United States
                   Environmental Protection
                   Agency
Office of Water
Vail Code 4304
EPA-822-F-93-C10
December, 1993
                  FACT  SHEET
                   FLUORIDE IN  DRINKING  WATER

       Fluoride occurs naturally In water.  It is also added to drinking water to reduce tooth decay
 State agencies or local public water supply authorities make the decision as to whether or not to add
 fluoride to specific drinking water supplies.
 Drinking Water Standards

 Fluoride in drinking water is regulated under
 Section 1412 of  the Safe Drinking  Water  Act
 (SDWA).   When regulating  a contaminant
 under this  Act, EPA promulgates  both a
 Maximum Contaminant Level  Goal (MCLG, a
 nonenforceable health goal), and a Maximum
 Contaminant Level (MCL, which is a federally
 enforceable standard).  The  MCL  is set as
 close to the  MCLG  as technically feasible
 taking  costs  and  other   factors  into
 consideration.   When  establishing  an MCLG,
 the  Act requires EPA to protect against
 adverse health effects  with a margin of safety.
 The  SDWA leaves the question  of  what
 constitutes an  adverse health effect  to EPA.

 EPA may also  promulgate nonenforceable
 secondary standards which are designed to
 protect  the   public   welfare.   Secondary
 standards are usually  based on  aesthetic
 considerations  such as taste or odor.
Fluoride Standards

In 1986, EPA promulgated both  the fluoride
MCLG and MCL at 4 mg/l. This level protects
humans from crippling skeletal fluorosis, an
adverse health effect.

At  the  same  time,  EPA  also  set  a
nonenforceable   Secondary   Maximum
Contaminant Level of 2 mg/l for fluoride in
drinking water to protect against objectionable
dental fluorosis (i.e., a staining and/or pitting
of the teeth).  While community water systems
are not required to reduce the level of fluoride
if it  exceeds 2 mg/l, they  are  required to
distribute a public notice which advises that
children are likely to develop objectionable
dental fluorosis.   In  developing the MCL and
the  MCLG at 4 mg/l (vs. 2  mg/l to protect
against dental fluorosis), EPA concluded that
  dental fluorosis is a cosmetic effect and not an
  adverse health effect.
  Fluoride Review

  In 1992, as part of an  ongoing review of
  fluoride, EPA requested the National Academy
  of Sciences (MAS) to review fluoride toxicity
  and exposure data.  In addition, EPA signed a
  consent decree  in   1992   with   Citizens
  Interested in Bull Run, Inc. concerning a review
  of the fluoride standard.

  The National Academy of  Sciences completed
  the fluoride review  in August 1993.  Among
  other points, they concluded that:

  • The current 4 mg/l MCLG and MCL Is appro-
    priate as an Interim standard pending receipt
    of additional data, and

  • The question of whether dental fluorosis is
   an adverse effect is a decision for regulatory
   agencies.
  Findings and Conclusions

  Based on the NAS review and other studies,
  there are no data available at  this time to
  conclude that the  fluoride drinking  water
  standards should be revised.

  EPA has requested that the U.S. Department of
  Health and  Human  Services address whether
  dental  fluorosis should be considered an
  adverse health  effect or a cosmetic  effect
  which  may Impact the MCLG  and  MCL
  standards.   EPA  has also  asked the U. S.
  Department  of Health and Human Services to
  explore  ways to  reduce fluoride  exposure
  when it exceeds beneficial levels.

-------