The federal government regulation of fluoride and water fluoridation is fragmented and easily misunderstood.

The Environmental Protection Agency (EPA), plays a key role, regulating the level of fluoride in public drinking water. It has the authority to allow, restrict or end water fluoridation.

The U.S. Public Health Service (USPHS), separate from the EPA, oversees two agencies that also play significant roles, the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). The Surgeon General is also under the authority of the USPHS.

In 2015, the USPHS recommended the concentration level of fluoride in public drinking water be lowered to 0.7 parts per million (ppm), due mainly to increasing dental fluorosis rates in children. It previously had recommended a range between 0.7 – 1.2 ppm.   

Below are the major responsibilities of each agency:

EPA

1. Regulates all contaminants in drinking water. EPA considers fluoride a contaminant.
2. Is the defendant in the current lawsuit (Food and Water Watch et al vs. Environmental Protection Agency) in federal district court that will decide if fluoridation is an unreasonable risk to human health.
3. Determines the maximum contaminant level (MCL) – the legal limit – allowed in drinking water. The MCL concentration is currently set at 4 ppm. It requires that cities and towns inform their residents if natural fluoride in their water exceeds 2 ppm.
4. Can set the maximum contaminant level goal (MCLG) – the level at which no adverse health effects have been observed.

CDC

1. Its oral health division is the main promoter of fluoridation in the federal government.
2. Financially supports state and local health departments in promoting fluoridation.
3. Provides consulting and infrastructure grants to states and localities.
4. Compiles statistics on fluoridation rates nationally and by state, displaying them on its website.
5. Made the often-quoted statement that fluoridation is one of the top ten public health achievements of the 20^th century.

FDA

1. Regulates fluoride (except in public drinking water, which is regulated by the EPA) as a drug. However, it has never undergone any clinical trials for safety and effectiveness and is officially designated as an “unapproved new drug.”
2. Requires a prescription from a physician to obtain ingested fluoride tablets, drops and lozenges.
3. Regulates fluoride in toothpaste and recommends that only a pea-sized dab of toothpaste be used. It requires this warning (or similar wording) be displayed on every tube of fluoridated toothpaste: “Keep out of the reach of children under 6 years of age. If you swallow more than used for brushing, get medical help or contact a poison control center right away.”
4. Requires that bottle water to which fluoride has been added not exceed a concentration of 0.7 ppm and be labeled indicating that it’s fluoridated.

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