National Academies Press: OpenBook

Fluoride in Drinking Water: A Scientific Review of EPA's Standards (2006)

Chapter: Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information

« Previous: Appendix A Biographical Information on the Committee on Fluoride in Drinking Water
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

APPENDIX B
Measures of Exposure to Fluoride in the United States: Supplementary Information

U.S. DATA ON ARTIFICIAL AND NATURAL FLUORIDE IN DRINKING WATER

The recommended “optimal” fluoride concentrations for community public water supply systems and school public water supply systems are shown in Table B-1. Both sets of recommendations are based on the “annual average of maximum daily air temperatures” (CDC 1995, based on two studies in the 1950s). Table B-2 provides the approximate number of persons receiving artificially fluoridated public water in 1992, by fluoride concentration. In practice, most states seem to use a single fluoride concentration for the whole state. Figure B-1 shows the fluoride concentration by state with respect to annual average temperature for that state over the period 1971-2000. Table B-3 presents the approximate number of persons receiving naturally fluoridated public water in 1992, by fluoride concentration.

The number of persons served with public water supplies exceeding 4 milligrams (mg) of fluoride per liter (L) is expected to be substantially lower now than in 1992. For example, South Carolina, which had more than half of the persons in that category in 1992 (Table B-3), now has only occasional violations of the maximum contaminant level (MCL) (e.g., two water systems with 10 violations in calendar year 2003; SCDHEC 20041). On the other hand, a recent news article indicates that some areas in Virginia

1

See also local drinking water information by state at http://www.epa.gov/safewater/dwinfo.htm.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-1 Recommended Optimal Fluoride Concentrations for Public Water Supply Systems

Annual Average of Maximum Daily Air Temperaturesa

Recommended Fluoride Concentrations, mg/L

°F

°C

Community Water Systems

School Water Systemsb

50.0-53.7

10.0-12.0

1.2

5.4

53.8-58.3

12.1-14.6

1.1

5.0

58.4-63.8

14.7-17.7

1.0

4.5

63.9-70.6

17.8-21.4

0.9

4.1

70.7-79.2

21.5-26.2

0.8

3.6

79.3-90.5

26.3-32.5

0.7

3.2

aBased on temperature data obtained for a minimum of 5 years.

bBased on 4.5 times the optimal fluoride level for communities. School water fluoridation is recommended only when the school has its own source of water and is not connected to a community water system. Several other criteria are also considered; for example, if >25% of the children attending the school already receive optimally fluoridated water at home, the school’s water should not be fluoridated.

SOURCE: CDC 1995.

are still served by water systems with fluoride exceeding 4 mg/L (Hirschauer 2004).

Miller-Ihli et al. (2003) reported on fluoride concentrations in water samples collected in 1999 from 24 locations nationwide; these locations were expected to provide nationally representative samples for the National Food and Nutrient Analysis Program.2 Not unexpectedly, their findings indicate a bimodal distribution of fluoride concentrations in public drinking water: either water was fluoridated at approximately 1 mg/L or it was not fluoridated, with concentrations bordering on undetectable.

WATER INGESTION AND FLUORIDE INTAKES

Tables B-4 to B-7 summarize recent estimates by the U.S. Environmental Protection Agency (EPA) of the mean and selected percentiles of water ingestion by source (community supplies, bottled water, “other” sources, and all sources combined) and subpopulation (EPA 2000a); Tables B-8 and B-9

2

Miller-Ihli et al. (2003) reported that 40% of the samples were fluoridated and suggested that, rather than using an average fluoride concentration for the country, an individual should be assumed to have a 40% probability of ingesting fluoridated water and a 60% probability of ingesting nonfluoridated water. However, CDC (2002a) estimates that about two-thirds of the U.S. population served by public water supplies receives fluoridated water. Thus, the sampling reported by Miller-Ihli et al. was probably not sufficiently representative on a population-weighted basis.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-2 Population Sizes by Level of Artificial Fluoridation in 1992

Fluoride, mg/L

Number of Statesa

Population

Percentage

States

0.7

1

149,290

0.11

Hawaii

0.7-0.9

1

8,014,583

5.88

Texas

0.7-1.0

1

1,282,425

0.94

Arizona

0.8

4

12,886,396

9.46

Florida, Louisiana, Oklahoma, South Carolina

0.8-1.0

1

432,700

0.32

Delaware

0.9

2

7,177,525

5.27

Kentucky,b Virginiac

0.9-1.2

1

1,921,525

1.41

Colorado

1.0

29

93,060,026

68.30

Alabama, California, Connecticut, District of Columbia, Georgia, Idaho, Illinois, Indiana,c Kansas, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina,c Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Washington, West Virginia,c Wisconsin

