Fluoride & Community Water

Fluoride Facts in Butte County

• Fluoride is a naturally occurring mineral that already exists in almost every water supply. Most water sources do not have high levels of naturally occurring fluoride which is enough to protect our teeth. But some sources do, like some groundwater and natural springs.
• Fluoride is recommended for oral health because it strengthens tooth enamel and makes teeth more resilient to decay (cavities).
• You can get fluoride in different forms:
  • Topical fluoride includes: toothpaste, foams, gels, mouthwashes, and fluoride varnish
  • Systemic fluoride (ingested) includes fluoridated water and dietary fluoride supplements (drops, tablets or lozenges) prescribed by a doctor or dentist. Systemic fluoride help develop teeth before they emerge.
• The optimal water fluoridation level currently recommended for a community water supply is 0.7 parts per million (ppm) - or 0.7 milligrams per liter. Community water fluoridation is the process of adjusting the amount of fluoride found in water for the purpose of preventing tooth decay for everyone in that community regardless of age, education or income level.
  • Fluoride may be added to community water supplies where the natural level is too low to be effective in preventing tooth decay (or cavities). For example, if the naturally occurring fluoride level is 0.2 ppm, an ideal adjustment would be to add 0.5 ppm to the water.
  • In some places, the naturally occurring fluoride in the water may be more than the recommended level of 0.7 ppm. So that means no extra fluoride should be added.
  • Each individual community decides if they want to fluoridate their water by adjusting the fluoride level - for example, sometimes a city council may decide this.
• Children ages 6 months and older who are at high risk of cavities and who do not live in a community with fluoridated water would benefit from prescribed fluoride supplements. However, children who drink optimally fluoridated water should NOT receive prescribed fluoride supplements (see Dental Fluorosis below).
• Call your water company or look at your water bill to find out if you have added fluoride to your water.
• If you have well water, wells should be tested comprehensively at least once every 3 years for contaminants as well as for fluoride levels (recommended by EPA for every 3 years).
• Water is the healthiest beverage to drink. But even if you have optimally fluoridated water and you don't drink tap water, you are probably still getting some benefits if you cook with that water. For example, rice, pasta, soups, and stews.

Dental Fluorosis

Fluoride provides us with oral health benefits but we need it in the right amount. If children do ingest (swallow) too much fluoride over a long period of time while teeth are developing - for example, through consuming fluoridated water, supplements or regularly swallowing toothpaste or mouth rinse - they may get a condition called dental fluorosis where white spots appear on the teeth. Many studies have shown that mild to moderate fluorosis is not harmful to overall health. Only children aged 8 years and younger might get dental fluorosis because this is when their permanent teeth are developing under the gums; children older than 8 years, adolescents, and adults cannot develop dental fluorosis.

People anywhere can have fluorosis, even in communities that do not add fluoride to the water. Dental fluorosis is not "fluoride poisoning." Mild fluorosis is only cosmetic and people with mild to moderate fluorosis have less tooth decay or cavities. On the other hand, severe dental fluorosis with "pitting" may increase cavities. Less than 1% of people in the U.S. have severe dental fluorosis (browning and pitting of the teeth).

Prevent Dental Fluorosis - Do not let children swallow fluoride mouth rinse and fluoride toothpaste.

You can prevent dental fluorosis by supervising your child when brushing and following the guidelines on how much toothpaste to use:

• Use a smear (or rice-grain size) for children 2 years and under
• Use a pea-sized amount for children ages 3 to 6 years old

The amount of fluoride in toothpaste is extremely higher than the amount recommended for drinking water. Although children's toothpaste may taste good, it is not meant to be swallowed; just like chewing gum has yummy flavors but it is not meant to be swallowed. Toothpaste does have a warning on the label because, like calcium and vitamin D, it is possible to get too much fluoride. Warning labels appear on many other products too, even vitamins!

Children should not use fluoride mouth rinse until they are fully able to spit which is usually around 6 years of age.

