Oral Health Program: Fluoride and Community Water Fluoridation

Fluoride is a mineral and helps prevent tooth decay.

Tooth decay is caused by certain bacteria in the mouth. When a person eats sugar and other refined carbohydrates, these bacteria produce acid that removes minerals from the surface of the tooth. Fluoride helps to remineralize tooth surfaces and prevents cavities from forming.

Fluoride in the body is necessary when teeth are forming under the gums to make teeth strong.

Fluoride on the surface works after teeth have erupted to continue to keep teeth strong.

In children younger than age 8, fluoride helps strengthen the adult (permanent) teeth that are developing under the gums.

Fluoride benefits children and adults throughout their lives.

The best way to get fluoride is through community water fluoridation. Natural fluoride is found in food, plants, animals, and ground water, but the amounts received in this way are usually too low to protect teeth from decay. Many Wisconsin communities adjust the amount of fluoride in drinking water to a level recommended for preventing tooth decay in a process called "community water fluoridation." This is a proven way to prevent dental decay throughout life.

Communities in Wisconsin have used water fluoridation to improve the oral health of residents since 1946. Community water fluoridation is safe, effective, and supported by public health, medical, and dental organizations worldwide. Fluoridation continues to be key to fight tooth decay in Wisconsinites.

Water fluoridation is not the only form of fluoride delivery that is effective in preventing tooth decay. In people of all ages, fluoride supports tooth enamel, keeping teeth strong and healthy. Fluoridated toothpaste, fluoride rinses, and fluoride varnish lower the risk for tooth decay, especially for people who are at higher risk for decay. Although these products reduce tooth decay, combined use with fluoridated water offers protection greater than any of these products used alone.

Fluoride varnish treatments can be received in a dental office, pediatrician's office, through a local health department, or Wisconsin Seal-A-Smile programs.

Fluoride is a mineral and in the right amount, fluoride in drinking water strengthens teeth.

The Wisconsin Oral Health Program follows the U.S. Department of Health and Human Services recommendation of 0.7 milligrams per Liter (mg/L) of fluoride, in your drinking water. Fluoride levels that range between 0.7 and 2mg/L prevent tooth decay and promote good oral health.

It is important to Know Your Water's Fluoride Level, P-03442 (PDF)

Fluoride found naturally in private wells is not regulated. Fluoride is present in virtually all waters but the amount varies across the state. It is important to know the fluoride content of your water.

Drinking water from private wells should be tested for fluoride regularly. Fluoride levels less than 0.7 mg/L are too low for oral health protection. Parents should talk with their child's medical or dental professional about supplementing with additional fluoride sources to ensure adequate oral protection.

• Community Water Fluoridation, P-40111 (PDF)  Department of Health Services (DHS) publication: Fact sheet containing information for addressing tooth decay as a public health issue affecting people of all ages in Wisconsin and how Community Water Fluoridation can help.
• How Fluoride Works CDC publication: Community Water fluoridation works to build a foundation for strong, healthy teeth. This infographic takes you through the process of how fluoridation prevents cavities and strengthens your smile. Print it to share with others.
• I Like My Teeth American Academy for Pediatrics (AAP): You may have a lot of questions about fluoridation, and rightly so. We all have questions about things that impact the health of our families. Here's where to get answers without the technical talk, to make finding what you need quick and easy.
• Community Water Fluoridation FAQs CDC: Read frequently asked questions about fluoridated water and infant formula, bottled water and more.
• Fluoride Myths and Facts AAP: You may have heard the myths, here is the correct information on the safety and effectiveness of fluoridation.
• Know Your Water's Fluoride Level, P-03442 (PDF) DHS publication: Fact sheet containing information for community water systems and private wells on finding your water's fluoride level, when a water test is necessary, and what to do with the results.
• My Water's Fluoride CDC: Most water contains some fluoride but usually not enough to prevent cavities. Community water systems can add just the right amount of fluoride to local drinking water to prevent cavities. My Water's Fluoride (MWF) allows consumers to learn about the fluoride level in their drinking water. Also, you can find out the number of people served by the system and the water source.