1.0-1.1

2

1,931,337

1.42

Iowa, Wyoming

1.0-1.2

2

214,865

0.16

Montana, New Hampshire

1.1

1

233,447

0.17

Vermontd

1.2

5

5,026,243

3.69

Alaska, Maine, Minnesota,e North Dakota, South Dakota

No dataf

2

3,911,884

2.87

Arkansas, Puerto Rico

Total

52

136,242,246

100

 

aIncludes the 50 states, the District of Columbia, and Puerto Rico.

bA few small water supplies have artificial fluoride concentrations of 4.0 mg/L.

cA few small water supplies have artificial fluoride concentrations of 4.5 mg/L.

dA few small water supplies have artificial fluoride concentrations of 4.9 mg/L.

eA few small water supplies have artificial fluoride concentrations of 5.4 mg/L.

fData for Arkansas were not provided (the table for Arkansas contained a duplication of the Alaska data). The water fluoridation data were not provided for Puerto Rico.

SOURCE: CDC 1993.

give the corresponding estimates for consumption of community water or all water as a function of body weight. The data in Tables B-4 through B-9 are for those persons who actually consume water from the indicated source, rather than per capita estimates for the entire population. Estimates include plain (noncarbonated) drinking water and indirect water (water added to foods and beverages during preparation at home or by local food service establishments). Water in processed foods (commercial water) or naturally contained in foods (biological water) was not included.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

FIGURE B-1 Level of artificial fluoridation in 1992 by state (Table B-2; CDC 1993) versus area-weighted annual average temperature (°F) for that state over the period 1971-2000 (NCDC 2002a). Temperature for the District of Columbia is for Climate District 4 of the state of Maryland (NCDC 2002b). States with a range of artificial fluoride levels (Arizona, Colorado, Delaware, Iowa, Montana, New Hampshire, Texas, and Wyoming) are included at each relevant fluoride level. Arkansas and Puerto Rico are not included because of the lack of information on fluoride levels. Thin line indicates the “recommended optimal fluoride levels” for the given range of “annual average of maximum daily air temperatures” (emphasis added; Table B-1; CDC 1995).

EPA’s estimates are based on U.S. Department of Agriculture surveys taken in 1994, 1995, and 1996 of food ingestion data for two nonconsecutive days for a sample of more than 15,000 individuals in the 50 states and the District of Columbia selected to represent the entire U.S. population based on 1990 census data (EPA 2000a). (An additional survey of children in 1998 was included in the estimates used in Chapter 2.) Because these estimates were developed for the purpose of estimating people’s exposures to substances in drinking water and also are based on relatively recent data,

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-3 Population Sizes by Level of Natural Fluoridation in 1992

 

 

Reported Level of Natural Fluoride, mg/L

 