As a general rule of thumb, if it is unknown whether the water you use for drinking and cooking has the optimal fluoride level in it, fluoride supplements should not be used. This is something that should be discussed with the child's doctor and dentist. Some families may live in areas where the water has higher amounts of naturally occurring fluoride than what is recommended (possibly some private wells).

Remember, consuming water with high levels of naturally occurring fluoride, or swallowing toothpaste and mouth rinses for long periods of time are also causes of dental fluorosis. Dental fluorosis is not just only caused by community water fluoridation.

Community Water Fluoridation

Community water fluoridation is the process of adjusting the amount of fluoride found in water for the purpose of preventing tooth decay for everyone in that community regardless of age, education or income level. Tooth decay is the Number 1 chronic disease among children and adolescents in the U.S. And because tooth decay is even more common in people with lower income levels, this public health measure is a step in the right direction to achieve the goal of health equity. Not everyone can get dental care or practice good oral hygiene.

Adjusting or adding fluoride to water is also similar to fortifying foods with vitamins and minerals. For example, orange juice may have added calcium, milk may have added vitamin D, bread may have added iron and folic acid, and salt has added iodine. The current recommendation of 0.7 ppm (or 0.7 milligrams per liter) has taken into account having enough fluoride to prevent tooth decay while still limiting the risk of children developing dental fluorosis.

As of 2019, California Water Boards reported that two public water systems in Butte County were fully fluoridated: the Cal-Water Service Company in Oroville, which covers only parts of Oroville, and the City of Gridley. For updated information, please visit the California Water Board.

Community water fluoridation is considered one of the 10 greatest public health achievements of the 20th century. Community water fluoridation is recommended by nearly all public health, medical, and dental organizations. It is recommended by the American Dental Association, American Academy of Pediatrics, U.S. Public Health Service, and World Health Organization.

Community water fluoridation helps promote better oral health but is also very cost-effective! Prevention of tooth decay saves money for both families and the health care system.

• Grand Rapids, Michigan, was the first city in the U.S. to fluoridate its water in 1945. By the early 1950s, results were clear: Compared to school children from nearby areas that did not fluoridate their water, children in Grand Rapids had fewer cavities.
• In New York (2010), Medicaid enrollees in counties where fluoridation was rare needed 33.4% more fillings, root canals, and extractions than those in counties where there was fluoridated water.
• A study of Alaskan children (2011) showed that kids living in non-fluoridated areas had a 32% higher rate of decayed, missing or filled teeth than kids in fluoridated communities
• Teenagers living in non-fluoridated areas of Ireland had an average rate of decay or related dental problems that was 52% higher than those living in fluoridated communities.
• The U.S. Task Force on Community Preventive Services, a blue-ribbon panel of experts, examined 21 studies and concluded (2000) that fluoridated water reduces tooth decay by a median rate of 29% among children of ages 4 to 17.
• The cost to fluoridate water for one person for his / her life can be less than the cost of filling one tooth.
• Scientists who testified before Congress in 1995 estimated that national savings from water fluoridation totaled $3.84 billion each year.
• A Texas study confirmed that the state saved $24 per child, per year in Medicaid expenditures for children because of the cavities that were prevented by drinking fluoridated water.

Fluoride in the right amount is good for our teeth because it helps reduce and prevent tooth decay (also known as cavities) by making tooth enamel stronger-it doesn't eliminate tooth decay completely.

Efficacy & Safety in Community Water Fluoridation in Reducing Tooth Decay

Yes, water fluoridation levels are regulated to keep us safe. Most cases of dental fluorosis (see above) are mild or moderate and are not harmful to overall health. There is a possibility for children under 8 years old to develop this cosmetic condition if they are swallowing too much fluoride over a long period of time; remember, it could be any source of fluoride, not just fluoridated water from the community water supply. Make sure to supervise children and all of their oral hygiene activities.

Other than the possibility of developing dental fluorosis, there are no harmful unwanted side effects such as lowered IQ scores or cancer, and it is not shown to be toxic to the environment even in amounts higher than the current recommended 0.7 ppm for drinking. In fact, ocean water has more naturally occurring fluoride than the 0.7 ppm that is currently recommended.