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Safety

Water safety is defined and determined by federal, state, and local regulations. The main federal law that ensures the quality of Americans' drinking water is the Safe Drinking Water Act (SDWA). Under SDWA, the U.S. Environmental Protection Agency (EPA) sets standards for drinking water quality and oversees the states, localities, and water suppliers who implement those standards.

CDC promotes effective public health practices, such as community water fluoridation. While it is not CDC’s responsibility to determine what levels of fluoride in water are safe, our understanding about the safety of fluoridation is guided by federal regulations, comprehensive reviews conducted by expert panels, and individual studies.

Nearly all water on earth contains naturally occurring fluoride at levels below, equal to, or above those used in community water fluoridation. Investigation of the decay preventing effects of naturally occurring fluoride in water led to the start of community water fluoridation in 1945. For more than 60 years scientists have made observations and conducted epidemiological and animal studies to determine the effectiveness and safety of fluoride in water.

These reviews are completed by panels of experts.

  • National Research Council (NRC) Report on Fluoride in Drinking Water

    The NRC released its report, Fluoride in Drinking Water: A Scientific Review of EPA’s Standard, on March 22, 2006. The purpose of this report is to provide recommendations to the Environmental Protection Agency (EPA) on whether the current maximum contaminant level goal (MCLG) of 4 mg/L protects children and others from adverse health effects. The NRC committee did not examine the health risks or benefits of water at the levels recommended for fluoridation of water to prevent tooth decay. The current range for water fluoridation of community water systems is 0.7 to 1.2 ppm (equivalent to 0.7-1.2 mg/L). Water that has fluoride at these levels is safe and effective for preventing tooth decay.

    CDC statement on the 2006 NRC report.

    See Frequently Asked Questions about the responsibilities of the EPA for setting standards for fluoride in water.

    Additional information on the NRC report including a Report in Brief *pdf icon(PDF-1.58Mb) and how to order copies of the full report is available at The National Academies.*

The proper amount of fluoride helps prevent and control dental caries (tooth decay). Fluoride ingested during tooth development can also result in a range changes in tooth enamel. Because fluorosis is a condition that occurs when teeth are forming, only children aged 8 years old or younger are at risk. Children older than eight, adolescents, and adults are not susceptible to fluorosis.

Enamel fluorosis occurs among some people in all communities, even in communities that do not fluoridate and have a low natural concentration of fluoride in drinking water. All persons are encouraged to know what steps can be taken to reduce the risk for enamel fluorosis.

The proper amount of fluoride at all stages of life helps prevent and control tooth decay. Recent studies have raised the possibility that mixing infant formula with fluoridated water, particularly for infants exclusively on a formula diet during the first year of life, may play a more important role in enamel fluorosis development than was previously understood. Learn more about infant formula and fluoridation.

A study published by Bassin and colleagues suggests an association between drinking fluoridated water and osteosarcoma in adolescent males.  The findings from a larger study on this topic, conducted by the same institution, are expected soon. In making recommendations on community water fluoridation, the CDC and the U.S. Public Health Service are always guided by one overriding goal and interest—all our recommendations are designed to protect the health and well-being of the public. These recommendations are based on reviews of the best available science. CDC continues to strongly support community water fluoridation as a safe and effective public health measure to prevent and control tooth decay and to improve overall health.

The safety of fluoride in drinking water at levels recommended for preventing tooth decay has been affirmed by numerous scientific and professional groups.

Scientists have found a lack of evidence to show an association between water fluoridation and a negative impact on people, plants, or animals.

Three additives—sodium fluoride, sodium fluorosilicate, and fluorosilicic acid—may be used to adjust the natural fluoride levels in water to concentrations that prevent or reduce tooth decay. Learn more about these additives and how they work in water.

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* 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.

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Date last reviewed: September 26, 2007
Date last modified: December 17, 2007
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion

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