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Oral Health Program: Fluoride and Community Water Fluoridation

Fluoride, a mineral found naturally in drinking water, helps prevent tooth decay.

A child drinking from a bubbler outside

Oral health plays a major role in the overall health of the body throughout a person’s life.

Although the nation’s oral health has improved overall during the past 50 years, tooth decay is still the most common chronic childhood disease—five times more common than asthma.

Tooth decay affects more than 80% of Americans by the time they begin their adult years.

Fluoride is a mineral that works by stopping or even reversing the tooth decay process—it keeps tooth enamel strong and solid.

Fluoride is a mineral and helps prevent tooth decay.

Tooth decay is caused by certain bacteria in the mouth. When a person eats sugar and other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth. Fluoride helps to remineralize tooth surfaces and prevents cavities from forming.

Fluoride in the body is necessary when teeth are forming under the gums to make teeth strong.

Fluoride on the surface works after teeth have erupted to continue to keep teeth strong.

In children younger than age 8, fluoride helps strengthen the adult (permanent) teeth that are developing under the gums.

Fluoride benefits children and adults throughout their lives.

The best way to get fluoride is through community water fluoridation. Natural fluoride is found in food, plants, animals, and ground water, but the amounts received in this way are usually too low to protect teeth from decay. Many Wisconsin communities adjust the amount of fluoride in drinking water to a level recommended for preventing tooth decay in a process called "community water fluoridation." This is a proven way to prevent dental decay throughout life.

Communities in Wisconsin have used water fluoridation to improve the oral health of residents since 1946. Community water fluoridation is safe, effective, and supported by public health, medical, and dental organizations worldwide. Fluoridation continues to be key to fight tooth decay in Wisconsinites.

Water fluoridation is not the only form of fluoride delivery that is effective in preventing tooth decay. In people of all ages, fluoride supports tooth enamel, keeping teeth strong and healthy. Fluoridated toothpaste, fluoride rinses, and fluoride varnish lower the risk for tooth decay, especially for people who are at higher risk for decay. Although these products reduce tooth decay, combined use with fluoridated water offers protection greater than any of these products used alone.

Fluoride varnish treatments can be received in a dental office, pediatrician's office, through a local health department, or Wisconsin Seal-A-Smile programs.

Fluoride is a mineral and in the right amount, fluoride in drinking water strengthens teeth.

The Wisconsin Oral Health Program follows the U.S. Department of Health and Human Services recommendation of 0.7 milligrams per Liter (mg/L) of fluoride, in your drinking water. Fluoride levels that range between 0.7 and 2mg/L prevent tooth decay and promote good oral health.

It is important to Know Your Water's Fluoride Level, P-03442. (PDF)

Fluoride found naturally in private wells is not regulated. Fluoride is present in virtually all waters but the amount varies across the state. It is important to know the fluoride content of your water.

Drinking water from private wells should be tested for fluoride regularly. Fluoride levels less than 0.7 mg/L are too low for oral health protection. Parents should talk with their child's medical or dental professional about supplementing with additional fluoride sources to ensure adequate oral protection.

Links to partner pages

The following partner webpages are excellent resources for quick information:

There is a lot of information about community water fluoridation and fluoride available on the internet. It is hard to know which information is accurate and it can be time consuming to sift through everything. Wisconsin's Oral Health Program has gathered and sorted comprehensive, evidence-based information and resources on fluoride and related topics.

Now, the general public, health care professionals, and water operators can find up-to-date, accurate, and reliable information about fluoride and community water fluoridation in one place.

Information for the general public

Two children sitting at a counter drinking water and laughing

Many people have questions about community water fluoridation and fluoride.

Informed decisions are good decisions.

Explore these resources to learn more about community water fluoridation and fluoride.

