Pennwell web 400 207

Community water fluoridation

May 1, 2011
Preventive dental care hit the media recently with the announcement of proposed fluoridation recommendations.

by Christine Nathe, RDH, MS
[email protected]

Preventive dental care hit the media recently with the announcement of proposed fluoridation recommendations. Some of your patients may have already inquired about the announcements; I know mine have. Realizing that community water fluoridation was one of the 10 public health achievements of the 20th century, the importance of fluoride in our water cannot be overstated. Currently, 69.2% of the U.S. population on public water supply systems receives fluoridated water. See map.1

Percentage of state public water systems receiving fluoridated water in 2006. Source: Centers for Disease Control and Prevention

The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) recently proposed new standards and guidelines on fluoride in drinking water. The HHS is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and the EPA is initiating a review of the maximum amount of fluoride allowed in drinking water. The proposed recommendation is for 0.7 milligrams of fluoride per liter of water to replace the current recommended range of 0.7 to 1.2 milligrams. This updated recommendation is based on recent EPA and HHS scientific reviews that suggest ways to prevent tooth decay while decreasing the effects of dental fluorosis in the population.

There are several reasons for the changes, including more sources of fluoride than were available when community water fluoridation was introduced in the 1940s. Other common sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and professionally applied fluoride. Community water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the U.S. over the past several decades.2

These proposed recommendations were published in the Federal Register, and HHS will be accepting comments from the public for 30 days. They are expected to publish final guidelines by spring of 2012. As a dental hygienist, it is a great idea to take a look. We need to be informed for our patients.

I have included recommendations from CDC that are great for educating interested patients or community groups. (See box)

CDC Recommendations


There is some potential for developing dental fluorosis when children consume fluoride during the time when teeth are forming under the gums (birth through age 8). To help prevent both tooth decay and dental fluorosis, the Centers for Disease Control and Prevention (CDC) recommends the following:

For parents: Children younger than 6 years have a poor swallowing reflex and tend to swallow much of the toothpaste on their brush. Toothpaste that is swallowed (but not toothpaste that is spit out) contributes to a child's total fluoride intake. Therefore:

As soon as the first tooth appears, begin cleaning by brushing without toothpaste with a small, soft-bristled toothbrush and plain water after each feeding. Begin using toothpaste with fluoride when the child is 2 years old. Use toothpaste with fluoride earlier if your child's doctor or dentist recommends it.

Do not brush your child's teeth more than two times a day with a fluoride toothpaste.

Apply no more than a pea-sized amount of toothpaste to the toothbrush.

Supervise your child's tooth brushing, encouraging the child to spit out toothpaste rather than swallow it. Additional information is available online at

If your child's pediatrician or dentist prescribes a fluoride supplement (or vitamin supplement that contains fluoride), ask him or her about any risk factors your child has for decay and the potential for dental fluorosis. If you live in an area with fluoridated water, fluoride supplements are not recommended.

You can use fluoridated water for preparing infant formula. However, if your baby is exclusively consuming infant formula reconstituted with fluoridated water, there is an increased potential for mild dental fluorosis. Additional information can be found in a CDC fact sheet on infant formula at


  2. 01/20110107a.html

Christine Nathe, RDH, MS, is a professor and graduate program director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of "Dental Public Health Research" (, which is in its third edition with Prentice Hall. She can be reached at [email protected] or (505) 272-8147.

More RDH Articles
Past RDH Issues