FDA Suggests Reductions in Fluoride Added to Bottled Water

A new FDA recommendation advises reductions in the amount of fluoride added to bottled water. The FDA recommends that manufacturers not add fluoride to bottled water at concentrations greater than a maximum final concentration of 0.7 milligrams per liter.

The recommendation is based on the recent U.S. Public Health Service (PHS) update of its 1962 Drinking Water Standards related to community water fluoridation. According to the PHS, the optimal concentration of fluoride is one that “provides the best balance of protection from dental caries while limiting the risk of dental fluorosis, a condition that changes the appearance of tooth enamel when children consume fluoride when their teeth are forming.”

The new recommendation concerning fluoride in bottled water from the FDA’s Center for Food Safety and Applied Nutrition is specific to fluoride that is added to bottled water and does not affect the levels of fluoride permitted under FDA’s bottled water regulations.

Center Director Susan T. Mayne, PhD, says that the allowable level of added fluoride in bottled water in the FDA’s regulation was based on the previous PHS recommendation and that the FDA intends to revise the quality standard for fluoride added to bottled water to be consistent with the updated PHS recommendation. “In the interim, we recommend that bottled water manufacturers do not add fluoride to bottled water at concentrations greater than a maximum final concentration of 0.7 milligrams per liter,” she says.

Depending on the source of the water, bottled water may contain fluoride that is naturally present in the original source. The FDA does not require manufacturers to list the amount of fluoride on the label unless fluoride is an extra added ingredient. According to the CDC, bottled water products labeled as deionized, purified, demineralized, or distilled have been treated so that they contain no or only trace amount of fluoride, unless it is specifically listed as an added ingredient.

The PHS gives several reasons for lowering the recommended fluoride concentration in community drinking water. The 1962 recommendations had set optimal fluoride concentrations for community water systems in the range of 0.7 to 1.2 milligrams per liter. Since that time, fluoride is consumed in many more sources. About 75 percent of the U.S. population drink fluoridated water from their community water systems, and other products now provide extra fluoride: fluoride toothpaste, mouth rinses, dietary fluoride supplements, and beverages prepared with fluoridated water.

Based on the assumption that children drink more water in higher temperature locations, the previous recommendations had also stated that the fluoride added to community drinking water should depend on the outdoor air temperature of the area. That assumption is no longer considered valid; studies since 2001 have shown that the water intake of children does not increase in higher temperatures.