Water Fluoridation : FAQ, Part 2

by CDC

(Page 4 of 4)

Does the U.S. Food and Drug Administration (FDA) or Environmental Protection Agency (EPA) regulate fluoride added to drinking water?

Neither the FDA nor the EPA publish standards for drinking water additives. A 1979 Memorandum of Agreement between the FDA and EPA establishes that the FDA has regulatory responsibility for beverages, and the EPA has regulatory responsibility for drinking water by community water systems. The EPA additives program was discontinued in 1984 and replaced by the American National Standards Institute program for drinking water additives. The FDA does not regulate community drinking water but does regulate bottled water because commercial bottled water is considered to be a beverage (food).

What standards for levels of fluoride in water are set by the EPA?

Under the Safe Drinking Water Act and its amendments (1974, 1986, and 1996), the EPA establishes criteria for safe drinking water. These standards include the maximum contaminant level goal (MCLG), the maximum contaminant level (MCL), and the secondary maximum contaminant level (SMCL). The MCLG is a nonenforceable health goal set at a concentration to minimize adverse health effects and serves as an advisory to the states. The MCL is an enforceable regulatory standard that is set as close to the MCLG as practical, taking into consideration other factors such as treatment technology and costs. The SMCL is a nonenforceable secondary standard providing guidance on cosmetic or aesthetic considerations. In 1986, EPA established an MCLG and MCL for fluoride at a concentration of 4 milligrams per liter (mg/L) and an SMCL of 2 mg/L. The Safe Drinking Water Act requires periodic reassessment of regulations for drinking water contaminants.

How does the release of the 2006 National Research Council report affect the standards set by the EPA and national recommendations for community water fluoridation?

As part of its normal regulatory process, the Environmental Protection Agency (EPA) periodically reviews the scientific basis for its regulatory criteria. In 2003, the EPA sponsored the National Research Council to evaluate the scientific basis of the EPA's maximum contaminant level goal (MCLG) and secondary contaminant level (SMCL) for fluoride. This review was conducted by the NRC's Committee on Fluoride in Drinking Water. The committee was asked to review the adequacy of the EPA's guidelines to protect children and others from adverse health effects. The committee was asked to consider the relative contribution of various fluoride sources (e.g., drinking water, food, dental hygiene products) to total exposure. In addition, the committee was asked to identify gaps in research data and to make recommendations for future research relevant for setting the MCLG and SMCL for fluoride.

How much does it cost the community to fluoridate the water?

The per person cost of fluoridation varies by the size of the community population. The average cost of providing fluoridated water to communities with more that 20,000 residents is about 50 cents per year. For communities of 10,000-20,000 residents, the cost is about $1, and for those living in communities of less than 5,000, the cost is about $3 per year.

Is community water fluoridation a cost-effective method for disease prevention?

Yes. In 2004, an estimated $78 billion was spent on dental services, representing about 5 percent of all expenditures for personal health care in the United States. A CDC study estimated that every $1 invested in community water fluoridation saved $38 in avoided costs for dental treatment. The national average cost to restore one cavity with dental amalgam is approximately $65 - the approximate cost of providing fluoridation to an individual for a lifetime.

About the Author

www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.