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MANDATORY STATE LAWS ON FLUORIDATION
Prepared by
Tom Reeves, CDC Fluoridation Engineer
December 1, 2000
(Source: Juneau Fluoride Study Commission, Exhibit C, July 11, 2006)
With Updates from Fluoride Action Network
Mandatory Laws:
|Twelve states, Puerto Rico and the District of Columbia have laws intended to provide statewide
fluoridation. These states and the year that the fluoridation legislation was passed are listed below:
District of Columbia (1952)
Has only one water system and it has been fluoridated since 1952.
2008 UPDATE: Population receiving optimally fluoridated water: 100%
California (1995)
Fluoridation is mandated for communities of 10,000 or more service connections (estimated 25, 000 population).
"Outside" funds must be found for purchase, installation, and operations of the fluoridation system.
The law does not address water supply wholesalers.
The law sets a MCL of 2.0 mg/L.
California's law cannot be enforced unless "outside" funds are made
available to the community for purchase, installation, and operation of the fluoridation system.
UPDATE:
•
Implementtion of mandatory fluoridation began in 2007 affecting approximately 18 million Southern Californians.
• Recommended range of 0.7 to 0.8 part per million
• 2006 rates for California population receiving optimally fluoridated water: 27.1% (9,881,390 people)
* see FAN's California NewsTracker
Connecticut (1965)
set lower limits on the size of the communities which must comply.
Fluoridation is mandated for communities with populations of 20,000 or more and
natural fluoride content of less than 0.8 mg/L.
Fluoridation levels must be maintained between 0.8-1.2 mg/L.
2008 UPDATE: Population receiving optimally fluoridated water: 88.9%
Delaware (1998)
Fluoridation is mandated for all municipalities but not rural water districts. State
funds will pay for fluoridation equipment, but not chemicals, for three years from
date of passage of the law. Delaware, which had previously passed a mandatory law in 1968,
changed it to require a referendum in 1974, then changed it again to a mandatory law in 1998.
Delaware provides funds for fluoridation equipment for 3 years from the date of passage of the law.
2008 UPDATE: Population receiving optimally fluoridated water: 73.6%
Georgia (1973)
Contain provisions which allow a community to exempt itself from compliance with the
State law, if a community decides it does not wish to institute this public health measure.
Georgia's law cannot be enforced unless money is made available to the community by the state.
Law mandates adding fluoride to all incorporated communities.
The fluoride level must be no greater than 1 ppm.
Exemption to fluoridation is by referendum.
The law provides for "non-compliance" unless state makes funds available for the
cost of the fluoridation equipment, the installation of such equipment and the
materials and chemicals required for six months.
The law provides tax deduction for cost of device to remove fluoride if person
deemed allergic and advised by physician or approved by the Department of
Human Resources.
2008 UPDATE: Population receiving optimally fluoridated water: 95.8%
• Georgia water worker fired on Nov 20, 2008, for refusing to purchase and add fluoride to water system
Illinois (1967)
The law provides for addition of fluoride according to rules of the Department of Public Health.
The fluoride levels must not be less than 0.9 or more than 1.2 mg/L.
Regulations specify adding fluoride to all water supplies when the fluoride
concentration is less than 0.7 mg/L.
2008 UPDATE: Population receiving optimally fluoridated water: 98.9%
Kentucky (1966)
Kentucky statutes clearly delegate powers to the State Board of Health to adopt regulations
necessary to protect the dental health of the people. Under this law, Kentucky established
standards for approval of public water supplies. These administrative regulations have been
challenged in the courts and upheld. Administrative regulations states that fluoridation is required
for all communities with a population of 1,500 or more.
2008 UPDATE: Population receiving optimally fluoridated water: 99.8%
Louisiana (2008)
UPDATE:
•
The state Legislature approved and Gov. Bobby Jindal recently signed into law Act 761, that requires
Louisiana public water systems that serve 5,000 or more customers to add fluoride to drinking water.
• Act 761 states that utilities are not required to move ahead with fluoridation unless the state
identifies sufficient funds to cover those costs.
• The new law also allows residents to opt out of fluoridation through a petition
signed by at least 15 percent of registered voters and a municipal election.
Minnesota (1967)
Fluoridation is mandated for all communities except where natural fluoride content
conforms with established regulations of the Board of Health.
Fluoride levels are to be established by Board of Health regulations.
Regulations set levels at Aaverage concentration of 1.2 mgs. per liter@ and
neither less than 0.9 mgs. nor more than 1.5 mgs.
2008 UPDATE: Population receiving optimally fluoridated water: 98.7%
Nebraska (1973)
As of 2000: Contain provisions which allow a community to exempt itself from compliance with the State law,
if a community decides it does not wish to institute this public health measure.
The law mandates adding fluoride to all political subdivisions.
It provides an exemption by adoption of an ordinance by initiative. Fluoride is not
to be added if the drinking water has a concentration of 0.7 mg/L or greater.