  • Community Water Fluoridation, P-40111 (PDF) Department of Health Services (DHS) publication: Fact sheet containing information for addressing tooth decay as a public health issue affecting people of all ages in Wisconsin and how Community Water Fluoridation can help.
  • Community Water Fluoridation Fact Sheet CDC publication: Community water fluoridation is safe and effective at preventing cavities. It also saves money. Learn more about the benefits of community water fluoridation with this CDC fact sheet.
  • How Fluoride Works CDC publication: Community Water fluoridation works to build a foundation for strong, healthy teeth. This infographic takes you through the process of how fluoridation prevents cavities and strengthens your smile. Print it to share with others.
  • I Like My Teeth American Academy for Pediatrics (AAP): You may have a lot of questions about fluoridation, and rightly so. We all have questions about things that impact the health of our families. Here's where to get answers without the technical talk, to make finding what you need quick and easy.
  • Community Water Fluoridation FAQs – Infant Formula CDC: Read frequently asked questions regarding infant formula and fluoridated water.
  • Fluoride Myths and Facts AAP: You may have heard the myths, here is the correct information on the safety and effectiveness of fluoridation.
  • Know Your Water's Fluoride Level, P-03442 (PDF) DHS publication: Fact sheet containing information for community water systems and private wells on finding your water's fluoride level, when a water test is necessary, and what to do with the results.
  • My Water's Fluoride CDC: Most water contains some fluoride but usually not enough to prevent cavities. Community water systems can add just the right amount of fluoride to local drinking water to prevent cavities. My Water's Fluoride (MWF) allows consumers to learn about the fluoride level in their drinking water. Also, you can find out the number of people served by the system and the water source.

Learn more about fluoride varnish

Fluoride varnishes are a safe, simple, effective, inexpensive treatment that benefits people of all ages. Fluoride varnish can be painted on teeth by certified health professionals, such as physicians, nurses, dental hygienists, and physician assistants.

What is fluoride varnish?

Fluoride varnish is a protective coating that is painted on teeth to help prevent new cavities and stop cavities that have already started.

Why do we recommend fluoride varnish?

  • Tooth decay (cavities) is one of the most common preventable diseases seen in children.
  • Children as young as 12-18 months can get cavities.
  • Cavities in baby teeth cause pain and can prevent children from being able to eat, speak, sleep, and learn properly.
  • Children do not lose all their baby teeth until they are about 11 or 12 years old.
  • Adults often get cavities at the gum line.
  • People with certain health care needs or who are unable to brush their own teeth are at higher risk of getting cavities.

Is fluoride varnish safe?

Yes, fluoride varnish can be used on people of all ages from babies with their first tooth to adults. Only a very small amount of fluoride varnish is used.

How is fluoride varnish put on the teeth?

The varnish is painted on the teeth. It is quick and easy to apply.

How often should I receive a fluoride varnish?

Your health care professional will recommend what is best for you. Typically, it is painted on the teeth two to four times per year.

Where can I get a fluoride varnish treatment?

Fluoride varnish treatments can be offered at a pediatricians office, local health department (WIC appointment), school-based dental program, long-term care facility, or dental office.

How much does a fluoride varnish treatment cost?

Most fluoride varnish treatments are offered free of charge for children. The costs are typically covered by Wisconsin Medicaid, health/dental insurance plans, or grant programs. Adults should ask their health care professional about charges.

Information for health care professionals

An adult drinking a glass of water

A wide variety of health professionals, both nationally and statewide, recommend community water fluoridation. Patients ask physicians, pharmacists, dentists, nurses, and dental hygienists about fluoride and fluoridation. If you are new to the topic, learn the community water fluoridation basics. If you have prior knowledge, you know that local public health or community leaders and patients are relying on you to share the oral health benefits of community water fluoridation and fluoride. Here are some resources to get your conversation started.

