86 l © 2025 American Dental Association
Section 3: Fluoridation Practice
From time to time, opponents of fluoridation allege that fluoridation additives are byproducts of
the phosphate fertilizer industry in an effort to suggest the additives are not safe. By definition,
byproducts are materials produced as a result of producing something else. In the chemical industry,
a byproduct (secondary product) is anything other than the principal product produced. The fact
that a product is a secondary product of a manufacturing process should not suggest the item is bad,
harmful, or a waste product. On the contrary, byproducts may have certain characteristics that make
them valuable resources. In the production of phosphate fertilizer, the fluoridation additive fluorosilicic
acid is a byproduct along with gypsum.378 Gypsum is commonly used in manufacturing wall board
used in construction. The production of orange juice provides another example of valuable byproducts.
In addition to orange juice, various byproducts are obtained from oranges during juice production that
are used in cleaners, fragrances, and flavorings.379
Fluoridation additives are valuable byproducts that come from producing phosphate fertilizer. To ensure
the public’s safety, additives used in water fluoridation meet standards of the AWWA and NSF.36
52. Does the process of water fluoridation present unusual safety
concerns for water systems and water facility operators?
Answer
No. With proper monitoring, maintenance, water facility operator training, and systems planning,
water fluoridation is a safe and reliable process.
Fact
Water facilities and water facility operators perform a valuable public service by carefully adjusting
the level of fluoride in water to improve the oral health of the community. Facilities and personnel
are subject to a number of regulations designed to ensure safety.
Employers must conform to federal Occupational Safety and Health Administration (OSHA)
requirements.380 OSHA’s mission is to assure safe and healthful workplaces by setting and enforcing
standards, and by providing training, outreach, education, and assistance. Under the Occupational
Safety and Health Act, employers are responsible for providing a safe and healthful workplace.
Employers must comply with all applicable OSHA standards.380
Additionally, to assist in protecting the professionals who produce sustainable supplies of high-quality
drinking water, the AWWA publishes detailed guidance on safety and safe working conditions for
water plant personnel.381
Furthermore, OSHA requires that Safety Data Sheets (SDSs), previously known as Material Safety Data
Sheets (MSDSs), be readily available to all employees for potentially harmful substances handled in the
workplace under the Hazard Communication regulation.382 SDSs often include instructions for the safe
use and potential hazards associated with a particular material and typically are made available in the
area where the material is stored or used. Information contained in an SDS focuses on the potential
hazards of working with the material in an occupational setting. Adherence to SDS guidelines for
handling fluoride additives helps to ensure that the recommended level of fluoride in drinking water
flows through the water system while maintaining water operator safety. With fluoride, the potential
hazards faced by a water facility employee in dealing with concentrated fluoride additives before they
enter the water system are not related to the level of fluoride in water as used by consumers. The
information found in the SDS is for the concentrated fluoride additives and is not applicable to water
with fluoride at the recommended level. Therefore, SDS sheets should not be used by consumers to
gauge potential hazards of community water fluoridation.
Section 3: Fluoridation Practice
From time to time, opponents of fluoridation allege that fluoridation additives are byproducts of
the phosphate fertilizer industry in an effort to suggest the additives are not safe. By definition,
byproducts are materials produced as a result of producing something else. In the chemical industry,
a byproduct (secondary product) is anything other than the principal product produced. The fact
that a product is a secondary product of a manufacturing process should not suggest the item is bad,
harmful, or a waste product. On the contrary, byproducts may have certain characteristics that make
them valuable resources. In the production of phosphate fertilizer, the fluoridation additive fluorosilicic
acid is a byproduct along with gypsum.378 Gypsum is commonly used in manufacturing wall board
used in construction. The production of orange juice provides another example of valuable byproducts.
In addition to orange juice, various byproducts are obtained from oranges during juice production that
are used in cleaners, fragrances, and flavorings.379
Fluoridation additives are valuable byproducts that come from producing phosphate fertilizer. To ensure
the public’s safety, additives used in water fluoridation meet standards of the AWWA and NSF.36
52. Does the process of water fluoridation present unusual safety
concerns for water systems and water facility operators?
Answer
No. With proper monitoring, maintenance, water facility operator training, and systems planning,
water fluoridation is a safe and reliable process.
Fact
Water facilities and water facility operators perform a valuable public service by carefully adjusting
the level of fluoride in water to improve the oral health of the community. Facilities and personnel
are subject to a number of regulations designed to ensure safety.
Employers must conform to federal Occupational Safety and Health Administration (OSHA)
requirements.380 OSHA’s mission is to assure safe and healthful workplaces by setting and enforcing
standards, and by providing training, outreach, education, and assistance. Under the Occupational
Safety and Health Act, employers are responsible for providing a safe and healthful workplace.
Employers must comply with all applicable OSHA standards.380
Additionally, to assist in protecting the professionals who produce sustainable supplies of high-quality
drinking water, the AWWA publishes detailed guidance on safety and safe working conditions for
water plant personnel.381
Furthermore, OSHA requires that Safety Data Sheets (SDSs), previously known as Material Safety Data
Sheets (MSDSs), be readily available to all employees for potentially harmful substances handled in the
workplace under the Hazard Communication regulation.382 SDSs often include instructions for the safe
use and potential hazards associated with a particular material and typically are made available in the
area where the material is stored or used. Information contained in an SDS focuses on the potential
hazards of working with the material in an occupational setting. Adherence to SDS guidelines for
handling fluoride additives helps to ensure that the recommended level of fluoride in drinking water
flows through the water system while maintaining water operator safety. With fluoride, the potential
hazards faced by a water facility employee in dealing with concentrated fluoride additives before they
enter the water system are not related to the level of fluoride in water as used by consumers. The
information found in the SDS is for the concentrated fluoride additives and is not applicable to water
with fluoride at the recommended level. Therefore, SDS sheets should not be used by consumers to
gauge potential hazards of community water fluoridation.
