ST. GEORGE — The U.S. Food and Drug Administration has released a proposed rule to lower the amount of fluoride that can be added to bottled water to help prevent overexposure to the mineral.
Fluoride is a naturally occurring mineral that strengthens teeth and prevents cavities. It is often added to drinking water, both bottled and municipal, which has been proven to benefit public health and help prevent tooth decay, according to the National Institutes of Health.
“Public fluoridation does more to prevent decay than anything else that we can do,” St. George dentist William Plumb said.
Finding the optimal level of fluoridation is complicated, however, because not enough fluoride puts the community at risk for tooth decay, while too much of it can cause minor-to-severe health conditions, including dental fluorosis and skeletal fluorosis.
Dental fluorosis is a condition that changes the appearance of tooth enamel, leaving white spots on the teeth, according to the Centers for Disease Control and Prevention. Only children under the age of 8 can develop dental fluorosis because their teeth are still developing.
In most cases, dental fluorosis is not harmful and may actually make the teeth stronger and more resistant to decay. Moderate-to-severe forms of dental fluorosis, while less common, can cause more extreme changes to the enamel and even form pits in the teeth.
Skeletal fluorosis, or brittle bone disease, while rare in the U.S., is a more serious condition in which the bones do not have enough flexibility and become brittle and break easily. It is directly linked to ingesting large amounts of fluoride over a long period of time, usually through water, according to the NIH.
Since 2015, the Public Health Service has determined 0.7 milligrams per liter to be the optimal level of fluoride in drinking water.
However, the allowable level of fluoride in bottled water remains 0.8 milligrams per liter. The FDA’s proposed rule would lower that to meet the PHS community water recommendation.
Most bottled water companies already limit the amount added so that it is at or below PHS standards, according to the FDA. Ozarka, for example, reports having 0.6 milligrams per liter in its fluoridated water, and none in its regular spring water.
Most water sources contain natural levels of fluoride, and many communities, including most of those in Southern Utah, choose not to treat their water with additional fluoride.
Communities and bottled water manufacturers that choose not to fluoridate are not required to keep their fluoride concentration under 0.7 milligrams per liter, so the levels could potentially be higher than the recommended amount.
Some cities, however, have the opposite problem and have water that falls below the recommended fluoride levels. The city of St. George chooses not to fluoridate its water, and the fluoride concentration is 0.23 milligrams per liter, according to the CDC.
Because fluoridated water is the most efficient way to prevent tooth decay, some, including Plumb, see this lower concentration of fluoride as a public health concern.
“Fluoridated water has done more to help prevent bacterial infection in your mouth than anything else,” Plumb said. “And it’s very inexpensive to fluoridate a community’s water. I would be all for that happening in our community.”
Tooth decay is one of the most common diseases in the world. It is the most common chronic disease in children aged 6-19 years old and affects 90 percent of all adults, according to the CDC.
Cavities are largely preventable, and studies have shown that water fluoridation in a community can reduce the amount of decay in children’s teeth by 18 to 40 percent.
With current regulations in the U.S., drinking fluoridated water alone is not enough to cause a serious health condition.
Studies have shown that it would take water with a fluoride concentration of about 2.14 milligrams per liter, combined with receiving larger amounts of fluoride from other sources, to cause severe dental fluorosis and around 4 milligrams per liter to cause skeletal fluorosis, according to the NIH.
However, the combination of fluoridated water, even at 0.7 milligrams per liter, and other products containing fluoride, such as toothpaste and baby formula, may be enough to cause mild dental fluorosis, even in normal doses.
The general recommended dosage for fluoride is about half a milligram per day for infants and toddlers up to 3 years of age, 1 milligram per day for children aged 4-8, 2 milligrams for ages 9-13, 3 milligrams for teens aged 14-18, 4 milligrams for adult men and 3 milligrams for adult women, according to the Community Dentist Network.
To cause a serious health issue, it takes a much larger amount of fluoride, Plumb said, such as eating large amounts of toothpaste.
“It’s really hard to get too much fluoride. You really have to have massive doses over a long period of time,” Plumb said. “Anything in massive doses is going to be harmful to our bodies, that’s just the way it is. But a little bit of fluoride is so inexpensive and can have such a profound, positive impact in our bodies that it should be something that we consider.”
The public is invited to participate in a 60-day comment period to share their opinions or ideas for revisions to the FDA’s proposed rule. To read the rule or submit a comment, visit the Federal Register’s website.
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