Statea

Reported Range, mg/L

≤1.2

1.3-1.9

2.0-3.9

≥4.0

Not givenb

Reported Totalc

Alabama

0.7-3.6

27,368

25,195

6,827

0

54,283

Arizona

0.7-7.4

242,309

63,132

39,259

516

345,266

Arkansas

NAd

17,239

California

0.7-3.5

389,715

24,583

500

0

414,798

Colorado

0.1-11.2

363,905

75,755

361,969

1,926

801,224

Connecticut

0.7-1.9

870

160

0

0

1,030

Delaware

0.6-0.9

7,171

0

0

0

7,171

Florida

0.5-3.6

890,443

37,435

1,227

0

929,105

Georgia

0.7-2.0

16,039

878

1,200

0

7,475

25,592

Hawaii

0.7

354

0

0

0

354

Idaho

0.6-15.9

293,127

8,275

2,650

500

304,552

Illinois

0.7-4.0

291,600

91,237

56,481

500

6,658

446,050

Indiana

0.7-4.4

177,890

36,254

5,541

5,790

31,928

264,233

Iowa

0.7-7.0

186,936

90,182

28,484

1,445

302,652

Kansas

0.5-2.6

81,884

14,958

22,846

0

41,558

161,515

Kentucky

NAe

0

0

0

0

1,899

1,899

Louisiana

0.7-3.8

302,520

44,787

12,599

0

357,210

Maryland

0.3-5.1

36,583

11,705

100

225

48,613

Massachusetts

1.0-1.1

122

0

0

0

122

Michigan

0.7-1.9

114,605

9,968

0

0

124,623

Minnesota

0.7-3.2

2,386

908

367

0

4,000

Mississippi

0.8-3.5

93,120

9,965

1,560

0

104,645

Missouri

0.7-5.0

74,412

58,168

16,906

180

143,603

Montana

0.1-7.3

85,452

3,923

7,171

1,814

492

82,985

Nebraska

0.3-1.4

31,246

4,352

0

0

35,598

Nevada

0.5-2.6

16,440

3,628

5,187

0

25,255

New Hampshire

1.0-3.9

12,612

3,749

11,190

0

27,551

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

New Jersey

0.7-2.5

32,344

56,450

24,651

0

113,445

New Mexico

0.7-13

178,754

45,619

58,556

4,295

261

287,485

New York

NAe

0

0

0

0

1,536

1,216

North Carolina

0.0-2.7

0

7,200

325

0

183,076

190,601

North Dakota

0.5-7.0

5,205

6,002

6,024

3,793

20,421

Ohio

0.8-2.8

131,963

104,558

13,450

0

1,010

249,755

Oklahoma

0.7-12.0

62,353

20,803

8,966

18,895

111,017

Oregon

0.7-2.4

39,865

2,320

680

0

42,865

South Carolina

0.1-5.9

62,924

27,968

190,430

105,618

378,995

South Dakota

0.7-6.0

10,097

14,053

41,038

692

37,758

Texas

0.7-8.8

2,234,504

426,341

233,326

36,863

25,200

2,955,395

Utah

0.7-2.0

8,240

2,560

0

0

10,800

Virginia

0.7-6.3

8,418

11,423

207,924

18,726

408

246,694

Washington

0.7-2.7

54,460

3,117

4,916

0

62,493

West Virginia

1.2

659

0

0

0

659

Wisconsin

0.7-2.7

90,713

36,570

50,140

0

174,850

Wyoming

0.7-4.5

14,694

21,984

2,144

120

38,942

Totals

 

6,674,302

1,406,165

1,424,634

201,898

301,501

9,954,559

aAlaska, the District of Columbia, Maine, Pennsylvania, Rhode Island, Tennessee, and Vermont reported no water systems with natural fluoridation.

bReported as 0.0 or some other number suspected to be a misprint.

cTotal given in the summary table for each state. Because of apparent internal inconsistencies, the numbers in the preceding columns do not necessarily give the same total.

dData for Arkansas were not provided (the table for Arkansas contained a duplication of the Alaska data).

eReported as 0.0 for all systems with natural fluoride.

SOURCE: CDC 1993.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-4 Estimated Average Daily Water Ingestion (mL/day) from Community Sources During 1994-1996, by People Who Consume Water from Community Sources

Population

Mean

50th Percentile

90th Percentile

95th Percentile

99th Percentile

Sample Size

Population

All consumers

1,000

785

2,069

2,600

4,273

14,012

242,641,675

<0.5 year

529

543

943

1,064

1,366

111

1,062,136

0.5-0.9 year

502

465

950

1,122

1,529

135

1,449,698

1-3 years

351

267

719

952

1,387

1,625

10,934,001

4-6 years

454

363

940

1,213

1,985

1,110

11,586,632

7-10 years

485

377

995

1,241

1,999

884

14,347,058

11-14 years

641

473

1,415

1,742

2,564

759

14,437,898

15-19 years

817

603

1,669

2,159

3,863

777

16,735,467

20-24 years

1,033

711

2,175

3,082

5,356

644

17,658,027

25-54 years

1,171

965

2,326

2,926

4,735

4,599

106,779,569

55-64 years

1,242

1,111

2,297

2,721

4,222

1,410

19,484,112

≥ 65 years

1,242

1,149

2,190

2,604

3,668

1,958

28,167,077

Males (all)

