U.S. Wants to Reduce Fluoride in Drinking Water
Officials Call for Lower Fluoride Levels to Prevent Dental Problems Due to Excess Fluoride
By Kathleen Doheny
WebMD Health News
Reviewed by Laura J. Martin, MD
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Jan. 7, 2011 --The recommended level of fluoride in U.S. drinking water supplies should be lowered to prevent dental problems, according to a joint announcement today by officials from the Department of Health and Human Services (HHS) and the Environmental Protection Agency (EPA).

The HHS is recommending that water supplies contain 0.7 milligrams of fluoride per liter of water, replacing the current recommended range of 0.7 to 1.2 milligrams.

That recommendation won't go into effect immediately. It will be published in the Federal Register, followed by a period of comment from the public and others for 30 days.

In other action today, the EPA said it will review the maximum amount of fluoride that will be allowed in drinking water, looking at the most recent research.

''Today's announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one's lifetime," says  HHS Assistant Secretary for Health Howard K. Koh, MD, MPH, in a news release.

The HHS recommendation comes in the wake of data finding that excess fluoride consumption during the tooth-forming years in children age 8 and younger may lead to dental fluorosis, a condition in which teeth can become streaked or spotty due to excess fluoride.
Fluorosis Cases

The recommendation is a proposed recommendation, says J. Nadine Gracia, MD, chief medical officer in the office of the assistant secretary for health at HHS. "These guidelines are voluntary guidelines and the decisions [about water fluoridation] are made by state and local municipalities," she tells WebMD.

Even if the new proposed recommendation goes into place, she says, municipalities may choose not to follow it.

"What we are proposing is based on the most up to date science," Gracia says. She estimates a final recommendation could be issued by spring of 2011.

Meanwhile, there's no reason to panic, says Matthew Messina, DDS, a Cleveland dentist and spokesman for the American Dental Association.

''Fluorosis in its most severe form [involves] tooth enamel becoming more opaque, so teeth look splotchy," he tells WebMD. "The vast majority of fluorosis cases are mild or moderate and you are not going to see it unless you are a dentist."

In the severe form, which is rare, according to HHS, there can be staining and pitting of the tooth surface.

The new HHS recommendation, Messina says, makes sense because in recent years the population has gotten more fluoride from other sources, such as toothpaste and mouthwashes.

At appropriate levels, he says, fluoride remains an effective cavity-fighter, Messina says. "We have a whole generation of kids who have almost no decay," he tells WebMD. "What a gift."

Meanwhile, scientists at the Environmental Working Group applaud the new recommendation but call it overdue. "It marks the government's belated recognition that many Americans are at risk from excess fluoride in drinking water and other sources," Jane Houlihan, EWG's  senior vice president for research, told reporters during a telephone briefing.

Sources of Fluoride Exposure

Fluoridation was introduced into U.S. drinking water supplies in 1945. By 2008, 64% of the U.S. population had access to community water fluoridation, says the HHS.

But fluoride is now found not only in toothpaste and drinking water, according to HHS, but also in mouth rinses, prescription fluoride supplements, and fluoride treatments applied in dental offices. It's found in infant formulas prepared with fluoridated water and in other beverages.

But fluoride toothpaste along with fluoride in drinking water do deserve most of the credit for the decline in tooth decay in recent decades in the U.S., HHS officials emphasize.

As the fluoride intake has increased, however, so has the number of children with dental fluorosis.

According to the HHS, national surveys conducted from 1999 to 2004 show an upswing in the prevalence of the condition, although mostly in very mild or mild forms.

The condition was found more in younger people than older people, with about 41% of teens age 12 to 15 affected, the surveys found.

The effects of excess fluoride aren't just a dental concern, says Houlihan.

Some data suggest that excess fluoride may also be linked with skeletal bone damage, she says, and possibly hormone disruption. "It has also been deemed an emerging neurotoxin."

As a result, she suggests the entire family, not just those with children, may want to assess their fluoride exposure.
How to Reduce Fluoride Exposure

What can those who want to reduce fluoride exposure now do?

"Bottled water is not the answer," Houlihan says. "It often also contains fluoride." (If it's not listed on the label, you can call the manufacturer and ask what the level is.)

Among the other steps she suggests to reduce fluoride exposure:

    * Learn how much fluoride is in your tap water. Call your local water municipality. The levels vary from city to city.
    * If it's above 0.7 milligrams per liter, the new proposed recommendation, you could consider filtering your water.
    * For infants on formula, consider using fluoride-free water to reconstitute their formula.