On August 26, 2003, after weeks of careful review and with strong support from Pinellas County water customers, the Pinellas County Board of County Commissioners approved the addition of fluoride to the Pinellas County water system.

At present, Pinellas County Utilities is the largest water supplier in the eastern United States whose community does not benefit from fluoridated tap water. By June 2004, in an effort to significantly reduce the occurrences of tooth decay in our community, Pinellas County will join 43 of the 50 largest cities in the U.S. by introducing water fluoridation to the Pinellas County Utilities water system.

• Water fluoridation has played an important role in the reduction of tooth decay (40-70%) in children and of tooth loss (40-60%) in adults.
• Water fluoridation is a safe and effective community health measure that benefits both children and adults.
• It is the success of water fluoridation, first used in 1945 in a U.S. public water supply, which led to the development and wide use of fluoride-containing products such as toothpaste, mouth rinse, and dietary supplements.
• Most large cities in the United States fluoridate their drinking water supplies including San Francisco, Los Angeles, Pittsburgh, Baltimore, and Washington, D.C.
• Water fluoridation is the least expensive and most effective way to reduce tooth decay and reduce the need for dental treatment and its costs.
• Water fluoridation is listed by the CDC and the Surgeon General as one of the top ten greatest public health achievements of the 20th century.

An Open Letter To the Customers of Pinellas County Utilities

Frequently Asked Questions

1. Is water fluoridation safe?
   
   
2. What level of fluoride will be added?
   
   
3. What are the benefits to water fluoridation?
   
   
4. Who benefits?
   
   
5. What will water fluoridation cost?
   
   
6. Should my child continue taking fluoride supplements?
   
   
7. Is fluoride considered a nutrient?
   
   
8. Should my family continue brushing with fluoride toothpaste?
   
   
9. Is fluoride safe for my pets?
   
   
10. Will a water softener affect the fluoride levels in my home's tap water?
    
    
11. Why did the Pinellas County Board of County Commissioners decide to fluoridate the County’s public water supply at this time?
    
    
12. Which cities in Pinellas County currently fluoridate their public water supply?
    
    
13. Does fluoridated water increase the lead levels in children?
    
    
14. Will fluoridated water affect the plumbing in my home?
    
    
15. Does the water softening process affect the concentration of fluoride in my drinking water?
    
    
16. What is fluorosis and when does it occur?
    
    
17. Is it true that over time fluoride (provided through water fluoridation) accumulates in the body causing adverse bone health affects, such as skeletal fluorosis?
    
    
18. Are we at risk of consuming too much fluoride through foods, beverages, AND water?
    
    
19. Who supports water fluoridation?
    
    
20. Where can I find out more about water fluoridation?
    
    
21. Do health studies exist on the chemicals used in water fluoridation?

Is water fluoridation safe?
As with other nutrients, fluoride is safe and effective when used and consumed properly. More than 50 years of evidence from 162 million Americans and nearly 60 other countries supports the effectiveness of fluoridated water and its ability to inhibit, reduce, or even reverse the onset and development of tooth decay. Through continuous research, drinking optimally fluoridated water has been scientifically proven to be safe (not toxic) and effective.

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What level of fluoride will be added?
Natural fluoride levels in Pinellas County water currently range from an average of 0.15-0.25 parts per million (ppm)*. Water fluoridation will adjust the natural fluoride concentration in Pinellas County’s drinking water to 0.8 ppm, a level recommended for optimal dental health in our climate.

* parts per million, ppm, is equivalent to one cent in $10,000

What are the benefits to water fluoridation?
Health experts endorse water fluoridation as the single, most effective public health measure to improve oral health.

• Water fluoridation can reduce tooth decay.
• Fluoride strengthens tooth enamel.
• Fluoride protects a baby’s first teeth.
• Water fluoridation is a cost effective means to improving community dental health.

Who benefits?
The entire community benefits from water fluoridation regardless of a person’s age, income, level of education, or ability to get dental care. A concentration of 0.8 ppm of fluoride can reduce the amount of cavities in children’s baby teeth by as much as 60% and reduce tooth decay in adults by nearly 35%.

What will water fluoridation cost?
Pinellas County Utilities estimates a cost of $300,000 to construct the fluoridation system with an annual cost of $115,000 for adding fluoride to the drinking water. This will be absorbed into current operating costs, an average of approximately 32 cents per customer per year, and will not require a water rate increase.

Should my child continue taking fluoride supplements?
The Florida Department of Health recommends that prescription dietary fluoride supplements should not be given to any child who lives or goes to school in a fluoridated water community. However, you should consult the pediatrician or dentist who prescribed the supplement before making any decisions.

Is fluoride considered a nutrient?
Fluoride is listed by the Institute of Medicine's Food & Nutrition Board as a micro nutrient. It is included on the Dietary Reference Intake (DRI) Table for phosphorus, calcium, magnesium, vitamin D and fluoride. Pharmacists frequently reference this table in the course of their work.

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Should my family continue brushing with fluoride toothpaste?
Yes. Fluoridated water is part of a total oral health program. You can get additional protection when you brush with a fluoride toothpaste. You should make sure your young children do not swallow toothpaste.

Is fluoride safe for my pets?
Yes. Fluoride is safe for pets including aquatic life. Having fluoride in the water dish may even benefit the dental health of those pets with teeth.

Why did the Pinellas County Board of County Commissioners decide to fluoridate the County’s public water supply at this time?
The Pinellas County Board of County Commissioners made the decision to fluoridate the County's water supply based on overwhelming information that fluoride is beneficial to the dental health of most citizens and is not harmful to the ordinary person.