1,052

814

2,164

2,733

4,616

7,082

118,665,763

<1 year

462

441

881

1,121

1,281

118

1,191,526

1-10 years

444

355

934

1,155

1,731

1,812

18,847,070

11-19 years

828

595

1,673

2,058

3,984

768

15,923,625

≥ 20 years

1,242

1,038

2,387

3,016

4,939

4,384

82,703,542

Females (all)

951

747

2,005

2,482

3,863

6,930

123,975,912

<1 year

560

542

967

1,122

1,584

128

1,320,308

1-10 years

426

329

940

1,109

2,014

1,807

18,020,621

11-19 years

638

457

1,382

1,774

2,598

768

15,249,740

≥ 20 years

1,116

943

2,165

2,711

4,268

4,227

89,385,243

Lactating women

1,665

1,646

2,959

3,588

4,098

34

971,057

Pregnant women

872

553

1,844

2,588

3,448

65

1,645,565

Women aged 15-44 years

984

756

2,044

2,722

4,397

2,176

55,251,477

SOURCE: EPA 2000a.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-5 Estimated Average Daily Water Ingestion (mL/day) from Bottled Water During 1994-1996, by People Who Consume Bottled Water

Population

Mean

50th Percentile

90th Percentile

95th Percentile

99th Percentile

Sample Size

Population

All consumers

737

532

1,568

1,967

3,316

3,078

57,316,806

<0.5 year

411

349

896

951

1,193

51

538,267

0.5-0.9 year

437

361

802

808

1,578

37

456,103

1-3 years

302

232

649

819

1,175

368

2,532,201

4-6 years

390

315

794

922

1,319

213

2,336,873

7-10 years

416

323

828

985

1,767

164

2,808,756

11-14 years

538

361

1,099

1,420

2,192

148

2,896,893

15-19 years

665

468

1,503

1,777

3,149

163

3,528,434

20-24 years

786

532

1,640

2,343

3,126

179

5,089,216

25-54 years

822

621

1,773

1,981

3,786

1,174

28,487,354

55-64 years

860

685

1,833

2,306

2,839

279

3,987,578

≥ 65 years

910

785

1,766

2,074

2,548

302

4,655,131

Males (all)

749

523

1,626

2,097

3,781

1,505

26,298,392

<1 year

414

317

805

1,012

1,397

48

575,019

1-10 years

365

266

767

847

1,685

376

3,755,220

11-19 years

682

464

1,423

1,822

2,802

144

2,969,950

≥ 20 years

845

592

1,774

2,303

3,855

937

18,998,203

Females (all)

727

532

1,542

1,893

3,031

1,573

31,018,414

<1 year

436

428

895

896

1,301

40

419,351

1-10 years

375

289

765

993

1,347

369

3,922,610

11-19 years

544

357

1,116

1,537

3,143

167

3,455,377

≥ 20 years

819

690

1,747

1,975

3,060

997

23,221,076

Lactating women

749

608

1,144

1,223

1,286

7

278,308

Pregnant women

891

683

1,910

1,957

2,198

27

698,645

Women aged 15-44 years

766

592

1,598

1,922

3,093

611

16,279,438

SOURCE: EPA 2000a.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-6 Estimated Average Daily Water Ingestion (mL/day) from Other Sources (e.g., Wells and Cisterns) During 1994-1996, by People Who Consume Water from Those Sources

Population

Mean

50th Percentile

90th Percentile

95th Percentile

99th Percentile

Sample Size

Population

All consumers

965

739

1,971

2,475

3,820

2,129

34,693,744

<0.5 year

306

188

637

754

878

15

117,444

0.5-0.9 year

265

172

552

560

567

14

198,639

1-3 years

347

291

710

761

1,190

206

1,243,498

4-6 years

390

285

778

1,057

1,332

137

1,382,002

7-10 years

485

399

992

1,093

1,623

134

2,121,832

11-14 years

733

553

1,561

1,884

3,086

121

2,243,452

15-19 years

587

395

1,221

1,721

2,409

109

2,372,842

20-24 years

640

472

1,305

1,648

1,937

67

1,809,825

25-54 years

1,124

917

2,175

2,834

4,728

731

15,480,754

55-64 years

1,276

1,110

2,365

2,916

5,152

272

3,504,576

≥65 years

1,259

1,188

2,136

2,470

3,707

323

4,218,880

Males (all)