  • All About Fluoride ADA publication: Fact sheet providing talking points and links to the latest science to help dental professionals learn about community water fluoridation and feel better prepared to share information with patients and community leaders.
    • Fluoridation Facts ADA publication: With answers to frequently asked questions, this e-book shares the scientific truth about community water fluoridation: It’s not only safe, but also good for preventing tooth decay and cavities. The book includes the newest research on the topic, helping keep policymakers and the general public in the know.
  • Campaign for Dental Health: Health Professionals AAP: As a healthcare professional, patients rely on your advice to live healthier, longer, lives. That is why it is vital to discuss how oral health and water fluoridation can help them do just that. Here are tools that can help!
  • Community Water Fluoridation, P-40111 (PDF) DHS publication: Fact sheet containing information for addressing tooth decay as a public health issue and how evidence-based prevention strategies like Community Water Fluoridation support Wisconsin's future.
  • Community Water Fluoridation 101 DHS training: Course covering the topic of community water fluoridation (CWF). The course will provide attendees examples of the type of myths spread by those opposed to CWF and how to respond. As a foundation to understanding these myths, the course will also provide basic information on the science behind fluoridation, how it works and why it works to prevent tooth decay. The objective of this course is to educate members of the oral health workforce (dental professionals, medical professionals, public health professionals, and water operators and engineers) on the evidence and science of CWF. Additionally, The Wisconsin Oral Health Coalition will offer one dental CE for Wisconsin dental providers completing the course.
  • Community Water Fluoridation Fact Sheet CDC publication: Fact sheet describing the international use of fluoridation and explains the public health achievement of Community Water Fluoridation as a safe, effective and cost-saving way to reduce disparities.
  • FLUID Fluoride Legislative User Information Database: Comprehensive database containing legal decisions by U.S. courts and current information on federal, state and local policies regarding community water fluoridation.
  • Fluoridation Learning Online (FLO) CDC training: A free resource designed to build the capability of state fluoridation programs, and to help increase knowledge and refine skills to implement and maintain community water fluoridation. Overview of FLO:
    Module 1: Science – the history and science of fluoridation, benefits, and health effects
    Module 2: Program – state program management and oversight, and communication principles
    Module 3: Water system overview and design
    Module 4: Technical information for water fluoridation additives and operations
  • Fluoride Exposed: Real Science for You Fluoride Exposed: Looking for info on fluoride? Fluoride Exposed is a source for quality, detailed science and history of fluoride, fluoridation and more.
  • Fluoride Science Fluoride Science: Fluoride Science reviews fluoride studies for professional communities that may engage in patient care and public health services.
  • My Water's Fluoride CDC: Most water contains some fluoride but usually not enough to prevent cavities. Community water systems can add just the right amount of fluoride to local drinking water to prevent cavities. Find fluoride content of public water supplies prior to prescribing fluoride supplements.

Learn more about fluoride varnish

Fluoride varnishes—safe, simple, effective, inexpensive, treatment applied to all teeth

Techniqueprescribed and completed by medical or dental providers

Materials/equipment—readily available from medical/dental supply companies

Wisconsin Medicaidreimbursement policy includes certified health professionals, such as physicians, nurses, dental hygienists, and physician assistants.

Fluoride varnish programs—easily accessible

  • Fluoride Safety: A Guide for Health Professionals AAP publication, Spanish: A concise explanation of the regulation and safety of fluoride additives and fluoridated water. Common concerns, including daily intake and infant formula, are addressed. Links to valuable resources are provided.
  • Fluoride Supplementation, P-44531 (PDF) DHS publication: Fact sheet containing information for health care professionals on Fluoride Supplementation.
  • Fluoride Varnish: an Evidence-Based Approach Research Brief Association of State and Territorial Dental Directors publication: This research brief is a review of the evidence for fluoride varnish programs and is a scientifically sound document for states to use when planning targeted population-based programs to reduce dental caries.
  • Fluorosis Facts: A Guide for Health Care Professionals AAP publication, Spanish: Gives health professionals a quick, thorough understanding of dental fluorosis and includes photos, follow-up resources, and suggestions for counseling on prevention.
  • Oral Health Practice Tools Helps primary care providers incorporate oral health into practice with these easy-to-use tools and downloadable resources. Learn how to perform an oral health risk assessment, provide nutrition and oral hygiene counseling, and to apply fluoride varnish as vital components of well-child exams. Starting with the Oral Health Prevention Primer can help!
  • Oral Health Toolkit for Primary Care Practice The integration of oral health into primary care practice is essential to improving oral health and overall health outcomes across the lifespan. For too long, oral health has been separated from the rest of the body, making it difficult for many populations and communities to access necessary preventive and emergent oral care. Developed through a collaboration between the Hawai'i State Department of Health, Family Health Services Division, and the UH Mānoa Nancy Atmosphera-Walch School of Nursing, this toolkit contains valuable resources for integrating oral health into your primary care practice. Download the Fluoride Varnish Factsheet for Parents.