Fluorides must be maintained in the range of 0.8-1.5 mg/L; optimum range 1.0-1.3 mg/L.
2008 UPDATE: Population receiving optimally fluoridated water: 69.8%
• In April 2008, the Nebraska Legislature passed LB 245. This piece of legislation requires all cities
with a population greater than 1,000 to add fluoride to their water supply by June 1, 2010.
The legislature included an opt out provision into LB 245. Either by vote of city council or public petition,
the question of fluoridation can be put to the vote of the people.
• Summary of Nov 4, 2008, Fluoridation Referendums: 80% (49 out of 61) communities voted against fluoridation.
• FAN's NewsTracker on Nebraska.
Ohio (1969)
Law mandates adding fluoride to systems supplying a population of 5,000 or more when natural
content is less than 0.8 mg/L
The system must maintain a fluoride level between 0.8 and 1.2 mg/L.
Ohio has provisions which allow a community to exempt itself from compliance with
the State law, if a community decides it does not wish to institute this public health measure.
Ohio, placed a time limit of 240 days on the period during which a referendum concerning fluoridation could be held.
Ohio provides funds for fluoridation equipment and chemicals.
2008 UPDATE: Population receiving optimally fluoridated water: 89.3%
Puerto Rico (1998)
by the passage of legislation in 1952, provided money for adding fluoride to the
water of those aqueducts of the Island of Puerto Rico as may be suitable therefore, as a
preventive to dental caries. This, in effect, made fluoridation mandatory in Puerto Rico, but it
was not enforced and as of 1997, there was no water fluoridation in Puerto Rico. In September
1998, the Governor of Puerto Rico signed into law a mandatory requirement for water
fluoridation. It will be implemented in phases and by the year 2000, 75% of the population in
Puerto Rico should be drinking fluoridated water.
2008 UPDATE: While FAN is not aware of any fluoridation scheme in Puerto Rico, in 2006,
the Association of State andTerritorial Dental Directors selected the communities of
Barranquitas, Cayey, and Fajardo-Ceiba for the 2006 Community Water Fluoridation Award Recipients.
NOTE: "Water fluoridation was instituted in Puerto Rico during the years 1953 and 1954.
However, during the latter part of the 1980’s, water fluoridation was discontinued due to budgetary constrains..."
South Dakota (1969)
Fluoridation is mandated for all communities of 500 or more except where natural
fluoride content conforms to State Department of Health regulations.
Regulations specify adding fluoride when the natural content is less than 0.9
mg/L and requires the system to maintain the fluoride concentration within a
range of 0.9 mg/L to 1.7 mg/L with an average level of 1.2 mg/L.
Public vote by special election was allowed, if petition filed within 120 days of
passage of the law. Special election to be held within 90-120 days after date of
filing petitions. Provides for reimbursement for actual cost of acquiring and
installing equipment, excluding chemicals.
2008 UPDATE: Population receiving optimally fluoridated water: 95.0%
Nevada (1999)
Nevada passed their law to apply only to counties over 400,000 population and only to water
systems in that county that serve a population of 100,000 or more. This applies to 4 water
systems in Clark County [Las Vegas]. The law also requires an advisory question must be placed
on the ballot in that county at the general election of November 7, 2000, to question if
fluoridation of the water should cease in any water system in that county. State regulations
required waters systems in Clark County to fluoridate by March 1, 2000. Fluoridation passed in
November 7, 2000.
It requires the fluoride level to be maintained between 0.7 mg/L and 1.2 mg/L. It also exempts any
well that is less that 15% of the total average annual water production of the water system.
The law also required a referendum to be held in Clark county on November 7, 2000 to determine
if fluoridation should be discontinued. Fluoridation was approved on November 7, 2000.
Nevada, which had passed a law in 1967 requiring a public vote before fluoridation, changed their
law in 1999 to mandatory fluoridation in all counties with populations greater than 400,000.
2008 UPDATE: Population receiving optimally fluoridated water: 72.0%
OTHER:
Michigan (1968)
passed a mandatory state law in 1968, with a lower limit population of 1,000 on the size
of the community which must comply, but in 1978, changed their law from "shall fluoridate" to "fluoridate."
2008 UPDATE: Population receiving optimally fluoridated water: 90.9%
Massachusetts
Law enables a community through a Board of Health order to implement fluoridation. Implementation is
subject to a 90-day waiting period during which a petition for referendum may be filed.
2008 UPDATE: Population receiving optimally fluoridated water: 59.1%
Maine (1957)
have laws which require a public vote before fluoridation can be instituted.
2008 UPDATE: Population receiving optimally fluoridated water: 79.6%
New Hampshire (1959)
have laws which require a public vote before fluoridation can be instituted.
2008 UPDATE: Population receiving optimally fluoridated water: 42.6%
Utah (1976)
have laws which require a public vote before fluoridation can be instituted.
2008 UPDATE: Population receiving optimally fluoridated water: 54.3%
• SEE more on State Mandates
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