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What is Fluoride

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  What is fluoride?  Fluoride compounds are salts that form when the element, fluorine, combines with minerals in soil or rocks. Uses for fluoride.  Many communities add fluoride to their drinking water to promote dental health.   If you are concerned about fluoride in a private well, please visit:    EPA's private drinking water wells website     Water Systems Council website  What are fluoride s health effects?  Exposure to excessive consumption of fluoride over a lifetime may lead to increased likelihood of bone fractures in adults, and may result in effects on bone leading to pain and tenderness. Children aged 8 years and younger exposed to excessive amounts of fluoride have an increased chance of developing pits in the tooth enamel, along with a range of cosmetic effects to teeth. This health effects language is not intended to catalog all possible health effects for fluoride. Rather, it is intended to inform consumers of some of the possible health effects associated with fluoride in drinking water. Top of page  What are EPA s drinking water regulations for fluoride?  In 1974, Congress passed the Safe Drinking Water Act. This law requires EPA to determine the level of contaminants in drinking water at which no adverse health effects are likely to occur. These non-enforceable health goals, based solely on possible health risks and exposure over a lifetime with an adequate margin of safety, are called maximum contaminant level goals (MCLG). Contaminants are any physical, chemical, biological or radiological substances or matter in water. The MCLG for fluoride is 4.0 mg/L or 4.0 ppm. EPA has set this level of protection based on the best available science to prevent potential health problems. EPA has set an enforceable regulation for fluoride, called a maximum contaminant level (MCL), at 4.0 mg/L or 4.0 ppm. MCLs are set as close to the health goals as possible, considering cost, benefits and the ability of public water systems to detect and remove contaminants using suitable treatment technologies. In this case, the MCL equals the MCLG, because analytical methods or treatment technology do not pose any limitation. EPA has also set a secondary standard (SMCL) for fluoride at 2.0 mg/L or 2.0 ppm. Secondary standards are non-enforceable guidelines regulating contaminants that may cause cosmetic effects (such as skin or tooth discoloration) or aesthetic effects (such as taste, odor, or color) in  drinking water. EPA recommends secondary standards to water systems but does not require systems to comply. However, states may choose to adopt them as enforceable standards. Tooth discoloration and/or pitting is caused by excess fluoride exposures during the formative period prior to eruption of the teeth in children. The secondary standard of 2.0 mg/L is intended as a guideline for an upper bound level in areas which have high levels of naturally occurring fluoride. The level of the SMCL was set based upon a balancing of the beneficial effects of protection from tooth decay and the undesirable effects of excessive exposures leading to discoloration. Fluoride is voluntarily added to some drinking water systems as a public health measure for reducing the incidence of cavities among the treated population. The decision to fluoridate a water supply is made by the s or local municipality, and is not mandated by EPA or any other Federal entity. The Centers for Disease Control and Prevention (CDC) provides recommendations about the optimal levels of fluoride in drinking water in order to prevent tooth decay.    Information about CDC's recommendations States may set more stringent drinking water MCLGs and MCLs for fluoride than EPA. The drinking water standards are currently under review. The Safe Drinking Water Act requires EPA to periodically review the national primary drinking water regulation for each contaminant and revise the regulation, if appropriate. In 2003 and as part of the first Six Year Review, EPA reviewed the drinking water standard for fluoride and found that new health and exposure data were available on orally ingested fluoride. EPA requested that the National Research Council (NRC) of the National Academies of Science (NAS) conduct a review of this data and in 2006, the NRC published their evaluation in a report entitled, Fluoride in Drinking Water: A Scientific Review of EPA's Standards. The NRC recommended that EPA update its fluoride risk assessment to include new data on health risks and better estimates of total exposure. In March 2010 and as part of the second Six Year Review, the Agency indicated that the Office of Water was in the process of developing its health and exposure assessments to address the NRC's recommendations. The Agency finalized the risk and exposure assessments for fluoride in January 2011 and announced its intent to review the drinking water regulations for fluoride to determine whether revisions are appropriate .  