Information for water operators

An adult collecting water samples from a faucet

Water operators, you play an important role in the public’s health and ensuring safe water supplies. One component of this responsibility might be adjusting the fluoride concentration of fluoride-deficient water supplies to the optimal level. This responsibility plays an enormous role in improving the oral health of residents with access to fluoridated water. Below are resources to assist you in fluoridation engineering/operations and in answering questions about the safety and effectiveness of community water fluoridation.

  • Campaign for Dental Health: Water Operators American Academy of Pediatrics: Many people take for granted that community water fluoridation (CWF) in the U.S. is a safe and well-accepted public health practice, but some people question or even oppose it. As a water facility operator, you may be confronted with questions from the customers you serve. We know that fluoridation is only a small portion of the important job you do. That’s why we have developed brief responses to common questions you may receive, including links to easy-to-read information for you and your customers.
  • The American Water Works Association Public Communication Toolkit American Water Works Association: The American Water Works Association has put together a public communications toolkit, housing all of their information on public communication. Use this toolkit to assist in conversations about community water fluoridation with the public.

Water Fluoridation Quality Awards (CDC)

Each year, many state drinking water programs and professional associations related to the drinking water industry have quality award programs. Many water utilities strive to qualify for these awards. Earning these awards represents a high level of operator care and accomplishment. To support state water fluoridation programs and recognize water treatment facilities that are doing an outstanding job of providing a consistent level of fluoride in the water supply, the CDC recognizes public water systems that achieve optimal fluoridation levels with an annual Water Fluoridation Quality Award.

For a water system to be eligible, its performance must be documented by the state in the Water Fluoridation Reporting System (WFRS). CDC issues the certificates annually to state oral health programs, which are responsible for distributing the award certificates to the recipient communities. These awards are important to community water systems because they provide CDC recognition for meeting high water quality standards that water systems can promote in their consumer communications.

For those systems that adjust fluoride levels, the Wisconsin Oral Health Program reviews monthly operating reports that have been submitted to the Department of Natural Resources (DNR). The reports are evaluated to identify those water systems that meet strict standards for accuracy in water fluoride treatment, daily monitoring and reporting. The information from these reports is entered into WFRS and used to identify systems that qualify for the Water Fluoridation Quality Award.

Water Fluoridation Quality Award criteria

  • Adequate Daily Samples
    • Sample required to be taken daily
    • Must be optimally fluoridating for 12 months within a year
    • 75% of daily samples must be in the recommended optimal operating range
  • Optimal Fluoride Concentration Control Range
    • Optimal fluoride concentration is 0.7 mg/L
    • Monthly average is a minimum of 0.7 mg/L
    • Lowest optimal concentration is 0.6 mg/L
    • Highest optimal concentration is 1.0 mg/L
  • Adequate Split Samples
    • Monthly split sample must be submitted to WSLH 12 months out of the year
    • Operator and lab split sample results must correlate
    • Split +/- tolerance is 0.20 mg/L
  • Monthly data entered into WFRS
    • by March 1 each year
    • Data that is entered after March 15 will not be used

Award certificates for individual water systems will be mailed to the state dental directors in early fall.

Not finding what you need? Reach out to the Oral Health Program.
Contact us and Sign Up for Oral Health Program updates.

Last revised April 12, 2024