Learn more about fluoride varnish

Fluoride varnishes are a safe, simple, effective, inexpensive treatment that benefits people of all ages. Fluoride varnish can be painted on teeth by certified health professionals, such as physicians, nurses, dental hygienists, and physician assistants.

What is fluoride varnish?

Fluoride varnish is a protective coating that is painted on teeth to help prevent new cavities and stop cavities that have already started.

Why do we recommend fluoride varnish?

• Tooth decay (cavities) is one of the most common preventable diseases seen in children.
• Children as young as 12-18 months can get cavities.
• Cavities in baby teeth cause pain and can prevent children from being able to eat, speak, sleep, and learn properly.
• Children do not lose all their baby teeth until they are about 11 or 12 years old.
• Adults often get cavities at the gum line.
• People with certain health care needs or who are unable to brush their own teeth are at higher risk of getting cavities.

Is fluoride varnish safe?

Yes, fluoride varnish can be used on people of all ages from babies with their first tooth to adults. Only a very small amount of fluoride varnish is used.

How is fluoride varnish put on the teeth?

The varnish is painted on the teeth. It is quick and easy to apply.

How often should I receive a fluoride varnish?

Your health care professional will recommend what is best for you. Typically, it is painted on the teeth two to four times per year.

Where can I get a fluoride varnish treatment?

Fluoride varnish treatments can be offered at a pediatricians office, local health department (WIC appointment), school-based dental program, long-term care facility, or dental office.

How much does a fluoride varnish treatment cost?

Most fluoride varnish treatments are offered free of charge for children. The costs are typically covered by Wisconsin Medicaid, health/dental insurance plans, or grant programs. Adults should ask their health care professional about charges.

• Common Questions about Fluoride: A Resource for Parents and Caregivers AAP publication, Common Questions about Fluoride in Spanish: Explains the importance and safety of fluoride in a question and answer format.
• Fluoride, P-44532 (PDF) DHS publication: Fluoride is a mineral and helps prevent tooth decay. Learn how it benefits people of all ages, where to get fluoride and more.
• Fluorosis Facts: A Resource for Parents and Caregivers AAP publication, Fluorosis Facts in Spanish: Fluoride is an important mineral for all children. Our mouths contain bacteria that combine with sugars in the foods we eat and the beverages we drink to produce an acid that harms our teeth. Fluoride protects our teeth. But, too much fluoride can cause something called dental fluorosis.
• Fluoride Varnish for Adults Q+A National Maternal and Child Oral Health Resource Center publication, Fluoride Varnish for Adults Q+A in Spanish: Provides information for adults, including pregnant women, about how fluoride varnish can make teeth more resistant to tooth decay.

