March 2022
The Maine Center for Disease Control and Prevention is committed to improving the health and well-being of Maine residents. Community water fluoridation, recognized as one of the ten great public health achievements of the 20th century, is an evidence-based approach for improving oral health. We agree with the scientific evidence available to us that adding fluoride to community water supplies at the recommended target level for drinking water is a safe and effective way to help prevent tooth decay. In Maine, that level has been 0.7 milligrams of fluoride to 1 liter of water (or one part per million) since February 2012, in accordance with recommendations from the US CDC.
Good oral health is part of good overall health and contributes significantly to an individual’s overall well-being. Children with poor oral health may suffer discomfort and pain but may also have problems in learning and in doing well in school. Benefits continue throughout the lifespan. Research suggests associations between poor oral health and the risk for, and effective management of, chronic and systemic diseases such as cardiovascular disease and diabetes, and with poor outcomes in pregnancy. When oral health is poor, management of these conditions may be more challenging.
Water fluoridation is a bargain for a community. Everyone benefits when fluoridated water is available in schools and other public places. Everyone gains from living in a healthier community. Fewer days are lost from work or school because of dental pain or the need to obtain treatment that could have been prevented, and fewer private and public dollars are spent on dental care.
Access to dental care, particularly for individuals without insurance, who are MaineCare members, and who live in areas where there are only a few dental providers, are issues that receive regular attention in Maine. Implementing and maintaining preventive programs on a community level is a primary strategy in improving access. Early childhood screenings, the availability of topical fluorides such as varnish, gels and rinses, and dental sealants can be integrated as important components in community level oral health programs. Along with these other strategies, community water fluoridation has been proven to be a safe, effective, and economical intervention that benefits all members of the community, regardless of their ability to gain access to dental care or to maintain other preventive practices.
Fluoride works in two ways to protect teeth against tooth decay, systemically when it is swallowed, and topically when it comes into contact with the teeth. Topical benefits come from using fluoridated toothpaste, fluoride rinses, gels, and varnish. But the effectiveness of topical fluorides is dependent on proper use, and they cannot provide the continuous benefit that a systemic fluoride offers. Community water fluoridation provides a systemic benefit starting early in life, by strengthening permanent teeth while they are forming under the gums. The benefit continues throughout the lifespan. The American Dental Association does recommend limiting exposure to fluoridated water for infants who get most or all of their nutrition from reconstituted formula, because of the potential of mild fluorosis. Fluorosis is not a disease, but it can change how teeth look, and may be caused when more than the right amount of fluoride is ingested by very young children. After teeth are in the mouth, fluorosis cannot occur. The first year of life is the most critical, when teeth can be most affected, so monitoring exposure to fluoride for infants is important. The occasional use of fluoridated water will not harm a baby’s developing teeth.
Fluoride is not a medication. It is a naturally occurring compound found in the environment. Water fluoridation should be considered the same way we look at using chlorine and other additives to our drinking water, and to other foods and beverages, such as vitamin D in milk, iodine in salt and folic acid in bread.
Maine drinking water regulations for fluoride require strict compliance with national standards for product quality and safety assurance, to prevent harmful levels of contaminants from all water treatment chemicals. The standards for fluoride used in drinking water are high, and carefully monitored. NSF/ANSI Standard 60, a program commissioned by the US Environmental Protection Agency and managed by NSF International, ensures the quality and safety of fluoride additives. Maine’s water system operators do an excellent job assuring the safety of the water they provide to the public.
Water fluoridation is a public health measure, no more and clearly nothing less. We believe the overwhelming weight of evidence shows it to be in the best interest of Mainers.