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Fluoride is the name given to a group of compounds that are composed of the naturally occurring element fluorine and one or more other elements. In the early 1940s, scientists discovered that people who lived where drinking water supplies had naturally occurring fluoride levels of approximately 1.0 part fluoride per million parts water (ppm) had fewer dental caries (cavities). More recent studies have supported this finding. Fluoride can prevent and even reverse tooth decay by enhancing remineralization, the process by which fluoride “rebuilds” tooth enamel that is beginning to decay. In 1945, Grand Rapids, Michigan adjusted the fluoride content of its water supply to 1 ppm and thus became the first city to implement community water fluoridation in a public water system. 

On January 7, 2011, the U.S. Department of Health and Human Services Agency (HHS) announced a proposal recommending that water systems practicing fluoridation adjust their fluoride content to 0.7 mg/L ppm, as opposed to the previous temperature-dependent optimal levels ranging from 0.7 mg/L to 1.2 mg/L. www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#5 

About 70 percent of community water systems in the U.S. are treated with fluoride. Water fluoridation is used in varying degrees in some countries, including Australia, Brazil, some parts of Canada, Chile, Ireland, Malaysia, and Vietnam, but Continental Europe largely does not fluoridate water. Some countries fluoridate salt. 

In California only about 30 percent of water systems are fluoridated, partly because of the high cost of fluoridating its highly complicated water systems. The California Department of Public Health provides a "California Statewide Fluoridation Table" www.cdph.ca.gov/certlic/drinkingwater/Documents/Fluoridation/PWS%20Statewide%20Fluoridation%20Table%202011.pdf showing the California water systems with fluoride. A state law passed in 1995 www.leginfo.ca.gov/cgi-bin/waisgate?WAISdocID=98920013026+0+0+0&WAISaction=retrieve, mandated that if the money for equipment and initial maintenance costs are provided by sources other than the utility or its customers, water companies must build fluoridation systems. California has identified and prioritizes 150 cities for fluoridation but never funded the program. 

Fluoride is naturally found in low concentration in drinking water and food and the ocean contains between 1.2 and 1.5 ppm. Fluoridated toothpaste is another main source of fluoride. Other fluoride-containing dental products include gels, varnishes, pastes, and restorative materials. The U.S. Food & Drug Administration (FDA) regulates toothpastes and other dental products but not fluoride in our water systems. Efforts have been made to get Congress to allow the FDA to regulate water additives, but such efforts have failed so far. 

The American Dental Association, the U.S. Centers for Disease Control and Prevention (CDC), the American Medical Association, the U.S. Surgeon General, and the World Health Organization all support fluoridation. The CDC calls water fluoridation one of 10 great public health achievements of the 20th century. www.cdc.gov/fluoridation If fluoride is beneficial to health, then why is water fluoridation so controversial?  

Below are some "Myths & Facts: Possible responses to common anti-fluoride claims." www.ilikemyteeth.org/wp-content/uploads/2010/11/Myths-and-Facts-Sheet-2.pdf  

* Opponents argue that fluoridation is a violation of the individual's right to informed consent to medication. Actually fluoride is not a medication. It is mineral naturally found in water and foods. The only question is what level of fluoridation should be added to the water supply. 

* We already can get fluoride in toothpaste, so why do we need it in our drinking water? The CDC reviewed this question in January 2011. After looking at all the ways we might get fluoride – including fluoride toothpaste – the CDC recommended continuing to fluoridate water at 0.7 ppm. Any less puts our teeth at risk. Fluoride toothpaste alone is insufficient, which is why pediatricians and dentists prescribe fluoride tablets to children in non-fluoridated areas. 

* Doesn't fluoridation cause fluorosis causing teeth to turn brown and pitted? Fluorosis is never caused by community water fluoridation because the concentrations are too low. Mild fluorosis – barely noticeable tiny white specs on one’s teeth – is more common, the result of higher-than-normal fluoride intake as a child. This condition, often noticeable only to dentists, is actually an indication of exceptionally strong teeth. Nevertheless, the CDC last year set the recommended level of fluoridation – 0.7 ppm – low enough to avoid even moderate fluorosis while still strengthening teeth. 

* Isn't fluoride especially toxic for small children? Actually, children who drink fluoridated water as their teeth grow will have stronger, more decay resistant teeth over their lifetime.  

* Is tooth decay still a problem in the United States? Tooth decay affects nearly 60 percent of children. Tooth decay causes problems that often last long into adulthood. For example, California children missed 874,000 school days in 2007 due to dental problems. 

* Does fluoridation cause cancer and other serious health problems? The National Cancer Institute has stated: “Many studies, in both humans and animals, have shown no association between fluoridated water and risk for cancer.” In 2006, a panel of the National Research Council—an arm of the National Academies of Science—found no convincing evidence of a causal link between fluoridation and cancer. And according to the American Council on Science and Health, “Historically, anti-fluoride activists have claimed, with no evidence, that fluoridation causes everything from cancer to mental disease.” 

* Is community water fluoridation too costly? No, according to the California Department of Health, the annual cost to fluoridate a community averages $.51 per person per year, depending on community size, labor costs, and type of chemicals and equipment used. This figure amounts to less than the cost of one filling. 

Fluoridation has been found to be safe by scientists and ruled proper by a California Court of Appeal in Hermine Beck v. City Council of Beverly Hills www.actionpa.org/fluoride/lawandcourts/ca-beverly-hills.html, which ruled in a landmark 1973 decision that adding fluoride to water supplies is "a reasonable and proper exercise of the police power in the interest of public health." However, even though scientists declared fluoride safe and effective, and the courts have ruled that adding fluoride to water systems legal, fluoridation is still controversial. For example, see the Fluoride Action Network website www.www.fluoridealert.org