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Community Water Fluoridation

Water Fluoridation Operations Group Photo
Community Water Fluoridation is a small portion of the public health work water operators do to keep water safe, but they may not realize the impact they have on the oral health of their community.  The Michigan Department of Health and Human Services and the Michigan Department of Environment, Great Lakes and Energy Drinking Water Division wants to ensure water operators have the tools and information necessary to do their job well.  The following information includes the most up to date resources on national and Michigan specific information that can help assist in ensuring the health and safety of the communities they serve.

What is Community Water Fluoridation?

Community Water Fluoridation (CWF) is a safe and effective public health intervention that prevents 25% of tooth decay for all age groups.  CWF is the adjustment of the fluoride level to the correct amount to prevent tooth decay and is considered one of the ten greatest public health achievements of the 20th century - on par with vaccinations and public sanitation - and has done more to prevent tooth decay than any other public health intervention.  Over 75 years of research has shown, and the CDC affirms water fluoridation is safe, effective and a cost savings to families as well as the US healthcare system. The protective effects of CWF cannot be effectively replicated by brushing and flossing alone.
CDC Infographic

How does Community Water Fluoridation Work?

Fluoride occurs naturally in all water; however, the amount is usually not enough to prevent tooth decay.  That is where Community Water Fluoridation comes in.
Fluoride has been proven to protect teeth from cavities.  When a person eats foods containing sugars or carbohydrates, bacteria is produced in the mouth and forms an acid.  That acid begins eating away minerals on the tooth's surface, weakening the tooth and over time cavities can develop.  Fluoride helps to rebuild and strengthen the teeth.  Water fluoridation works by providing frequent and consistent contact with low levels of fluoride to the teeth in order to reduce tooth decay. 
The Center for Disease Control and Prevention (CDC) recommends all public drinking water supplies contain low levels of fluoride to provide a barrier against tooth decay.  The current CDC recommended level of fluoride concentration in water is 0.7 mg/L.  Water operators closely monitor and adjust these levels on a daily basis.  Are you unsure if your water system is fluoridating?  The CDC has a website to check if your county-

Community Water Fluoridation in Michigan

The Michigan Department of Health and Human Services (MDHHS) monitors fluoride levels in community water systems by working with local water operators providing relevant education and technical assistance to city officials, water municipalities, public health professionals, and the public. The Michigan Department of Environment, Great Lakes, and Energy (EGLE) is the regulatory agency for water fluoridation in Michigan and ensures fluoride levels do not exceed secondary and maximum contaminant levels and water systems are tracking daily fluoride levels when added to the water system.  This partnership has shown to be a key factor in the success of Community Water Fluoridation in Michigan.
Community Water Fluoridation started in Michigan in 1945 with the city of Grand Rapids, and the city is still fluoridating their water today.  2019 data shows that 89.2% of Michiganders have access to fluoridated drinking water, over 6.5 million people.  However, only 31.48% of Michiganders statewide have access to optimally fluoridated water.  This percentage is assessed by tracking daily fluoride levels that must range between 0.60mg/L-1.00mg/L with the recommended level being 0.70mg/L.  The MDHHS Oral Health Program works with Michigan EGLE Drinking Water and local water operators to continue to improve those who receive optimally fluoridated water.  The Healthy People 2030 guidelines have a goal of increasing the proportion of people whose water systems have the recommended amount of fluoride to 77.1% by 2030.

Water Fluoridation Quality Awards

Many public water systems are recognized by the CDC with an annual Water Fluoridation Quality Award.  To be eligible in Michigan, public water systems must meet stringent requirements.  Below you can see past recipients as well as systems who have been awarded 50-year awards presented by the CDC, the American Dental Association, and the Association of State and Territorial Dental Directors for their dedication to fluoridating for 50 years.
  • CDC 2018 Quality Awards
  • CDC 2019 Quality Awards


Fluoridation Equipment Needs

Fluoridation equipment is not made to last forever.  Luckily, our partners at Delta Dental Foundation have funding opportunities for updating and installing fluoride equipment for communities in Michigan.  If you are interested or have questions regarding funding, please call Sandy Sutton, Community Water Fluoridation Coordinator at 517-582-8593. The Fluoridation Equipment Grant includes criteria for qualifying and questions that will be asked on the application for funding to be considered.
Fluoridation Equipment Image 1 Fluoridation Equipment Image 2 Fluoridation Equipment Image 3

Training and Educational Opportunities

Are you new to water operations or interested in learning more about how community water fluoridation works?  A FREE CWF Training is available from the CDC and includes in depth information on background, fluoridation system design and operations, fluoride additives, including dosage, feed rates and daily sampling.  Even better, water operators in Michigan can receive 4 CE credits for completing the course.

The American Water Works Association publishes a manual that includes essential information for decision makers planning fluoridation installations, engineers designing them, and water utility personnel operating them. The manual contains history of use, health effects, calculating dosage and managing levels as well as equipment considerations (installation, operation, and maintenance). The manual can be found here.
Fluoridation Facts is the American Dental Association's premier resource on fluoridation, answering frequently asked questions about community water fluoridation and the latest scientific research.  The eBook can be downloaded for FREE.

Educational Materials

Community Water Fluoridation has been well documented as a safe and effective public health practice for over 75 years; however, some people may question the practice or even oppose it. As a water operator, you may be confronted with questions from the customers you serve. The information below may help answer questions you or the community may have. 

Websites - Valuable Information Specific to your Role as a Water Operator
CDC - Community Water Fluoridation for Water Operators and Engineers
American Fluoridation Society - Common Myths about Community Water Fluoridation