Top of page  How does fluoride get into my drinking water?  Some fluoride compounds, such as sodium fluoride and fluorosilicates, dissolve easily into ground water as it moves through gaps and pore spaces between rocks. Most water supplies contain some naturally occurring fluoride. Fluoride also enters drinking water in discharge from  fertilizer or aluminum factories. Also, many communities add fluoride to their drinking water to promote dental health. A federal law called the Emergency Planning and Community Right to Know Act (EPCRA) requires facilities in certain industries, which manufacture, process, or use significant amounts of toxic chemicals, to report annually on their releases of these chemicals. For more information on the uses and releases of chemicals in your state, contact the Community Right-to-Know Hotline: (800) 424-9346.    EPA's Toxics Release Inventory (TRI) website provides information about the types and amounts of toxic chemicals that are released each year to the air, water, and land.  END Water fluoridation  is the controlled addition of  fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur   naturally or by adding fluoride. [2]  Fluoridated water operates on tooth surfaces: in the mouth it creates   low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. [3]  Typically a fluoridated   compound is added to drinking water, a process that in the U.S. costs an average of about $1.02 per person-year . [2][4] Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. [5]   A 1994 World Health Organization expert committee suggested a level of   fluoride from 0.5 to 1.0 mg/L (milligrams per litre), depending on climate. [6] Bottled water  typically has unknown fluoride levels, and some domestic water filters remove some or all fluoride. [7]  Dental caries remain a major  public health concern in most industrialized countries, affecting 60  –   90% of schoolchildren and the vast majority of adults. [8]  Water fluoridation prevents cavities in both   children and adults, [9]  with studies estimating an 18  – 40% reduction in cavities when water fluoridation   is used by children who already have access to toothpaste and other sources of fluoride. [2]  Studies suggest that the use of water fluoridation particular in industrialized countries may be unnecessary for caries prevention, because topical fluorides (such as in toothpaste) are widely used and caries has become low. [3]      Although fluoridation can cause dental fluorosis, which can alter the appearance of  developing   teeth or  enamel fluorosis, [3] most of this is mild and usually not considered to be of aesthetic or public-   health concern. [10]  There is no clear evidence of other  adverse effects from water   fluoridation. [11]  Studies on adverse effects have been mostly of low quality. [11]  Fluoride's effects   depend on the total daily intake of fluoride from all sources. Drinking water is typically the largest source; [12]  other methods of  fluoride therapy include fluoridation of toothpaste, salt, and milk. [13]  Water  fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk. [8]     In 1999 the U.S. Centers for Disease Control and Prevention listed water fluoridation as one of the ten great public health achievements of the 20th century; [14]  in contrast, most European countries have experienced substantial declines in tooth decay without its use, primarily due to the introduction of fluoride toothpaste in the 1970s. [3]  Fluoridation may be more justified in the U.S. because of   socioeconomic inequalities in dental health and dental care. [15]  Public water fluoridation was first practiced in the U.S., [16]  and has been introduced to many other countries to varying degrees, [17]  with many countries having water that is naturally fluoridated to recommended levels and others, such as in Europe, using fluoridated salts as an alternative source of fluoride. [18]     Contents [hide]      1 Goal    2 Implementation    3 Mechanism    4 Evidence  o  4.1 Effectiveness  o  4.2 Fluorosis  o  4.3 Safety    5 Alternatives    6 Economics    7 Ethics and politics    8 Use around the world    9 History    10 References    11 External links  Goal  A cavity starts in a tooth's outer enamel and spreads to thedentin and pulp inside.   The goal of water fluoridation is to prevent tooth decay by adjusting the concentration of fluoride in public water supplies. [2]  Tooth decay (dental caries) is one of the most prevalent chronic   diseases worldwide. [19]   Although it is rarely life-threatening, tooth decay can cause pain and impair eating, speaking, facial appearance, and acceptance into society, [20]  and it greatly affects the quality   of life of children, particularly those of low socioeconomic status. [19]  In most industrialized countries, 
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