© 2025 American Dental Association l 87
Fluoridation Facts
As part of safety procedures, water facility personnel receive training on the management of the
additives in water plants. With proper use of personal protective equipment (PPE), an operator will not
have hazardous exposure to fluoride additive products. Fluoride additives present risks comparable
to other water additives in common use at water facilities, such as hypochlorite, quicklime, aluminum
sulfate, sodium hydroxide, and ferrous sulfate. In some cases, the fluoride additives are much less
dangerous than many other additives, including chlorine gas commonly used in many water facilities.381
Today’s equipment generally allows water facility personnel to easily monitor and maintain the desired
fluoride concentration. Automatic monitoring technology is also available that can help to ensure that
the fluoride concentration of the water remains within the recommended range.36
It is important that the water facility personnel responsible for monitoring the addition of fluoride to
the water supply are appropriately trained and that the equipment used for this process is adequately
maintained.36 With more than 80 years of experience and thousands of water systems adding fluoride
every day, water facility personnel have not only an excellent safety record related to their personal
safety, but also an excellent record in providing safe drinking water to their customers.
53. Does fluoridation present difficult engineering problems?
Answer
No. Adding fluoride products to water is no different than adding other commonly used water
treatment additive products using the same equipment and techniques.
Fact
Fluoride additives used to adjust the fluoride level in drinking water are compatible with other water
treatment processes, often using the same type of equipment and other standard materials designed
for the safe handling of other water treatment additive products in drinking water treatment facilities.
Fluoride additives are introduced to the water supply as liquids. There are many control devices, some
in use for decades and some newer equipment, that allow water facility personnel to easily monitor and
maintain the desired fluoride level, as well as levels of other water treatment additives and naturally
occurring substances that can be in the water. Automatic monitoring technology is available that can
help to ensure that the fluoride concentration of the water remains within the recommended range.36
When added to community water supplies, the concentrated fluoride additives become greatly
diluted.89 For example, fluorosilicic acid is typically diluted approximately 315,000 times to reach the
recommended target concentration of 0.7 mg/L. The exact dilution factor depends on the concentration
of the fluoride additive and the amount of additive being used to reach the concentration of 0.7 mg/L.
At 0.7mg/L (or 0.7 ppm), seven-tenths of one part of fluoride is diluted in 999,999.3 parts of water.
With more than 80 years of experience with water fluoridation, there is considerable guidance on
sound engineering practices to design, construct, operate, and maintain water fluoridation systems.
By design and with proper maintenance and testing, water systems can provide the recommended level
of fluoride within a narrow control range of the target of 0.7 mg/L.383,384 Additional design features such
as the use of a day tank (that holds only one day’s supply of fluoride) can limit the amount of fluoride that
can be added to a water system in a 24-hour period and is the most reliable method to ensure overfeed
protection.36 The state Office of Drinking Water, or a similar state agency, will normally establish
engineering requirements for safety. Additional standards and references on best engineering
practice are available from the AWWA and the CDC.36,385
Fluoridation Facts
As part of safety procedures, water facility personnel receive training on the management of the
additives in water plants. With proper use of personal protective equipment (PPE), an operator will not
have hazardous exposure to fluoride additive products. Fluoride additives present risks comparable
to other water additives in common use at water facilities, such as hypochlorite, quicklime, aluminum
sulfate, sodium hydroxide, and ferrous sulfate. In some cases, the fluoride additives are much less
dangerous than many other additives, including chlorine gas commonly used in many water facilities.381
Today’s equipment generally allows water facility personnel to easily monitor and maintain the desired
fluoride concentration. Automatic monitoring technology is also available that can help to ensure that
the fluoride concentration of the water remains within the recommended range.36
It is important that the water facility personnel responsible for monitoring the addition of fluoride to
the water supply are appropriately trained and that the equipment used for this process is adequately
maintained.36 With more than 80 years of experience and thousands of water systems adding fluoride
every day, water facility personnel have not only an excellent safety record related to their personal
safety, but also an excellent record in providing safe drinking water to their customers.
53. Does fluoridation present difficult engineering problems?
Answer
No. Adding fluoride products to water is no different than adding other commonly used water
treatment additive products using the same equipment and techniques.
Fact
Fluoride additives used to adjust the fluoride level in drinking water are compatible with other water
treatment processes, often using the same type of equipment and other standard materials designed
for the safe handling of other water treatment additive products in drinking water treatment facilities.
Fluoride additives are introduced to the water supply as liquids. There are many control devices, some
in use for decades and some newer equipment, that allow water facility personnel to easily monitor and
maintain the desired fluoride level, as well as levels of other water treatment additives and naturally
occurring substances that can be in the water. Automatic monitoring technology is available that can
help to ensure that the fluoride concentration of the water remains within the recommended range.36
When added to community water supplies, the concentrated fluoride additives become greatly
diluted.89 For example, fluorosilicic acid is typically diluted approximately 315,000 times to reach the
recommended target concentration of 0.7 mg/L. The exact dilution factor depends on the concentration
of the fluoride additive and the amount of additive being used to reach the concentration of 0.7 mg/L.
At 0.7mg/L (or 0.7 ppm), seven-tenths of one part of fluoride is diluted in 999,999.3 parts of water.
With more than 80 years of experience with water fluoridation, there is considerable guidance on
sound engineering practices to design, construct, operate, and maintain water fluoridation systems.
By design and with proper maintenance and testing, water systems can provide the recommended level
of fluoride within a narrow control range of the target of 0.7 mg/L.383,384 Additional design features such
as the use of a day tank (that holds only one day’s supply of fluoride) can limit the amount of fluoride that
can be added to a water system in a 24-hour period and is the most reliable method to ensure overfeed
protection.36 The state Office of Drinking Water, or a similar state agency, will normally establish
engineering requirements for safety. Additional standards and references on best engineering
practice are available from the AWWA and the CDC.36,385
