Fluoridation Practice l Fluoridation Facts 77 NSF/ANSI Standard 604,6 provides for purity of drinking water additives as it limits an additive’s contribution of harmful contaminants to drinking water. The Standard also provides for safety assurances from production through distribution to ensure product quality is maintained. Additionally, the Standard requires documentation of the purity of the additives including specific criteria for products imported from other countries. NSF/ANSI Standard 614,6 is a related standard that provides guidance for equipment/products used in water treatment plants that come in contact with drinking water. Both NSF/ ANSI standards were developed by a consortium of associations including NSF, AWWA, the Association of State Drinking Water Administrators and the Conference of State Health and Environmental Managers with support from the U.S. Environmental Protection Agency.4 Fluoride additives, like all of the more than 40 additives typically used in water treatment, are “water grade” additives. All additives used at the water plant are classified as water grade additives meeting NSF Standard 60 requirements. Examples of other “water grade” additives which are commonly used in water plant operations are chlorine (gas), ferrous sulfate, hydrochloric acid, sulfur dioxide and sulfuric acid.8 Sometimes antifluoridationists express the view that they are not really opposed to fluoridation, but are opposed to the use of “industrial grade” fluoride additives. They may even go so far as to state that they would support fluoridation if the process was implemented with pharmaceutical grade fluoride additives that were approved by the U.S. Food and Drug Administration (FDA). On the surface, this may appear to be a “common sense” approach. In fact, this is usually a ploy whose only real purpose is to stop fluoridation. First, the EPA, not the FDA, has regulatory authority for additives used in public water systems. Second, and perhaps most importantly, the U.S. Pharmacopeia (USP) monograph on sodium fluoride does not provide for certification of quality by an independent credentialing body.4,9 Third, the USP and The National Formulary (USP-NF) standards used to formulate prescription drugs are not appropriate for water fluoridation additives as they could actually allow higher levels of contaminants to be introduced into drinking water than is allowed by the current EPA standards.4,9 According to the CDC:9 The USP does not provide specific protection levels for individual contaminants, but establishes a relative maximum exposure level for a group of related contaminants. Some potential impurities have no restrictions by the USP, including arsenic, some heavy metals regulated by the U.S. EPA, and radionuclides. Given the volumes of chemicals used in water fluoridation, a pharmaceutical grade of sodium fluoride for fluoridation could potentially contain much higher levels of arsenic, radionuclides, and regulated heavy metals than an NSF/ANSI Standard 60-certified product. Additional information about this topic can be found in this Section, Question 49. Lastly, USP-grade sodium fluoride product is more likely to result in water plant personnel being exposed to fluoride dust as it is more powder-like than the preferred AWWA-grade sodium fluoride which is crystalline and so minimizes dusting when handled.4 Additional information about this topic can be found in this Section, Question 52. 49. Does fluoridating the community water supply raise concerns about lead, arsenic and other toxic contaminants to the water supply? Answer. No. The concentrations of contaminants in drinking water as a result of fluoridation do not exceed, but are in fact, well below regulatory standards set to ensure the public’s safety. Fact. Fluorosilicic acid is used to fluoridate the majority of community water systems in the United States.10 Because the additive is derived from ore mined from the earth, fluorosilicic acid may contain minute amounts of contaminants such as lead and arsenic. However, existing regulations and standards require that these contaminants, and others, be at levels considered acceptable by the U.S. Environmental Protection Agency when the fluorosilicic acid or other fluoridation additives are diluted to produce optimally fluoridated water.6 NSF International and the American National Standards Institute (NSF/ ANSI) Standard 60 as well as AWWA standards are applicable to all fluoride additives.4,6