USA to lower fluoride levels in drinking water

USA to lower fluoride levels in drinking water

11 Nov 2010

 The US Department of Health and Human Services has recommended that the fluoride in America’s drinking water be lowered, as high levels of fluoride contribute to dental fluorosis. Will this have an impact on the UK water fluoridation debate?...  

The US Department of Health and Human Services (HHS) is proposing that the recommended level of fluoride in drinking water be set at the lowest end of the current optimal range to prevent tooth decay, and the US Environmental Protection Agency (EPA) is initiating a review of the maximum amount of fluoride allowed in drinking water. 

These important steps are to ensure that standards and guidelines on fluoride in drinking water continue to support good dental health, especially in children. 

EPA assistant administrator for the Office of Water, Peter Silva, said, “Today both HHS and EPA are making announcements on fluoride based on the most up-to-date scientific data. EPA’s new analysis will help us make sure that people benefit from tooth decay prevention while, at the same time, avoiding the unwanted health effects from too much fluoride.” 

Updated recommendations

Although water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the US over the past several decades, HHS and EPA reached an understanding of the latest science on fluoride, its effect on tooth decay prevention, and the development of dental fluorosis that may occur with excess fluoride consumption during the tooth forming years; age eight and younger. 

HHS’ proposed recommendation of 0.7mg of fluoride per litre of water replaces the current recommended range of 0.7 to 1.2mg (based on outdoor air temperatures in different regions). These assessments will also guide EPA in making a determination of whether to lower the maximum amount of fluoride allowed in drinking water, which is set to prevent adverse health effects. The EPA’s assessments of fluoride were undertaken in response to findings of the National Academies of Science (NAS). At EPA’s request, NAS reviewed new data on fluoride in 2006 and issued a report recommending that EPA update its health and exposure assessments, taking into account bone and dental effects, and considering all sources of fluoride. 

The HHS’ proposed recommendation was based on the following information: 

• In addition to drinking water, other sources of fluoride are available that include dental products, such as toothpaste and mouth rinses, prescription fluoride supplements, and professionally applied fluoride products.

• Community water fluoridation is the most cost-effective method of delivering fluoride for the prevention of tooth decay.

• Significant caries preventive benefits can be achieved and risk of fluorosis reduced at 0.7mg/L, the lowest concentration in the range of the USPHS recommendation. 

• Recent data does not show a convincing relationship between children’s fluid intake and outdoor air temperatures in different regions of the US. Thus, there is no need for different recommendations for water fluoride concentrations in different temperature zones.

Commenting on this announcement, chief executive of the BDHF, Dr Nigel Carter, commented, “The United States is following Ireland in reducing their recommendation for the level of water fluoridation to 0.7ppm. There is some evidence from studies in both the States and Ireland of increased levels of fluorosis in children when water is fluoridated at 1ppm. 

“With the far greater availability of fluoride in toothpaste and mouthwashes, than when water fluoridation schemes were first introduced, the new proposed level of 0.7ppm seems sensible to obtain maximum protective effect from fluoride in both water and toothpaste, but to reduce any possibility of the slight adverse effect of increased levels of fluorosis.”

In response to this report, questions may arise as to whether the few UK cities and towns with fluoride in their drinking water supplies, should follow suit. Barry Cockcroft, chief dental officer at the Department of Health, told The Probe, “I welcome any addition to science surrounding water fluoridation. I was encouraged to see that the US Department of Health and Human Services reaffirmed the protection fluoridation offers in support of good dental health. 

“The hearing of the Judicial Review on NHS South Central’s decision to fluoridate the water supply serving Southampton was completed on January 20. The judgement is expected in four to six weeks. We we will be assessing the implications of the outcome of the review with NHS South Central and considering any new scientific recommendations on adjusting fluoride content of water supplies.”

Water fluoridation debate

The fluoridation of drinking water supplies debate intensified when the South Central Strategic Health Authority (SCSHA) used statutory powers to instruct Southern Water, the local water provider in Southampton, to go ahead with fluoridation in February 2009 to improve dental health. The Authority gave the go-ahead despite a public consultation showing 72 per cent opposed the idea. Now, resident, Geraldine Milner, is taking legal action to challenge this decision. The Judicial Review will decide if SCSHA properly considered the views. 

Milner’s counsel, David Wolfe accused the Authority of failing in its legal obligation to properly assess the cogency of the arguments for and against mass fluoridation.

As the hearing continues, health secretary, Andrew Lansley, said, “I am taking a close interest in the Judicial Review hearing on the decision to fluoridate the water supply by NHS South Central. I will assess the implications of the outcome of the review with the Strategic Health

Believing that fluoridating drinking water is a step forward, Graham Barnby, from La Perla Clinic in Buckinghamshire, commented, “Putting fluoride in the drinking water is the best public health measure for the whole population. 1ppm has been proved over the years to be beneficial and safe. Fluoride at this level occurs naturally in the water in many parts of the UK and we know it makes a significant reduction in the caries rate in all ages in these areas. 

“We should support this public dental health measure that will help improve the tooth resistance to caries particularly in the child population.”

Professor ten Cate, Head of Preventative dentistry at the Academic Center for Dentistry Amsterdam (ACTA), agreed. “The best way to achieve a frequent application of fluoride is in the drinking water, because you drink it, you have it in your tea and your cooked food.”

Dr Carter added, “The Foundation remains totally committed to extending water fluoridation schemes in the UK to those areas with greatest need. With levels of decay in our five-year-olds still at over 30 per cent, water fluoridation is an essential tool to help reduce health inequalities and reduce the pain and suffering experienced by so many children. 

“Having practiced in fluoridated Birmingham for most of my life, I have seen, first hand, the huge benefits that addition of fluoride to the water can achieve. 

 “After 46 years of fluoridation, the West Midlands now has some of the best levels of oral health in the UK, not only for children, but also for adults, and more of the population deserve to benefit in the same way.”     


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