About Fluoride in drinking water
Fluoridation of drinking water has been endorsed by the American Dental
Association (ADA) since 1950 because of the public health benefit that
fluoridation provides in preventing tooth decay. The Centers for Disease
Control (CDC) considers drinking water fluoridation one of the ten great
public health achievements of the Twentieth Century. In 1968, Chester
Water Authority water received a permit from PA DEP to fluoridate.
In January of 2011, the US Department of Health and Human Services and
the EPA issued a new recommendation. The new recommended fluoride level
is 0.7 ppm, replacing the previous recommended range of 0.7-1.2 ppm.
We have accordingly lowered our treatment goal from 0.8 ppm fluoride
to 0.7 ppm. CWA water contained an average of 0.69 ppm of flouride in
For parents (caregivers) of
The ADA and the CDC have recommended the following for the parents of infants:
Questions and Answers Regarding
Fluoride in Drinking Water
- Parents should consider preparing powdered or liquid concentrate formulas
for infants using water that contains no or low levels of fluoride, if
reconstituted formula is the primary source of nutrition for the infant.
Other sources of infant nutrition could include breast milk or ready to
feed (no-mix) formula, both of which are low in fluoride.
- Some fluoride is beneficial, but dental fluorosis or mottling of the
teeth can occur if an infant receives too much fluoride. Infants are susceptible
to receiving too much fluoride due to their low body weight and high fluid
intake. Parents should consult with their infantís doctor and the formula
manufacturer for the most appropriate water to use in formula preparation.
For more information on infant formula and fluoride refer to CDC at www.cdc.gov
and ADA at www.ada.org.
Background: Infant Formula
and the Risk for Enamel Fluorosis
- What is Fluoride? Fluoride is a natural mineral and a form
of the element fluorine, the 13th most abundant element in the earth's
crust. Fluorine combines with other elements to form stable and naturally
occurring compounds. In humans, fluoride is mainly associated with bones
- Is there Fluoride in my water? Yes, Chester Water Authority
adds fluoride to the drinking water supplied to all its customers and
has for more than for forty years. In 1968, the Authority applied for
and was permitted by Pennsylvania's Department of Environmental Protection
(PA DEP) to use fluorosilicic acid in its treatment process.
We continuously monitor for fluoride at our treatment plant. In 2012,
the water pumped from our treatment plant averaged 0.69 ppm of fluoride.
On January 7, 2011, the US Department of Health and Human Services and
the Environmental Protections Agency issued a new recommendation for fluoride
in drinking water. They are now recommending that the level fluoride in
drinking water be set at the lowest end of the current optimal range to
prevent tooth decay, which is 0.7 ppm to 1.2 ppm.
We have accordingly lowered our treatment goal from 0.8 ppm to 0.7 ppm.
This is well below the 2 ppm maximum fluoride level for drinking water
standard set by PA DEP.
Chester Water Authority also provides an annual Water Quality Report which
is available by clicking
- Why is fluoride in my water? The practice of fluoridating
drinking water provides a public health benefit. Studies have shown that
fluoride prevents the formation, slows the progression, and can even reverse
Many public health agencies and experts endorse adding fluoride to drinking
water as an effective method of preventing tooth decay. The American Water
Works Association (AWWA) supports the recommendations of the World Health
Organization (WHO), American Medical Association (AMA), Canadian Medical
Association (CMA), Centers for Disease Control (CDC), American Dental
Association (ADA), Canadian Dental Association (CDA), and other professional
organizations in the medical community. The Centers of Disease Control
(CDC) recognized fluoridation of drinking water as one of the ten greatest
achievements in public health in the last century.
- Where can I get more information concerning fluoride and drinking
water? The following websites are useful sources of information:
For your reference, the following is taken directly from the CDC website
The proper amount of fluoride from infancy through old age helps prevent and
control tooth decay. In a minority of children, fluoride exposure during the
ages when teeth are forming (from birth through age 8) also can result in
a range of changes within the outer surface of the tooth called enamel fluorosis.
Recent evidence suggests that mixing powdered or liquid infant formula concentrate
with fluoridated water on a regular basis may increase the chance of a child
developing the faint white markings of very mild or mild enamel fluorosis.
This occurs on baby and permanent teeth while they are forming under the gums.