Specifically, Pinellas County relied on the reviews of data and/or the recommendations from the Centers for Disease Control (CDC), US Environmental Protection Agency (USEPA), American Medical Association (AMA), American Dental Association (ADA), US Surgeon General, Florida Health Department and the County Health Department. The Commission was made aware that most of the public utilities in Florida and in the Tampa Bay Area have been fluoridated for years. The health concerns from those who have been opposed to fluoridation have not been identified in these other communities.

The Commission had also instructed that a statistically valid survey be conducted among the water customers of Pinellas County Utilities to determine their support or opposition to the fluoridation of the public water supply. The survey, conducted between December 2001 and February 2002, found that 51% of Pinellas County Utilities’ customers support water fluoridation while 12% were opposed; the remaining 37% could not form an opinion on the issue. Of those opposed only 4% were concerned about the health impacts of fluoridation.

The Pinellas County Board of County Commissioners acted with a thorough review of the fluoridation information and, based on the data supported in concert with the majority of its water customers, felt that there was a health benefit associated with fluoridation of the public water supply.

Which cities in Pinellas County currently fluoridate their public water supply?

St. Petersburg, Gulfport, South Pasadena, parts of Oldsmar, Belleair, and Dunedin

Does fluoridated water increase the lead levels in children?
Scientific studies that have allegedly shown elevated lead levels in children living in fluoridated water areas have been reviewed by appropriate health agencies. They do not, in most cases, meet strict scientific research guidelines, and they do not show a “cause & effect” relationship between fluoride and elevated lead levels in children.

Will fluoridated water affect the plumbing in my home?
There is no known adverse impact on home plumbing from the addition of fluoride in drinking water. Opponents contend that fluorosilicic acid lowers pH, thus enhancing corrosivity. The amount added will not significantly impact pH in the well-buffered source water used by PCU. Additionally, pH is carefully monitored and adjusted to optimal levels at entry points to the distribution system.

Does the water softening process affect the concentration of fluoride in my drinking water?
Fluoride in drinking water is present as the fluoride ion, which is not typically removed by water softeners. Processes that may significantly reduce fluoride ions in drinking water include reverse osmosis and activated alumina filtration. Consult with a water filtration company for more specific information on these processes and how they may work for you.

What is fluorosis and when does it occur?
Dental fluorosis is a change in the appearance of teeth and is caused when higher than optimal amounts of fluoride are ingested in early childhood while tooth enamel is forming. The risk of dental fluorosis can be greatly reduced by closely monitoring the proper use of fluoride products by young children.

Dental fluorosis is caused by a disruption in enamel formation which occurs during tooth development in early childhood. Enamel formation of permanent teeth, other than third molars (wisdom teeth), occurs from about the time of birth until approximately five years of age. After tooth enamel is completely formed, dental fluorosis cannot develop even if excessive fluoride is ingested. Older children and adults are not at risk for dental fluorosis. Dental fluorosis only becomes apparent when the teeth erupt. Because dental fluorosis occurs while teeth are forming under the gums, teeth that have erupted are not at risk for dental fluorosis. (American Dental Association. Fluoridation Facts 1999.)

Is it true that over time fluoride (provided through water fluoridation) accumulates in the body causing adverse bone health affects, such as skeletal fluorosis?
After ingestion of fluoride, such as drinking a glass of optimally fluoridated water, the majority of the fluoride is absorbed into the blood stream. The fluoride levels quickly reach a peak concentration and then rapidly decline, usually within three to six hours. This decline is due to the uptake of fluoride by hard tissue, such as bones and teeth, and the efficient removal of fluoride by the kidneys. The amount of fluoride taken up by bone and retained in the body is inversely related to age. More fluoride is retained in young bones than in the bones of older adults.

According to generally accepted scientific knowledge, the ingestion of optimally fluoridated water does not have an adverse effect on bone health. Evidence of advanced skeletal fluorosis, or crippling skeletal fluorosis, “was not seen in communities in the United States where water supplies contained up to 20 ppm (natural levels of fluoride).” Crippling skeletal fluorosis is extremely rare in the United States and is not associated with optimally fluoridated water. (American Dental Association. Fluoridation Facts 1999.)

Are we at risk of consuming too much fluoride through foods, beverages, AND water?
The total intake of fluoride from air, water and food in an optimally fluoridated community in the United States does not pose significant health risks.

Children living in a community with water fluoridation get a portion of their daily fluoride intake from fluoridated water and a portion from dietary sources which would include food and other beverages. When considering water fluoridation, an individual must consume one liter of water fluoridated at 1 part per million (1 ppm) to receive 1 milligram (1 mg) of fluoride. Children under six years of age would consume, on average, less than 0.5mg of fluoride a day from drinking optimally fluoridated water (at 1 ppm).

The optimal concentration for fluoride in water in the United States has been established in the range of 0.7 to 1.2 ppm, depending on the annual average of the maximum daily air temperature in the geographic area. Therefore, in Pinellas County, the optimal concentration for fluoride in water is 0.8 ppm.

Studies of fluoride intake from the diet including foods, beverages and water indicate the fluoride ingestion from these sources has remained relatively constant for over half a century and, therefore, is not likely to be associated with an observed increase in dental fluorosis. Dental decay has decreased because children today are being exposed to fluoride from a wider variety of sources than decades ago.

(American Dental Association. Fluoridation Facts 1999.)

Who supports water fluoridation?
Virtually all major national and international health, service and professional organizations endorse or support water fluoridation, including the following:

• American Dental Association (ADA)
• American Medical Association (AMA)
• American Academy of Pediatrics
• American Academy of Pediatric Dentistry
• US Public Health Service
• United States Center for Disease Control and Prevention (CDC)
• World Health Organization (WHO)
• National Academy of Sciences
• American Water Works Association (AWWA)
• Florida Department of Health (FDOH)