Since 1962, the U.S. Department of Health and Human Services, Public Health Service (PHS), has recommend that community water systems add fluoride to drinking water to prevent tooth decay.  Currently more than 210 million people across the country – about 75% of all people served by community water systems – benefit from this safe and effective intervention.  Accordingly, the State Board of Health, State Health Commissioner, and Virginia Department of Health recommend that all community water systems in Virginia, which are also known as “waterworks,” deliver the optimum fluoride ion concentration as determined by the PHS.  This recommendation is included in the amendments to Virginia’s Waterworks Regulations, which became effective on June 23, 2021.

The Virginia Department of Health, through the Office of Drinking Water, regulates more than 1,000 community waterworks in Virginia.  For the community waterworks that add fluoride, the Office of Drinking Water reviews plans and specifications for fluoride feed systems and requires regular reports about the fluoride concentration in water that consumers receive.  Beginning in 2015, the PHS recommended an optimum fluoride concentration of 0.7 mg/L (milligrams per liter) to decrease the occurrence and severity of tooth decay and reduce the risk of dental fluorosis.  This value replaces the previous recommended range of 0.7 – 1.2 mg/L, issued in 1962, to account for fluoride that is available from other sources such as toothpaste and mouthwash.

Community waterworks in Virginia and other states monitor fluoride levels daily to ensure they are consistently and reliably at 0.7 mg/L.  Although fluoride occurs naturally in groundwater in some parts of Virginia and, at high levels can lead to a condition known as skeletal fluorosis (a bone disease caused by excessive fluoride intake for a long period of time that in advanced stages can cause pain or damage to bones and joints), no community waterworks in Virginia that is currently permitted has reported fluoride levels that are close to or above the U.S. Environmental Protection Agency’s (EPA) maximum level for drinking water, 4.0 mg/L.

For more information about fluoridation and public health, see http://www.cdc.gov/fluoridation/index.htm, https://www.vdh.virginia.gov/oral-health/cwf/, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547570/?report=classic

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