Water Fluoridation Reporting System

The Water Fluoridation Reporting System (WFRS) is a tool that helps states to manage the quality of their water fluoridation programs. WFRS information also is the basis for national reports that describe the percentage of the U.S. population on public water systems who receive optimally fluoridated drinking water. The system was developed by the Centers for Disease Control and Prevention (CDC) in partnership with the Association of State and Territorial Dental Directors (ASTDD) to provide states with a management and tracking tool.

Water fluoridation programs are managed at the state level. However, many states do not have the resources to develop their own dedicated tracking system for their water fluoridation program. The U.S. Environmental Protection Agency (EPA) has a database on water systems; however, this database was developed for the purpose of ensuring compliance with the federally-established maximum contaminant level (MCL) of fluoride in water. States can use the EPA database to report those water systems that exceed the MCL for fluoride in water.

Monitoring the Quality of Water Fluoridation

Before 1998, the quality of water fluoridation was monitored using Quarterly Fluoridation Reports developed by the ASTDD and the CDC Fluoridation Census. These reports and the Fluoridation Census provided an overview of community-level fluoridation activities. However, these independent efforts lacked the specific detail necessary to monitor, plan, and effectively implement improvements to state fluoridation programs.

Developed in 1998, WFRS provides states with a comprehensive, Web-based system to track water fluoridation program information.  The WFRS database structure was modeled using the same data strategy and structure as the Environmental Protection Agency’s Safe Drinking Water Information System (SDWIS), which permits exchange of data and updates on utility system configurations. Each water system in the WFRS database includes basic demographic information including utility name, address, population served, fluoridation status (e.g., not adjusted, adjusted, natural, variable, or consecutive), natural fluoride concentrations, counties and communities served, system type, and which systems buy or sell water to other systems.

Water systems that adjust the fluoride of their water to the optimal level for decay prevention also collect data to monitor fluoridation quality. This information includes average fluoride concentrations, results of daily testing, and laboratory split sample results (see Fact Sheet on the Fluoride Laboratory Proficiency Testing Program). The dates of facility inspections, operator training, and other relevant information also can be included.

State fluoridation managers enter this data into WFRS and generate reports that can be used to develop general quality improvement measures. A Microsoft PowerPoint presentation can be viewed that provides a Water Fluoridation Reporting System Overview  (PPT–2Mb)  (PDF–1.6Mb) showing basic application interface features and data organization.

Coordination with Environmental Protection Agency

The WFRS database is compatible with the U.S. Environmental Protection Agency's (EPA) Safe Drinking Water Information System (SDWIS). The EPA tracks approximately 160,000 water systems in the SDWIS database through a unique SDWIS identification number. Using the same public water system identification number for WFRS assures that updates between these two databases work together.

Of the 160,000 water systems listed in SDWIS, 54,000 are identified as community water systems; these are included in WFRS. About 16,500 community water systems are listed by WFRS as either having fluoride levels that are adjusted, are naturally occurring, or that are consecutively fluoridated (purchased from a neighboring water system that has optimally fluoridated water).

Access to WFRS

The data collected and used in WFRS is owned by the states and tribes.  Employees of state oral health and drinking water programs can be granted permission to use the WFRS database and to enter the required information into WFRS.  People interested in receiving the original data should contact their state oral health program (www.astdd.org*) or an individual tribe.

Public Access to WFRS Information

Some states post fluoridation data from WFRS and the fluoridation status in their state using other CDC data applications that have a public access component. More than 39 states provide the public with the ability to view the fluoride content of public water systems on My Water’s Fluoride. My Water’s Fluoride allows consumers in participating states to learn basic information about their public water system including the number of people served by the system and the fluoride level. Consumers also can learn the fluoride content of their water system by contacting their local water utility service. Water fluoridation information from WFRS is also displayed in Oral Health Maps, a Web-based Geographic Information System interactive mapping application that shows the percentage of people receiving fluoridated water at the state and county level. An interactive graphic on How CDC Water Fluoridation Data Systems Relate to WFRS displays the relationship of CDC data applications with respect to public access of WFRS data.

Water Fluoridation Quality Award

Water utility companies have customers that desire a quality product. Being recognized as providing a good product and customer service is valued. There are several award programs in place by the U.S. Environmental Protection Agency, many state drinking water programs, and some professional associations related to the drinking water industry, and many water utilities work to qualify for those awards.

The CDC issues Water Fluoridation Quality Awards to recognize those water systems that adjust the fluoride concentration in drinking water, achieving a monthly average fluoride level that is within the optimal range for 12 consecutive months in a year as documented in WFRS. This represents a high level of operator care and accomplishment. Providing a consistent level of fluoride in water ensures the greatest benefit in reducing tooth decay.

One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader to view and print these documents.

One or more documents on this Web page is available in Microsoft PowerPoint (PPT). You will need PowerPoint Viewer to view and print these documents.

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

Page last reviewed: September 26, 2007
Page last updated: January 22, 2008
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion