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Community Water Fluoridation

The following information provides answers to frequently asked questions about community water fluoridation.  A one-page fact sheet is also available.

What is community water fluoridation? Fluoride is naturally present in all water.  Community water fluoridation is the adjustment of the natural fluoride level in public water systems to an optimal level to prevent tooth decay.  In Ohio, most water systems that serve more than 5,000 persons are currently required by law to adjust the fluoride level.

What is the status of community water fluoridation in Ohio? About 91 percent, or 10.5 million Ohioans, are served by public water supplies. Of those, 92 percent are served by systems with adequate fluoride levels. Nationally, Ohio ranks 11th in the percentage of persons on public water systems receiving fluoridated water. However, about 822,000 Ohioans on public water systems do not receive fluoridated water.

How does the Ohio Department of Health (ODH) promote community water fluoridation? ODH provides information on the safety, benefits and cost of fluoridation and gives technical assistance to communities considering water fluoridation. ODH also recognizes community water systems that have fluoridated for more than 50 years by presenting the National Fluoridation 50 Year Awards.  Please see the list of the 2015 recipients, which includes a list of past recipients as well.

ODH also offers limited funds for the start-up and maintenance of community water fluoridation. Communities of any size can request funds for equipment used in the fluoridation feed system, fluoride compounds (limited) and fluoride testing equipment used in the water treatment laboratory.  Program guidelines and application materials can be found on the Fluoridation Assistance Program Web page.

What do the experts think about water fluoridation?
There are many national and international organizations that recognize the public health benefits of community water fluoridation for preventing dental decay. The American Dental Association has compiled an impressive compendium, listing more than 100 such organizations.  Policy statements from many of these organizations are available.  A coalition of public health organizations has created a website with more information on the safety and benefits of fluoridation. The ODH has called community water fluoridation “the single most important step a community can take to improve the dental health of its residents.” More than 70 years of research and community experience have shown that fluoridation works.

Does Ohio require fluoridation? In 1969, convinced of the public health benefits of community water fluoridation, the Ohio General Assembly passed a law requiring fluoridation of public water supplies that serve more than 5,000 persons. The law provided customers of the affected water systems the opportunity to be exempted through a referendum held within 240 days of the law’s passage.

Which cities are exempt? Thirty Ohio communities held special referenda in 1970 and were exempted from the law. Since then, eight of those communities have reversed the decision. Athens, Bellefontaine, Bellevue, Fairborn, Lebanon, Middletown, Delaware and Tipp City are now fluoridated. However, 22 communities remain exempt from fluoridation.

Can a water system with fewer than 5,000 persons fluoridate? Yes. If a community or a water authority wishes to implement fluoridation, they should contact ODH and the Ohio Environmental Protection Agency (Ohio EPA) for information on how to go about providing this valuable public health measure to its residents.

What agency monitors fluoridation? The Ohio EPA regulates the fluoridation of public water systems and has primary enforcement responsibility. Water treatment personnel are required to monitor fluoride levels daily and submit monthly operating reports to the Ohio EPA. Visit the Ohio Revised Code for information about laws and rules pertaining to community water fluoridation.

Community water systems in Ohio that achieve optimal fluoridation levels for all 12 months each year are recognized by the Centers for Disease Control and Prevention (CDC) for excellence.  

What other information does ODH have about fluoride and fluoridation? ODH informs health professionals and the public on the proper use of other various preventive fluoride measures, such as fluoride varnish and dietary fluoride supplements.  ODH maintains information on the fluoride levels of public water systems in Ohio counties and provides information on how to test a private well or other water source for fluoride.

Last Updated: 10/23/15

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