May 1, 2002

By Stacie Crozier

Washington ? As part of its periodic review of drinking water standards, the Environmental Protection Agency says fluoride regulations don't need to be revised at this time.

But it will ask the National Academy of Sciences to update the risk assessment for fluoride, including a review of recent fluoride studies and the contribution to total fluoride intake from other fluoride sources such as fluoride-containing foods and dental care products.

In 1993, the results of the last NAS review of fluoride were published as a "Health Effects of Ingested Fluoride," a report still widely referenced by physicians, dentists, researchers, public health officials and others.

On April 17, the EPA announced the results of its most recent periodic review of 68 different chemical National Primary Drinking Water Regulations, including the fluoride regulation, and made preliminary determinations to revise or not to revise each regulation. The EPA determined that the fluoride regulation falls under the "Not Appropriate for Revision at this Time" category. At the same time, the EPA announced it will accept public comment on the results of its review through June 17 and will publish its final revise/not revise decision for these NPDWRs in August.

"Fluoride has been used and scrutinized for its safety and effectiveness for 55 years," says Dr. Herschel S. Horowitz, a public health dentist, former researcher at the National Institute of Dental and Craniofacial Research and ADA spokesman on fluoridation issues. "Each review has shown that fluoride is safe and effective at reducing the prevalence of dental caries. This review is just part of a routine procedure to scrutinize drinking water and make sure it meets or exceeds safety standards. We certainly expect that the EPA will give fluoride a clean bill of health once again."

Under the Safe Drinking Water Act, the EPA is required to periodically review drinking water regulations to "identify those for which current health risk assessments, changes in technology, and/or other factors, provide a health or technical basis to support a regulatory revision that will improve or strengthen public health protection," states a summary published in the April 17 Federal Register.

The ADA, the EPA, the dental and scientific communities and many other interested parties continually review the latest scientific evidence regarding safety and efficacy, Dr. Horowitz adds, to ensure that community water fluoridation policy is based on the latest scientific research.

EPA's drinking water regulations for fluoride address levels of naturally occurring fluoride, which can vary widely from location to location. Public water systems that adjust fluoride water levels to reduce caries maintain concentrations established as optimal by the U.S. Public Health Service, with levels that range from 0.7-1.2 ppm (or 0.7-1.2 mg/L), far below the EPA's maximum concentration limit of 4 mg/L. Some water systems have naturally occurring fluoride that is higher than the EPA standard. These systems have the option of defluoridating their water or seeking alternative water sources to protect children from developing enamel fluorosis, a cosmetic condition with no known adverse health effects.

Enamel fluorosis can occur when children are chronically exposed to fluoride at concentrations of 2 mg/L or higher. Optimal fluoride levels of around 1 mg/L enable individuals to use fluoride-containing toothpastes and eat and drink fluoride-containing foods and drinks with minimal risk of developing cosmetically prominent fluorosis. The NAS review will address the contribution to total fluoride intake from other fluoride sources, including a growing variety of fluoride-containing toothpastes, mouth rinses and other products as well as fluoride ingested from foods and beverages.

The EPA currently requires water suppliers to notify customers by mail within a 12-month period when its naturally occurring water fluoride level exceeds 2 mg/L. This action is mandated to help inform families of how they can reduce or control fluoride exposure levels. The EPA will also review this notification timetable, and may make recommendations for revisions in notification procedures.

The Centers for Disease Control and Prevention proclaimed fluoridation one of 10 greatest public health achievements in the 20th Century, reducing tooth decay among children by between 18 and 40 percent.