The state of Washington is working on a new rule to reduce the amount of fluoride that is added to community water supplies after the federal government issued new recommendations in April.
In the Tri-Cities, only Pasco fluoridates its water. West Richland has naturally occurring fluoride that can be higher than optimal. Kennewick and Richland water has too little naturally occurring fluoride to detect and the cities do not add it.
For more than 50 years, the U.S. Department of Health and Human Services has recommended utilities supplement water to bring fluoride levels to 0.7 to 1.2 milligrams per liter.
The new federal recommendation is a single level of 0.7 milligrams per liter.
Americans now have more access to fluoride, including through toothpaste and mouth rinses, than they did when the original recommendation was made in 1962. As a result, dentists have seen an increase in fluorosis, which, in most cases, appears as barely visible lacy white markings or spots.
Dentists told the Washington State Board of Health, which met in Walla Walla this week, that fluoridating water low in the naturally occurring element still is needed.
“I’d rather see a little fluorosis than bombed-out teeth” because of dental decay, said retired Walla Walla dentist Howard Blessing.
Water fluoridation prevents tooth decay by providing frequent and consistent contact with low levels of fluoride, ultimately reducing tooth decay by about 25 percent in children and adults, according to the Centers for Disease Control and Prevention.
The process to change the state rule, which includes a public comment period, takes about a year. In the meantime, the state Department of Health recommends water utilities reduce added fluoride to about 0.8 milligrams of fluoride per liter.
The state is expected to adopt a new range of about 0.6 milligrams to 1 or 1.1 milligrams of fluoride, said Clark Halvorson, director of the Department of Health’s Office of Drinking Water. The full health benefits are not realized below 0.6 milligrams.
A range is needed because consistently meeting an exact level is difficult, Halvorson said. The new range being considered is smaller than the current range, but should be achievable for community water systems. The bottom of the range could be reduced to just 0.6 milligrams because below that health benefits for teeth are not as strong.
The goal would still be about 0.7 milligrams, and the state would work with community water systems and their technology if they have trouble keeping close to that, Halvorson said.
Pasco already has moved to reduce the level of fluoride in its city water, as officials saw the federal government moving toward a lower recommendation. The system runs at an average of 0.89 milligrams.
The latest annual community water report showed that the 828 samples collected in 2014 ranged from 0.7 to 1.11 milligrams of fluoride per liter of water.
Water systems that draw from rivers generally have lower levels of naturally occurring fluoride than those drawn from wells. As water moves through the ground, it picks up fluoride, which is the 13th most abundant element in the Earth’s crust, Halvorson said.
West Richland gets about 80 percent of its water from wells, one of which has high levels of fluoride. The city’s 2013 Drinking Water Quality Report said water samples, which are drawn at well heads, ranged from 0.36 to 3.06 milligrams of fluoride per liter.
The high-fluoride well is blended with other city water to reduce the amount of fluoride that comes out of household taps.
However, the city likely will not be able to get fluoride down to the new recommended level of 0.7 milligrams, said Roscoe Slade, the public works director. The city will look into ways to further reduce levels.
The amount of fluoride in water varies across West Richland, and residents can request a free test of their tap water by calling 967-5434. The tests can be conducted at different times of the year because the level of fluoride can fluctuate. Water for testing can be obtained from an outdoor spigot, so residents do not have to be home.
The information about the level of fluoride in homes can be taken to dentists to come up with a plan on how to balance fluoride from other sources such as toothpaste, mouthwash and fluoride treatments.
Children are at risk of developing fluorosis as their teeth form. However, most fluorosis in the United States is mild and has no effect on how teeth look or function, according to the CDC.
Every dollar spent on fluoride saves $43 in treatment costs, said Emily Firman, of the Washington Dental Service Foundation, at the Walla Walla meeting.
Pasco began fluoridating its water 14 years ago.
Pasco dentist Spencer Jilek said in a letter to the state board that he has seen the transformation fluoridated water has brought to his patients.
Fluoridation safely and effectively reduces cavities, and patients who live in communities with fluoridated water have fewer cavities than others, he said.
“This has been my experience treating patients from Pasco, Richland and Kennewick, of which only Pasco has enough fluoride in its water to make a positive difference,” he said.
Fluoridation is especially helpful for children because dental disease tends to follow them through their lifetime, Blessing said. But it can also help older adults, particularly if they take medications that make their mouth dry or have receding gums that expose new areas of teeth.
The revised fluoridation levels set by the federal government are a positive development, Jilek said.
“It underscores that even though people are getting fluoride from other sources, such as toothpaste and mouthwash, water fluoridation remains one of the safest and most effective ways to prevent tooth decay,” he said.
In Washington, the decision on whether to fluoridate is left up to communities.
A small number of the state’s water systems fluoridate, but those, including the Seattle system, provide water for nearly half the people in the state, Halvorson said. Another 200,000 people drink water from systems with significant amounts of naturally occurring fluoride. Most of the naturally fluoridated water is from wells in the Mid-Columbia.
The state plans an informal comment period on a new draft rule on fluoridation levels in August, followed by a state Board of Health public hearing in March. The rule could take effect in May 2016.