• All About Fluoride ADA publication: Fact sheet providing talking points and links to the latest science to help dental professionals learn about community water fluoridation and feel better prepared to share information with patients and community leaders.
  • Fluoridation Facts ADA publication: With answers to frequently asked questions, this e-book shares the scientific truth about community water fluoridation: It’s not only safe, but also good for preventing tooth decay and cavities. The book includes the newest research on the topic, helping keep policymakers and the general public in the know.
• Campaign for Dental Health: Health Professionals AAP: As a healthcare professional, patients rely on your advice to live healthier, longer, lives. That is why it is vital to discuss how oral health and water fluoridation can help them do just that. Here are tools that can help!
• Community Water Fluoridation, P-40111 (PDF) DHS publication: Fact sheet containing information for addressing tooth decay as a public health issue and how evidence-based prevention strategies like Community Water Fluoridation support Wisconsin's future.
• Community Water Fluoridation 101 DHS training: Course covering the topic of community water fluoridation (CWF). The course will provide attendees examples of the type of myths spread by those opposed to CWF and how to respond. As a foundation to understanding these myths, the course will also provide basic information on the science behind fluoridation, how it works and why it works to prevent tooth decay. The objective of this course is to educate members of the oral health workforce (dental professionals, medical professionals, public health professionals, and water operators and engineers) on the evidence and science of CWF. Additionally, The Wisconsin Oral Health Coalition will offer one dental CE for Wisconsin dental providers completing the course.
• FLUID Fluoride Legislative User Information Database: Comprehensive database containing legal decisions by U.S. courts and current information on federal, state and local policies regarding community water fluoridation.
• Fluoridation Learning Online (FLO) CDC training: A free resource designed to build the capability of state fluoridation programs, and to help increase knowledge and refine skills to implement and maintain community water fluoridation. Overview of FLO:
  Module 1: Science – the history and science of fluoridation, benefits, and health effects
  Module 2: Program – state program management and oversight, and communication principles
  Module 3: Water system overview and design
  Module 4: Technical information for water fluoridation additives and operations
• Fluoride Exposed: Real Science for You Fluoride Exposed: Looking for info on fluoride? Fluoride Exposed is a source for quality, detailed science and history of fluoride, fluoridation and more.
• Fluoride Science Fluoride Science: Fluoride Science reviews fluoride studies for professional communities that may engage in patient care and public health services.
• My Water's Fluoride CDC: Most water contains some fluoride but usually not enough to prevent cavities. Community water systems can add just the right amount of fluoride to local drinking water to prevent cavities. Find fluoride content of public water supplies prior to prescribing fluoride supplements.

Learn more about fluoride varnish

Fluoride varnishes—safe, simple, effective, inexpensive, treatment applied to all teeth

Technique—prescribed and completed by medical or dental providers

Materials/equipment—readily available from medical/dental supply companies

Wisconsin Medicaid—reimbursement policy includes certified health professionals, such as physicians, nurses, dental hygienists, and physician assistants.

Fluoride varnish programs—easily accessible

• School-based sealant programs—Wisconsin Seal-A-Smile
• Local health departments/Health Check agencies—WIC: Women, Infants, and Children Program
• Pediatric primary care practices—considered standard of care

• Fluoride Safety: A Guide for Health Professionals AAP publication, Fluoride Safety in Spanish: A concise explanation of the regulation and safety of fluoride additives and fluoridated water. Common concerns, including daily intake and infant formula, are addressed. Links to valuable resources are provided.
  • Common Questions about Fluoride: A Resource for Parents and Caregivers AAP publication, Common Questions about Fluoride in Spanish: Explains the importance and safety of fluoride in a question and answer format. A companion to Fluoride Safety: A Guide for Health Professionals, this handout lets your patients leave the office with accurate fluoride information in hand.
  • Fluorosis Facts: A Resource for Parents and Caregivers AAP publication, Fluorosis Facts in Spanish: Explains sources of fluoride, dental fluorosis, and gives parents stepwise guidance on preventive oral health care. A companion to Fluorosis Facts: A Guide for Health Professionals, this handout lets your patients leave the office with helpful information in hand.
• Fluoride Supplementation, P-44531 (PDF) DHS publication: Fact sheet containing information for health care professionals on Fluoride Supplementation.
• Fluoride Varnish: an Evidence-Based Approach Research Brief Association of State and Territorial Dental Directors publication: This research brief is a review of the evidence for fluoride varnish programs and is a scientifically sound document for states to use when planning targeted population-based programs to reduce dental caries.
• Fluorosis Facts: A Guide for Health Care Professionals AAP publication, Fluorosis Facts in Spanish: Gives health professionals a quick, thorough understanding of dental fluorosis and includes photos, follow-up resources, and suggestions for counseling on prevention.
• Oral Health Practice Tools Helps primary care providers incorporate oral health into practice with these easy-to-use tools and downloadable resources. Learn how to perform an oral health risk assessment, provide nutrition and oral hygiene counseling, and to apply fluoride varnish as vital components of well-child exams. Starting with the Oral Health Prevention Primer can help!
• Oral Health Toolkit for Primary Care Practice The integration of oral health into primary care practice is essential to improving oral health and overall health outcomes across the lifespan. For too long, oral health has been separated from the rest of the body, making it difficult for many populations and communities to access necessary preventive and emergent oral care. Developed through a collaboration between the Hawai'i State Department of Health, Family Health Services Division, and the UH Mānoa Nancy Atmosphera-Walch School of Nursing, this toolkit contains valuable resources for integrating oral health into your primary care practice. Download the Fluoride Varnish Fact Sheet for Parents.

