Fluoridation

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.  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 that adjust the fluoride concentration monitor fluoride levels daily to ensure they are consistently and reliably at the optimum concentration.  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). Customers of community waterworks that exceed the U.S. Environmental Protection Agency’s (EPA) maximum contaminant level for fluoride drinking water of 4.0 mg/L or exceed the secondary maximum contaminant level of 2.0 mg/L will be notified by the waterworks owner. Customers of community waterworks can refer to the Consumer Confidence Report, published annually by the water utility, for information on the fluoride level. Customers should reach out to their water utility for a copy of the report.

For more information about fluoridation and public health, see  https://www.cdc.gov/fluoridation/about/index.html

https://www.vdh.virginia.gov/oral-health/cwf/, and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547570/?report=classic

Also see the “Water Fluoridation” webinar video and slides hosted by Virginia Health Catalyst and the Virginia Department of Health’s Office of Drinking Water, on Thursday, January 23, 2025.

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Last Updated: March 13, 2025