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 and teeth.

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.

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 newly-formed cavities.

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.

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 infant’s 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.

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 this link. 

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.

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 on 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.

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.

The following websites are useful sources of information:

www.epa.gov/safewater
www.depweb.state.pa.us
www.cdc.gov/fluoridation/