• Chairside Guide for Talking to Your Patients About Fluoride Michigan Department of Health publication: Talking with your patients about fluoride can be difficult – there is a lot of misinformation out there and it can often seem like you’re at a loss for words. Here’s a few phrases to start or reframe the discussion about fluoride.
• Say This, Not That: Tips For Talking About Community Water Fluoridation AAP publication, Say This, Not That in Spanish: Designed to help health providers address technical, challenging questions with comfort and ease. Addressing many of the most common concerns, this tool offers discussion-friendly responses in a clever graphic format.

• Fluoridation Learning Online (FLO) CDC training: A free resource designed to build the capability of state fluoridation programs, and to help increase knowledge and refine skills to implement and maintain community water fluoridation. Overview of FLO:
  Module 1: Science – the history and science of fluoridation, benefits, and health effects
  Module 2: Program – state program management and oversight, and communication principles
  Module 3: Water system overview and design
  Module 4: Technical information for water fluoridation additives and operations
• Water Fluoridation Practice and Operation Tips & Tricks DHS training: A 30-minute webinar covering the basic principles of fluoridation engineering and community water fluoridation administrative guidance. Learn from Christopher Linskens, Wisconsin Department of Natural Resources, about the evidence and science behind this important public health benefit.
• Water Operators and Engineers CDC: Variety of resources, programs, and training for water operators and engineers.
  • Water Fluoridation Quality Awards CDC: Based on WFRS data, CDC issues Water Fluoridation Quality Awards to recognize those water systems that adjust the fluoride concentration in drinking water and achieve a monthly average fluoride level that is within the optimal range for 12 consecutive months in a calendar year. This represents a high level of operator care and accomplishment. Providing a consistent level of fluoride in water ensures the benefit of preventing tooth decay. See below for award criteria.
• Wisconsin Department of Natural Resources: Wis. Admin. Code ch. NR 809 Safe Drinking Water Wisconsin Department of Natural Resources (DNR): Information on compliance requirements for public water systems that fluoridate water, including the recommended optimal level of fluoride in drinking water, the maximum contaminant levels and the secondary drinking water standard. There is also information on sample collection, analytical requirements, requirements for fluoride containers, violation categories and information on situations that require public notification.
• Wisconsin Department of Natural Resources: Wis. Admin. Code ch. NR 810 Requirements for the Operation and Maintenance of Public Water Systems DNR: Governs the general operation and maintenance of all public water systems. This section includes valuable information on monitoring, reporting and recordkeeping requirements.
• Wisconsin Department of Natural Resources: Wis. Admin. Code ch. NR 811 Requirements for the Operation and Design of Community Water Systems DNR: Information on fluoride storage, chemical feed installations, secondary controls, dust control, protective equipment, testing equipment and dilution equipment.

• Campaign for Dental Health: Water Operators American Academy of Pediatrics: Many people take for granted that community water fluoridation (CWF) in the U.S. is a safe and well-accepted public health practice, but some people question or even oppose it. As a water facility operator, you may be confronted with questions from the customers you serve. We know that fluoridation is only a small portion of the important job you do. That’s why we have developed brief responses to common questions you may receive, including links to easy-to-read information for you and your customers.
• The American Water Works Association Public Communication Toolkit American Water Works Association: The American Water Works Association has put together a public communications toolkit, housing all of their information on public communication. Use this toolkit to assist in conversations about community water fluoridation with the public.