Fluoride and Fluoridation

Fluoride is a mineral found in water, soil, and plants. It is well known for supporting dental health by strengthening tooth enamel and helping protect teeth from decay. Because of these benefits, fluoride is commonly added to many dental care products like toothpaste and mouth rinses. In addition to its role in oral care, fluoride compounds are used in industries such as aluminum, steel, and glass manufacturing. They can also be released into the environment during the production of phosphate fertilizers, bricks, tiles, and ceramics.

California’s fluoride primary drinking water standards (health-based) for drinking water can be found at 22 CCR 64433.2. These fluoride standards have optimal levels and control ranges that depend on daily air temperatures.

Fluoride levels in drinking water must be tested daily (22 CCR 64433.3). If more than 20% of the daily samples collected in a month fall outside of the control range, the water system would be out of compliance with the secondary MCL (consumer acceptance-based).

In the context of drinking water, fluoride is often added through a process called fluoridation, which adjusts fluoride to optimal levels to prevent tooth decay. Fluoridation is a public health practice that has been used since 1945 and is supported by major health organizations worldwide, including:

• American Academy of Pediatrics
• American Dental Association
• American Medical Association
• American Public Health Association
• American Water Works Association
• California Dental Association
• California Department of Public Health (CDPH)
• International Association for Dental, Oral, and Craniofacial Research
• S. Centers for Disease Control and Prevention (CDC)
  • Community Water Fluoridation Facts
• World Health Organization

Tooth decay is the number one chronic condition for children. It may result in pain, poor nutrition, and dysfunctional speech, as well as a lack of concentration, poor appearance, low self-esteem, and absenteeism. Optimally fluoridated water is the single most cost-effective strategy that a community can take to improve the oral health of its residents. Studies consistently show that water fluoridation reduces tooth decay by 20 to 40 percent. The recommendations of HHS resulted from an updated review of the various current sources of fluoride, including water fluoridation. Providing the optimal level of fluoride protects the dental health of people of all ages, not just children.

Concerns have been raised about the use of fluoridated drinking water in infant formula. For more information on this topic, see:

• CDC Community Water Fluoridation FAQ
• American Dental Association Fluoridation FAQ
• UCSF California Childcare Health Program

Visit the CDC’s My Water’s Fluoride page to see if your water system provides fluoridated drinking water.  For more detailed information about your water system’s fluoride level, please contact your water system and request a copy of their most recent Consumer Confidence Report or Water Quality Report. In addition, the following statewide fluoridation data is available:

• 2016 Fluoridation Table
• 2014-2015 Fluoridation Table
• 2013 Fluoridation Table
• 2012 Fluoridation Table
• 2011 Fluoridation Table
• 2010 Fluoridation Table
• 2009 Fluoridation Table
• 2008 Fluoridation Table

The Division of Drinking Water (DDW) within the State Water Resources Control Board is the regulatory agency responsible for regulating the content of fluoride in water served by California public water systems and assuring drinking water is optimally fluoridated to provide dental health benefits to the public. DDW also provides technical and engineering expertise to water systems for permitting and operating fluoridation systems. DDW is responsible for regulating the activities of fluoridating public water systems in California. This responsibility includes assuring water fluoridation is conducted in a safe and effective manner. Public water systems must obtain a permit from DDW to fluoridate their drinking water supplies and must monitor the fluoride levels in their water system on a daily basis.

The Office of Oral Health within CDPH is responsible for securing funds to purchase and install fluoridation equipment for water systems. This office also provides scientific, technical, and health related expertise to communities interested in fluoridating their drinking water.

The reporting requirements and forms below are used by DDW and water systems for fluoridation management. The public water system operational and monitoring information is reported to DDW. For copies of the reporting requirements and reporting forms, click on the links below.

Reporting Requirements and Reporting Forms

• California statutes regarding fluoridation are in Health and Safety Code sections 116409, 116410, and 116415
• California regulations regarding fluoridation are in California Code of Regulations (CCR), Title 22, Division 4, Chapter 15, Article 4.1
• CDPH’s Office of Oral Health
• S. EPA’s Fluoride Risk Assessment and Relative Source Contribution