  4. Is community water fluoridation still effective?
  5. Will this final recommendation affect how we operate in New York?
  6. Am I required to lower my fluoride target level? If so, when should I begin?
  7. Does this affect the maximum contaminant level (MCL) for fluoride?

Letter to Public Water Suppliers

May 28, 2015

Dear Public Water Supplier:

On April 27, 2015 the U.S. Department of Health and Human Services (DHHS) released the final Public Health Service (PHS) recommendation for the optimal fluoride level in drinking water to prevent tooth decay. The new recommendation is for a single level of 0.7 milligrams of fluoride per liter (parts per million, ppm) of water. It updates and replaces the previous recommended range (0.7 to 1.2 milligrams per liter) issued in 1962. This final recommendation by the PHS is being made after careful analysis of extensive scientific information and extensive input from the public and stakeholders.

In New York State, the long standing optimal target level for fluoride in water had been 1.0 ppm, with an operating control range of 0.8 to 1.2 ppm. With this latest recommendation from the DHHS and the PHS, the New York State Department of Health (NYS DOH) also recommends that community water systems target an optimal concentration of 0.7 mg/L (0.7 ppm). We understand that additional recommendations will be forthcoming from the DHHS about engineering, technical, and administrative aspects of community water fluoridation. These may include a suggested control range for water treatment facility operation. As more information becomes available we will pass this along as appropriate.

Prior to modifying the fluoride feed rate at your system to meet this new optimal concentration, please consult with your local health department. They will be able to work with you to ensure that there will not be any water chemistry changes that could impact the existing disinfection or corrosion control measures at your system.

The DHHS and New York State continue to support fluoridation as a significant and cost effective public health measure. Supporting documentation released by DHHS concurrently with the final PHS recommendation affirms community water fluoridation as a safe and effective practice to help prevent and control tooth decay. Currently about 13 million New York State residents receive the benefits of water that is either adjusted to optimal levels of fluoride or that contains naturally occurring fluoride at approximately optimal levels. The following links include supporting documentation about the final PHS recommendation and water fluoridation: http://www.cdc.gov/fluoridation; http://www.hhs.gov/news/press/2015pres/04/20150427a.html.

If you have any questions, please contact your local health department. You may also contact the Bureau of Dental Health at (518) 474-1961 or the Bureau of Water Supply Protection at (518) 402-7650.

Roger C. Sokol, PhD
Director, Bureau of Water Supply Protection

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

Why has the DHHS lowered the optimal fluoride level?

According to DHHS the change was recommended because Americans now have access to more sources of fluoride, such as toothpaste and mouth rinses, than they did when water fluoridation was first introduced in the United States. As a result, there has been an increase in fluorosis, which, in most cases, manifests as barely visible lacy white marking or spots on the tooth enamel. The new recommended level will maintain the protective decay prevention benefits of water fluoridation and reduce the occurrence of dental fluorosis.

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 community water fluoridation still effective?

Yes. According to U.S. Deputy Surgeon General Rear Admiral Boris D. Lushniak, M.D., M.P.H. "Community water fluoridation continues to reduce tooth decay in children and adults beyond that provided by using only toothpaste and other fluoride-containing products." Community water fluoridation has led to such dramatic declines in both the prevalence and severity of tooth decay that the Centers for Disease Control and Prevention (CDC) named it one of 10 great public health achievements of the 20th century. According to CDC, the return on investment (ROI) for community water fluoridation including productivity losses was $6.71 in small communities and $42.57 in large communities.

Will this final recommendation affect how we operate in New York?

Some community water systems had already begun targeting lower levels of fluoride than in the past after the DHHS issued its proposed recommendation in January 2011. These water systems likely targeted about 0.8 mg/L, the lower end of NYS DOH's previously recommended control range. Now that the DHHS has finalized its recommendation, the NYS DOH also recommends that fluoride-adjusting water systems target an optimal fluoride concentration of 0.7 mg/L (0.7 ppm). It is expected that the change will require only a minor reduction in chemical feed rates for most water systems. Water systems should discuss any proposed changes with their county health department or NYSDOH district office.

Am I required to lower my fluoride target level? If so, when should I begin?

Fluorideadjusting systems should target recommended optimal fluoride levels. Systems that make adjustments to target the new recommended optimal level should implement these as soon as practical in consultation with their local health department.

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

No it does not. While the US Environmental Protection Agency (EPA) has announced its intention to reconsider the federal MCL of 4.0 ppm, this process is not yet complete. 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.