On January 7, the Department of Health and Human Services (HHS) and EPA made a joint announcement about fluoride in drinking water.
The HHS proposed a new recommended optimal level of 0.7 mg/L of fluoride for community water fluoridation. The recommendation was published in the January 13 Federal Register and comments are being accepted until February 14. The previous recommendation, set in 1962, was a range of 0.7-1.2 mg/L, based on ambient air temperature and the belief that people living in warmer climates consume more water. The HHS recommendation is "intended to apply to community water systems that are currently fluoridating or will initiate fluoridation" and is based on an analysis of:
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scientific evidence related to effectiveness of water fluoridation on cavity prevention and control across all age groups;
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fluoride in drinking water as one of several available fluoride sources,
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trends in the prevalence and severity of dental fluorosis; and
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current evidence on fluid intake in children across various ambient air temperatures.
At the recommendation of the Regulatory Committee, AMWA will draft a letter in response to the HHS recommendation asking CDC to revise the 1995 Engineering and Administrative Recommendations for Water Fluoridation (http://www.cdc.gov/mmwr/PDF/rr/rr4413.pdf) to reflect the final optimal fluoridation recommendation. Table 2 of the 1995 document recommends a control range of 0.6-1.2 mg/L to achieve the recommended fluoride concentration of 0.7 mg/L.
"One of water fluoridation's biggest advantages is that it benefits all residents of a community-at home, work, school, or play," said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH. "Today's announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one's lifetime."
EPA announced the availability of two peer-reviewed scientific assessments that were developed in response to the 2006 National Academies of Science Report on Fluoride in Drinking Water: A Scientific Review of EPA's Standards.
EPA's quantitative dose-response assessment, which is based on the available data for severe dental fluorosis, estimates a reference dose (RfD) for inorganic fluoride at 0.08 mg/kg/day. "The RfD is an estimate of the fluoride dose that will protect against severe dental fluorosis, clinical stage II skeletal fluorosis and skeletal fractures" while allowing for a fluoride exposure adequate to protect against dental caries.
EPA’s relative source contribution analysis for fluoride indicates that depending on a person’s age, between 40 and 70 percent of fluoride exposure is from drinking water. When EPA’s MCL for fluoride was originally set, it was assumed that 100 percent of exposure was due to drinking water. EPA will rely on these new assessments to review the existing drinking water MCL for fluoride to determine whether it should be revised. Additional information including links to EPA’s Q&A document is online at http://tinyurl.com/epa-fluoridejan2011.