82 l © 2025 American Dental Association
Section 3: Fluoridation Practice
48. What standards have been established to ensure the safety of
fluoride additives used in community water fluoridation in the
United States?
Answer
The three fluoride additives used in the United States to fluoridate community water systems
(sodium fluoride, sodium fluorosilicate, and fluorosilicic acid) meet safety standards established
by the American Water Works Association and NSF International.36
Fact
Additives used in water treatment meet safety standards prepared in response to a request by
the EPA to establish minimum requirements to ensure the safety of products added to water for
its treatment, thereby ensuring the public’s health.36 Specifically, fluoride additives used in water
fluoridation meet standards established by the American Water Works Association (AWWA) and
NSF International.36 Additionally, the American National Standards Institute (ANSI) endorses both
AWWA and NSF standards for fluoridation additives and includes its name on these standards.36
The AWWA364 is an international nonprofit scientific and educational society dedicated to providing
total water solutions to assure the effective management of water. Founded in 1881, the AWWA is
the largest organization of water supply professionals in the world. The membership represents the full
spectrum of the water community: public water and wastewater system professionals, environmental
advocates, scientists, academicians, and others who hold a genuine interest in water. AWWA unites
the diverse water community to advance public health, safety, the economy, and the environment.364
NSF International,365 an independent accredited organization, is dedicated to being the leading global
provider of public health and safety-based risk management solutions. Manufacturers, regulators,
and consumers look to NSF to develop public health standards and certifications that help protect
food, water, consumer products, and the environment. Its professional staff includes microbiologists,
toxicologists, chemists, engineers, and environmental and public health professionals. Founded in 1944
as the National Sanitation Foundation, NSF’s mission is to protect and improve global human health.365
ANSI366 is a private non-profit organization that administers and coordinates the US voluntary
standardization and conformity assessment system. ANSI’s mission is to enhance both the global
competitiveness of US business and the US quality of life by promoting and facilitating voluntary
consensus standards and conformity assessment systems as well as safeguarding their integrity.366
The AWWA documents provide manufacturers, suppliers, and purchasers with standards for the
manufacturing, quality, and verification for each of the three fluoride additives listed below. The
AWWA standards set the physical, chemical, and impurities standards, including information on
verification of the standard requirements and requirements for delivery.364
• ANSI/AWWA B701 Sodium Fluoride
• ANSI/AWWA B702 Sodium Fluorosilicate
• ANSI/AWWA B703 Fluorosilicic Acid36
Section 3: Fluoridation Practice
48. What standards have been established to ensure the safety of
fluoride additives used in community water fluoridation in the
United States?
Answer
The three fluoride additives used in the United States to fluoridate community water systems
(sodium fluoride, sodium fluorosilicate, and fluorosilicic acid) meet safety standards established
by the American Water Works Association and NSF International.36
Fact
Additives used in water treatment meet safety standards prepared in response to a request by
the EPA to establish minimum requirements to ensure the safety of products added to water for
its treatment, thereby ensuring the public’s health.36 Specifically, fluoride additives used in water
fluoridation meet standards established by the American Water Works Association (AWWA) and
NSF International.36 Additionally, the American National Standards Institute (ANSI) endorses both
AWWA and NSF standards for fluoridation additives and includes its name on these standards.36
The AWWA364 is an international nonprofit scientific and educational society dedicated to providing
total water solutions to assure the effective management of water. Founded in 1881, the AWWA is
the largest organization of water supply professionals in the world. The membership represents the full
spectrum of the water community: public water and wastewater system professionals, environmental
advocates, scientists, academicians, and others who hold a genuine interest in water. AWWA unites
the diverse water community to advance public health, safety, the economy, and the environment.364
NSF International,365 an independent accredited organization, is dedicated to being the leading global
provider of public health and safety-based risk management solutions. Manufacturers, regulators,
and consumers look to NSF to develop public health standards and certifications that help protect
food, water, consumer products, and the environment. Its professional staff includes microbiologists,
toxicologists, chemists, engineers, and environmental and public health professionals. Founded in 1944
as the National Sanitation Foundation, NSF’s mission is to protect and improve global human health.365
ANSI366 is a private non-profit organization that administers and coordinates the US voluntary
standardization and conformity assessment system. ANSI’s mission is to enhance both the global
competitiveness of US business and the US quality of life by promoting and facilitating voluntary
consensus standards and conformity assessment systems as well as safeguarding their integrity.366
The AWWA documents provide manufacturers, suppliers, and purchasers with standards for the
manufacturing, quality, and verification for each of the three fluoride additives listed below. The
AWWA standards set the physical, chemical, and impurities standards, including information on
verification of the standard requirements and requirements for delivery.364
• ANSI/AWWA B701 Sodium Fluoride
• ANSI/AWWA B702 Sodium Fluorosilicate
• ANSI/AWWA B703 Fluorosilicic Acid36
