Oral Health Program: Fluoridation for Water Operators
You have a role in cavity prevention
Water operators 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 of 0.7 milligrams per liter.
This responsibility plays an enormous role in improving the oral health of residents with access to fluoridated water.
The following resources will assist you in fluoridation engineering, operations, and answering questions about the safety and effectiveness of community water fluoridation.
Fluoridation Learning Online (FLO) CDC (Centers for Disease Control and Prevention) training: This is 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
The Wisconsin Department of Natural Resources offers free continuing education credits to water operators taking the CDC FLO training (PDF). Water operators must submit training certificates to DNROpCert@wisconsin.gov for credits. Certificates for all modules must be submitted for full credit. Partial submissions only receive partial credits.
- Water Fluoridation Practice and Operation Tips & Tricks (Login required.) DHS training: This is a 30-minute webinar covering the basic principles of fluoridation engineering and community water fluoridation administrative guidance. Learn from Christopher Linskens, Wisconsin Department of Natural Resources, about the evidence and science behind this important public health benefit.
- Water Operators and Engineers CDC: This webpage provide a variety of resources, programs, and training for water operators and engineers.
- Water Fluoridation Quality Awards: Based on Water Fluoridation Reporting System data, Water Fluoridation Quality Awards recognize those water systems that adjust the fluoride concentration in drinking water and achieve a monthly average fluoride level that is within the optimal range for 12 consecutive months in a calendar year. This represents a high level of operator care and accomplishment. Providing a consistent level of fluoride in water ensures the benefit of preventing tooth decay. Access award criteria.
- Campaign for Dental Health: Water Operators American Academy of Pediatrics: Many people take for granted that water fluoridation 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 asked questions from the customers you serve. Fluoridation is only a small portion of the important job you do. This resource has brief responses to common questions you may receive, including links to easy-to-read information for you and your customers.
- American Water Works Association Strengthen Public Trust Resources American Water Works Association: The American Water Works Association has put together resources to guide conversations about water with the public. These resources can be used to help you discuss community water fluoridation in your community.
- Wis. Admin. Code ch. NR 809 Safe Drinking Water Wisconsin Department of Natural Resources (DNR): This includes information on compliance requirements for public water systems that fluoridate water, including the recommended optimal level of fluoride in drinking water, the maximum contaminant levels and the secondary drinking water standard. There is also information on sample collection, analytical requirements, requirements for fluoride containers, violation categories and information on situations that require public notification.
- Wis. Admin. Code ch. NR 810 Requirements for the Operation and Maintenance of Public Water Systems DNR: This governs the general operation and maintenance of all public water systems. This section includes valuable information on monitoring, reporting, and recordkeeping requirements.
- Wis. Admin. Code ch. NR 811 Requirements for the Operation and Design of Community Water Systems DNR: This includes information on fluoride storage, chemical feed installations, secondary controls, dust control, protective equipment, testing equipment and dilution equipment.
- Fluoride in Drinking Water (DNR): Learn about fluoridated water and how the DNR regulates it.
- Answers to Your Common Questions About Fluoride, P-03691 (PDF) Department of Health Services (DHS) publication: This fact sheet contains the most common questions about water fluoridation and its safety.
- Community Water Fluoridation, P-40111 (PDF) DHS publication: This fact sheet contains 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 FAQs CDC: Read frequently asked questions about fluoridated water and infant formula, bottled water, and more.
- 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. Here's where to get answers without the technical talk, to make finding what you need quick and easy.
- Fluoride in Drinking Water DNR: Read frequently asked questions about the regulation of fluoridation.
- Fluoride Science: Fluoride Science reviews fluoride studies for professional communities that may engage in patient care and public health services.
Water Fluoridation Quality Awards
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, public water systems that achieve optimal fluoridation levels receive 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). Certificates are issued annually to state oral health programs. These awards are important to community water systems because they provide 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
- Eighty percent 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 the Wisconsin State Lab of Hygiene 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
- March 1 each year
- Data 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.
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