Once the teeth come into the mouth, they are no longer able to develop this
condition. Typically, very mild or mild fluorosis is barely noticeable, if
noticed at all. Studies have not shown that teeth are likely to develop more
esthetically noticeable forms of fluorosis, even with regular mixing of formula
with fluoridated water.
In children younger than 8 years of age, combined fluoride exposure from all
sources-water, food, toothpaste, mouth rinse, or other products-contributes
to enamel fluorosis. Currently one-third (33%) of children aged 12 to 15 years
in the United States have very mild to mild forms of this condition. It is
important to understand that some fluoride exposure to developing teeth also
plays a long-term role in preventing tooth decay. Parents and health providers
should weigh the balance between a child's risk for very mild or mild enamel
fluorosis and the benefit of fluoride for preventing tooth decay and the need
for dental fillings.
The possibility of an association between fluoride in infant formula and the
risk for enamel fluorosis has been studied for many years. Until now, most
researchers concluded that fluoride intake during a child's first 10 to12
months had little impact on the development of this condition in permanent
teeth. A recent study, however, has raised the possibility that fluoride exposure
during the first year of life may play a more important role on fluorosis
development than was previously understood. It now appears that the amount
of the fluoride contained in the water used for mixing infant formula may
influence a child's risk for developing enamel fluorosis, particularly if
the child's sole source of nutrition is from reconstituted infant formula.
CDC will continue to assess the science regarding the use of fluoride in preventing
tooth decay while limiting enamel fluorosis, and will modify its recommendations
as warranted. CDC believes that community water fluoridation is safe and healthy
and promotes its use for people of all ages.
Can I use fluoridated water
for preparing infant formula?
Yes. You can use fluoridated water for preparing infant formula. However,
if your child is exclusively consuming infant formula reconstituted with fluoridated
water, there is the increased potential for mild dental fluorosis, which is
a white spotting on teeth. Additional information can be found in a fact sheet
What is enamel fluorosis?
Enamel fluorosis is a hypomineralization of the enamel surface of the tooth
that develops during tooth formation. Clinically, this appears as a range
of cosmetic changes varying from barely noticeable white lines or spots to
pitting and staining of the outer enamel layer. More cosmetically objectionable
forms of this condition can occur when young children consume excess fluoride
from all sources during critical periods of tooth development. More can be
learned about enamel fluorosis at www.cdc.gov/fluoridation/safety/dental_fluorosis.htm
What type of water does CDC
recommend for mixing infant formula?
Parents should follow the advice of the formula manufacturer and their child's
doctor for the type of water appropriate for the formula they are using. Parents
and caregivers of infants fed primarily with formula from concentrate who
are concerned about the effect that mixing their infant's formula with fluoridated
water may have in developing enamel fluorosis can lessen this exposure by
mixing formula with low fluoride water most or all of the time. If tap water
is fluoridated or has substantial natural fluoride (0.7 mg/L or higher), a
parent may consider using a low-fluoride alternative water source. Bottled
water known to be low in fluoride is labeled as purified, deionized, demineralized,
distilled, or prepared by reverse osmosis. Most grocery stores sell these
types of low-fluoride water. Ready to feed (no-mix) infant formula typically
has little fluoride and may be preferred for use at least some of the time.
Why is there a focus on infant
formula as a source of fluoride?
Infant formula manufacturers take steps to assure that infant formula contains
low fluoride levels-the products themselves are not the issue. Although formula
itself has low amounts of fluoride, when infant formula concentrate is mixed
with fluoridated water and used as the primary source of nutrition, it may
introduce fluoride at levels above the amount recommended to minimize the
risk for fluorosis. Infants consume little other than breast milk or formula
during the first four to six months of life, and continue to have a high intake
of liquids during the entire first year. Therefore, proportional to body weight,
fluoride intake from liquids is generally higher for younger or smaller children
than for older children, adolescents, or adults. Mixing concentrate with fluoridated
tap water on an occasional basis is unlikely to be of much risk. However,
when used consistently as the primary source of nutrition over longer periods
of the first year, a child may receive enough fluoride to increase his/her
chances of developing very mild or mild fluorosis.
© Copyright 2000 - 2014. Site developed and maintained by Chester Water