An Overview of Drinking Water Fluoridation

With cost efficiency community fluoridation overcomes disparities in oral health regardless of community size, age, education, or income level. A dental health study found that the savings from fluoridation in communities of 1,000 people or more exceeded program costs by $20 per every dollar invested. When Juneau, Alaska voted to end fluoridation in 2007, a study found that children six years and under had an increase of one dental cavity per year, roughly equivalent to $300 in dental costs per child annually. Juneau’s increase in cavities was also reflected in adults.

All water contains some levels of naturally-occurring fluoride though these levels are often too low for health benefits. In untreated water, fluoride levels vary considerably with geology and land practices. Fluoride is introduced to water when dissolved from the Earth’s crust into groundwater or discharged from fertilizer and aluminum factories. Systems with fluoridation should set final levels near 0.7 mg/L as suggested by the Department of Public Health. This concentration factors for other sources of consumer fluoride exposure such as toothpaste. Fluorosilicic acid (FSA) is most commonly used in water treatment. Though fluoridation decisions are left to a state or local municipality, the EPA has established federal standards for the upper limits allowed in drinking water.

At high levels fluoride can cause the development of bone disease and tooth mottling. As a result, the EPA has set both the Maximum Contaminant Level Goal (MCLG) and the MCL for fluoride at 4 mg/L. Levels higher than 4 mg/L can lead to increased rates of bone fracture, Enamel Fluorosis, and Skeletal Fluorosis. If systems find fluoride concentrations higher than the MCL, they are required to notify customers within 30 days and potentially install treatment methods such as distillation or reverse osmosis to remove the excess fluoride. 

The EPA has also set a secondary standard for fluoride at 2.0 mg/L. The secondary standard is intended to be used as a guideline for an upper bound level in areas with high levels of naturally occurring fluoride. Below this level, the chance for tooth mottling and more severe health impacts are close to zero. Even if the secondary standard is reached, systems must notify customers. In the U.S. very few systems have exceeded the fluoride MCL at all. Where violations have occurred, the concentrations are generally a result of natural, geological conditions. 

Even with this track record, some concerned customers are still weary of fluoridation. When customers broach fluoridation concerns, operators can offer educational materials and refer customers to consumer confidence reports. The CDC and the EPA offers a variety of consumer-friendly educational material that operators can reference in addition to the resources linked in this blog post. Remember that good customer service starts by establishing a trusted relationship with your community.

Water Documentaries, Public Awareness and Customer Concerns

Much has been said about shining a light on the value of clean water and the hidden infrastructure and personnel involved. In the past decade or so dozens of documentary films about water have been produced that do exactly that. From films that expose the aged and decaying pipes under our feet to films that reveal more complex and difficult truths about who is responsible for this decay, documentary filmmakers can bring big water issues, and the controversies and emotions that come with them, into the spotlight. 

Take for example the recent documentary Troubled Water, a film that highlights water contamination and public health issues in America. Watching the film, and seeing, sometimes for the first time, that many communities do not have access to safe drinking water can hit hard on the public's emotions. They might wonder about the lack of access to safe drinking water or about why there are so many toxins and, especially, they might wonder what people plan to do, and when, to fix the problems. 

Or this film about plastic microfibers showing up in tap water. Samples taken from Asia to Europe to the Americas, the video maintains, demonstrate that 80% of the world's tap water contain these fibers. Scientists interviewed in the film, while agreeing that more research is necessary, believe that chemicals bound to these fibers could be toxic to humans. With plastic surrounding us everywhere we look, the public can feel like there is no escape! 

With their dramatic soundtracks and interviews, these documentaries can certainly get people mobilized to push for meaningful change. Yet they can also erode trust and authentic communication between the community, local governments and their water utilities, especially if the concerns are based on incomplete knowledge.

The trick perhaps is to first acknowledge that any kind of public water awareness, no matter how it comes about, is essentially a good thing. Indeed, according to this EPA fact sheet on communicating with customers about contamination, every contact with the public provides an opportunity to build up public trust, develop closer ties, explain your utility's commitment to delivering safe water, prepare the public for future communication and gain support for investment in their water system.

At the same time it is important to know that whether or not these films play a significant role in public perception, results from recent polls show that Americans are increasingly becoming more concerned about water quality issues. Many utility personnel field water quality concerns from their customers on a daily basis already, so being prepared with good information and a positive attitude can go a long way in staying calm through a public relations storm, or just as inquiries increase over time. The AWWA has a helpful toolkit for talking honestly and openly with your community about difficult issues such as lead contamination.  

In the meantime, you can get ahead of the game by anticipating questions that your customers might have about their water, where it comes from, and who is in charge. Here is a list of recent water documentaries (with links for watching if available) that may be weighing on your customers minds lately. 

• Water & Power: A California Heist This films explores competing interests in California's groundwater reserves and the privatization of water.
• Troubled Water This film investigates drinking water contamination in communities across the country.
• Liquid Assets This film tells the story of our water infrastructure
• Tapped This film examines the role of the bottled water industry and its effects on our health, climate change, pollution, and our reliance on oil.
• The Water Front This film explores issues of affordability and changing neighborhoods, as well as the strengths and limitations of community activism.
• Flow This film asks the question: Can anyone really own water? 
• Nova: Poisoned Water  This NOVA series uncovers the science behind corrosion control and lead in pipes.
• Parched This National Georgraphic water series treats a variety of topics including affordability, lead in pipes, PFAs/C-8 contamination, rooftop water tanks and more.
• Beyond the Mirage This film focuses on drought, growth and the future of water in the West.
• Written on Water This film shows innovators in Olton, Texas who fight to keep their town alive against the decline of the Ogallala Aquifer. 
  

Finally, it is hard to not get overwhelmed by the sense of despair that such documentaries can sometimes produce. However, this documentary produced in 2011 by the Alliance of Indiana Rural Water takes a more positive spin on how states and towns can tackle water quality challenges a little bit at a time to add up to significant improvements for all.