• The Pinellas County Board of County Commissioners approved the addition of fluoride to the water system on Nov. 29, 2012, with implementation on March 1, 2013.
• Pinellas County’s first priority is the protection of public health. We are in full compliance with the U.S. Environmental Protection Agency’s (EPA) standard for fluoride in drinking water. Pinellas County’s fluoride level is well below EPA’s Maximum Contaminant Level (MCL) of 4.0 parts per million (ppm) and EPA’s Secondary MCL of 2 ppm, which was set to protect against cosmetic dental effects that may occur from excess fluoride consumption.
• Based on new information regarding the relative contribution of fluoride from sources other than drinking water, the U.S. Department of Health and Human Services (DHHS) has proposed an optimum fluoride level of 0.7 ppm.
• The fluoride level in our community drinking water will be 0.7 ppm, which is the minimum of the optimum range of 0.7 to 1.2 ppm recognized to promote dental health.
• Pinellas County will remain alert for further developments regarding any proposed regulatory revisions pertaining to drinking water fluoridation.

Frequently Asked Questions

1. Is water fluoridation safe?
   
   
2. What level of fluoride is added?
   
   
3. What are the benefits to water fluoridation?
   
   
4. Who benefits?
   
   
5. What does 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?
    
    
12. Who will be affected by the addition of fluoride?
    
    
13. Does fluoridated water increase the lead levels in children?
    
    
14. Does 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. Can I remove the fluoride from my home drinking water?
    
    
20. Who supports water fluoridation?
    
    
21. Do health studies exist on the chemicals used in water fluoridation?
    
    
22. Where can I find out more about 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 is added?
Natural fluoride levels in Pinellas County water currently range from an average of 0.15-0.50 parts per million (ppm)*. Water fluoridation will adjust the natural fluoride concentration in Pinellas County’s drinking water to 0.7 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 improve 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 0.7 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 does water fluoridation cost?
Pinellas County will have an annual cost of approximately $130,000 for adding fluoride to the drinking water. This is absorbed into annual operating costs.

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 micronutrient. 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?
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 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.

Who will be affected by the addition of fluoride?
This change will affect all Pinellas County water customers, as well as the customers of Clearwater, Pinellas Park, Safety Harbor and Tarpon Springs.

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.

Does 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 Pinellas County. 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 0.7 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.)

Can I remove the fluoride from my home drinking water?
Fluoride may be removed from water by some home water treatment systems with varying effectiveness. Although each type reduces fluoride to some extent, some units may reduce fluoride by greater than 95%. Consult with home treatment system providers for information regarding fluoride removal efficiency of their products.

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)

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Do health studies exist on the chemicals used in water fluoridation?
The claim is sometimes made that no health studies exist on the silicofluoride chemicals used in water fluoridation. The scientific community does not study health effects of concentrated chemicals as put into water. The health effects of the treated water are studied, i.e. what those chemicals become when added to water such as the fluoride ion, silicates and the hydrogen ion. The health effects of fluoride have been analyzed by literally thousands of studies over 50 years and have been found to be safe and effective in reducing tooth decay. The EPA has not set any Maximum Contaminant Level (MCL) for the silicates as there are no health concerns for them at the low concentrations found in drinking water.

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Where can I find out more about water fluoridation?

• Bill insert
• Fluoridated water - What's in it for you (UtiliTalk Feb./Mar. 2013 upcoming issue)

Also visit the following websites for information on water fluoridation: 

• www.ada.org
• www.ama-assn.org
• www.cdc.gov
• www.who.int