occurring fluoride in drinking water; they are not recommendations about the practice of adding fluoride to public drinking-water systems (see below). In this report, the National Research Council’s (NRC’s) Committee on Fluoride in Drinking Water reviews the nature of the human health risks from fluoride, estimates exposures to the general public from drinking water and other sources, and provides an assessment of the adequacy of the MCLG for protecting public health from adverse health effects from fluoride and of the SMCL for protecting against cosmetic effects. Assessing the efficacy of fluoride in preventing dental caries is not covered in this report.

This chapter briefly reviews the sources of fluoride in drinking water, states the task the committee addressed, sets forth the committee’s activities and deliberative process in developing the report, and describes the organization of the report.


Fluoride may be found in drinking water as a natural contaminant or as an additive intended to provide public health protection from dental caries (artificial water fluoridation). EPA’s drinking water standards are restrictions on the amount of naturally occurring fluoride allowed in public water systems, and are not recommendations about the practice of water fluoridation. Recommendations for water fluoridation were established by the U.S. Public Health Service, and different considerations were factored into how those guidelines were established.


Fluoride occurs naturally in public water systems as a result of runoff from weathering of fluoride-containing rocks and soils and leaching from soil into groundwater. Atmospheric deposition of fluoride-containing emissions from coal-fired power plants and other industrial sources also contributes to amounts found in water, either by direct deposition or by deposition to soil and subsequent runoff into water. Of the approximately 10 million people with naturally fluoridated public water supplies in 1992, around 6.7 million had fluoride concentrations less than or equal to 1.2 mg/L (CDC 1993). Approximately 1.4 million had natural fluoride concentrations between 1.3 and 1.9 mg/L, 1.4 million had between 2.0 and 3.9 mg/L, and 200,000 had concentrations equal to or exceeding 4.0 mg/L. Exceptionally high concentrations of fluoride in drinking water are found in areas of Colorado (11.2 mg/L), Oklahoma (12.0 mg/L), New Mexico (13.0 mg/L), and Idaho (15.9 mg/L).

Areas of the United States with concentrations of fluoride in drinking water greater than 1.3 mg/L are all naturally contaminated. As discussed

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