44 l © 2025 American Dental Association
Section 2: Safety
22. Does the total intake of fluoride from air, water, food, and beverages
in the community in the United States with drinking water fluoridated
at the recommended level pose significant health risks?
Answer
No. The total intake of fluoride from air, water, food, and beverages in the community in the
United States with drinking water fluoridated at the recommended level does not pose significant
health risks.
Fact
In the United States, the Safe Drinking Water Standards in place account for all sources of fluoride and
provide assurance of safety with respect to fluoride exposure. From time to time, concerns have been
raised about fluoride exposures adversely affecting different aspects of health however, with further
study, none of these concerns has been demonstrated to pose significant health risks.
Fluoride from the Air
The atmosphere contains negligible concentrations of airborne fluorides. Studies reporting the levels
of fluoride in air in the United States show that ambient fluoride contributes very little to a person’s
overall fluoride intake.26,199
Fluoride from Water
Water and water-based beverages are the chief source of dietary fluoride intake. Previous studies,
when the recommended water fluoride level was 1.0 mg/L, estimated that most individuals received
approximately 75% of dietary fluoride from water and water-based beverages.205,206 The recommended
level for fluoride in drinking water in the United States since 2015 has been established at 0.7 mg/L
by the USPHS to reduce tooth decay substantially while balancing the occurrence of dental fluorosis.39
Thus, the proportion of dietary fluoride from water has decreased for those drinking optimally
fluoridated water, although water remains the chief source.
In the United States, the natural level of fluoride in groundwater varies from very low levels (less than
0.2 mg/L) to more than 4 mg/L. Public water systems in the country are monitored by the EPA, which
requires that public water systems not exceed a naturally occurring fluoride level of 4 mg/L.201
When considering water fluoridation, an individual consuming 1 L of water fluoridated at 0.7 mg/L
receives 0.7 milligrams of fluoride, while those consuming 1 L of water at 4.0 mg/L receive 4.0 milligrams
of fluoride. Thus, while there can be considerable variation in fluoride intake from water across all
water fluoride levels, for people drinking optimally fluoridated water, the amount of fluoride intake
from water is relatively low. Individuals 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 include
foods and other beverages.
For generations, millions of people have lived in areas where fluoride is found naturally in drinking
water in concentrations as high as or higher than those recommended to prevent tooth decay, and
sometimes higher than 4.0 mg/L. Research conducted among these populations confirms the safety of
fluoride in the water supply.182-186 For example, a 10-year comparison study186 of long-time residents
of Bartlett and Cameron, Texas, where the water supplies contained 8.0 and 0.4 mg/L of fluoride,
respectively, included examinations of organs, bones, and tissues. Other than a higher prevalence
of dental fluorosis in the Bartlett residents (8.0 mg/L fluoride), the study indicated that long-term
consumption of fluoride from water and food sources (resident average length of fluoride exposure
Section 2: Safety
22. Does the total intake of fluoride from air, water, food, and beverages
in the community in the United States with drinking water fluoridated
at the recommended level pose significant health risks?
Answer
No. The total intake of fluoride from air, water, food, and beverages in the community in the
United States with drinking water fluoridated at the recommended level does not pose significant
health risks.
Fact
In the United States, the Safe Drinking Water Standards in place account for all sources of fluoride and
provide assurance of safety with respect to fluoride exposure. From time to time, concerns have been
raised about fluoride exposures adversely affecting different aspects of health however, with further
study, none of these concerns has been demonstrated to pose significant health risks.
Fluoride from the Air
The atmosphere contains negligible concentrations of airborne fluorides. Studies reporting the levels
of fluoride in air in the United States show that ambient fluoride contributes very little to a person’s
overall fluoride intake.26,199
Fluoride from Water
Water and water-based beverages are the chief source of dietary fluoride intake. Previous studies,
when the recommended water fluoride level was 1.0 mg/L, estimated that most individuals received
approximately 75% of dietary fluoride from water and water-based beverages.205,206 The recommended
level for fluoride in drinking water in the United States since 2015 has been established at 0.7 mg/L
by the USPHS to reduce tooth decay substantially while balancing the occurrence of dental fluorosis.39
Thus, the proportion of dietary fluoride from water has decreased for those drinking optimally
fluoridated water, although water remains the chief source.
In the United States, the natural level of fluoride in groundwater varies from very low levels (less than
0.2 mg/L) to more than 4 mg/L. Public water systems in the country are monitored by the EPA, which
requires that public water systems not exceed a naturally occurring fluoride level of 4 mg/L.201
When considering water fluoridation, an individual consuming 1 L of water fluoridated at 0.7 mg/L
receives 0.7 milligrams of fluoride, while those consuming 1 L of water at 4.0 mg/L receive 4.0 milligrams
of fluoride. Thus, while there can be considerable variation in fluoride intake from water across all
water fluoride levels, for people drinking optimally fluoridated water, the amount of fluoride intake
from water is relatively low. Individuals 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 include
foods and other beverages.
For generations, millions of people have lived in areas where fluoride is found naturally in drinking
water in concentrations as high as or higher than those recommended to prevent tooth decay, and
sometimes higher than 4.0 mg/L. Research conducted among these populations confirms the safety of
fluoride in the water supply.182-186 For example, a 10-year comparison study186 of long-time residents
of Bartlett and Cameron, Texas, where the water supplies contained 8.0 and 0.4 mg/L of fluoride,
respectively, included examinations of organs, bones, and tissues. Other than a higher prevalence
of dental fluorosis in the Bartlett residents (8.0 mg/L fluoride), the study indicated that long-term
consumption of fluoride from water and food sources (resident average length of fluoride exposure