1,031

785

2,107

2,821

4,734

1,155

17,880,530

<1 year

243

148

554

567

773

16

198,829

1-10 years

426

320

884

1,077

1,630

259

2,566,652

11-19 years

702

564

1,366

1,753

2,787

103

2,011,715

≥20 years

1,212

1,001

2,286

3,017

4,883

777

13,103,334

Females (all)

894

710

1,826

2,225

3,035

974

16,813,214

<1 year

344

256

537

579

759

13

117,254

1-10 years

416

352

865

1,039

1,165

218

2,180,680

11-19 years

624

406

1,394

1,873

2,489

127

2,604,579

≥ 20 years

1,046

941

1,925

2,371

3,123

616

11,910,701

Lactating women

1,248

915

2,148

2,410

2,620

7

182,414

Pregnant women

1,066

660

1,676

1,807

3,374

7

168,433

Women aged 15-44 years

904

666

1,863

2,319

3,056

283

6,759,992

SOURCE: EPA 2000a.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-7 Estimated Average Daily Water Ingestion (mL/day) from All Sources During 1994-1996 by Consumers of Water

Population

Mean

50th Percentile

90th Percentile

95th Percentile

99th Percentile

Sample Size

Population

All consumers

1,241

1,045

2,345

2,922

4,808

15,172

259,972,235

<0.5 year

544

545

947

1,078

1,365

156

1,507,727

0.5-0.9 year

580

563

1,130

1,273

1,672

154

1,732,993

1-3 years

422

351

807

993

1,393

1,814

12,143,483

4-6 years

548

468

1,019

1,268

2,031

1,193

12,438,322

7-10 years

608

514

1,131

1,425

2,172

937

15,248,676

11-14 years

815

651

1,625

1,962

3,033

812

15,504,627

15-19 years

1,006

776

1,897

2,414

4,027

814

17,697,092

20-24 years

1,283

1,013

2,508

3,632

5,801

678

18,544,787

25-54 years

1,486

1,273

2,638

3,337

5,259

4,906

113,011,204

55-64 years

1,532

1,378

2,557

2,999

4,395

1,541

21,145,387

≥65 years

1,453

1,345

2,324

2,708

3,750

2,167

30,997,937

Males (all)

1,300

1,070

2,483

3,149

5,212

7,689

126,998,276

<1 year

549

538

1,121

1,278

1,567

151

1,560,310

1-10 years

536

451

1,024

1,254

1,817

1,993

20,495,833

11-19 years

1,001

761

1,898

2,434

4,011

809

16,887,932

≥ 20 years

1,549

1,331

2,740

3,524

5,526

4,736

88,054,201

Females (all)

1,185

1,021

2,221

2,703

4,252

7,483

132,973,959

<1 year

577

559

950

1,131

1,654

159

1,680,410

1-10 years

528

445

993

1,226

2,035

1,951

19,334,648

11-19 years

830

664

1,652

1,955

3,083

817

16,313,787

≥20 years

1,389

1,221

2,416

2,928

4,512

4,556

95,645,114

Lactating women

1,806

1,498

3,021

3,767

4,024

41

1,171,868

Pregnant women

1,318

1,228

2,339

2,674

3,557

70

1,751,888

Women aged 15-44 years

1,265

1,065

2,366

2,952

4,821

2,314

58,549,659

SOURCE: EPA 2000a.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-8 Estimated Average Daily Water Ingestion (mL/kg of Body Weight per Day) from Community Sources during 1994-1996, by People Who Consume Water from Community Sources

Population

Mean

50th Percentile

90th Percentile

95th Percentile

99th Percentile

Sample Size

Population

All consumers

17

13

33

44

79

13,593

236,742,834

<0.5 year

88

85

169

204

240

106

1,034,566

0.5-0.9 year

56

52

116

127

170

128

1,405,128

1-3 years

26

20

53

68

112

1,548

10,417,368

4-6 years

23

18

45

65

95

1,025

10,751,616

7-10 years

16

12

33

39

60

820

13,427,986

11-14 years

13

10

27

36

54

736

14,102,256

15-19 years

12

9

26

32

62

771

16,646,551

20-24 years

15

11

31

39

80

637

17,426,127

25-54 years

16

13

32

40

65

4,512

104,816,948

55-64 years

17

14

32

38

58

1,383

19,011,778

≥65 years

18

16

32

37

53

1,927

27,702,510

Males (all)

16

13

32

43

81

6,935

117,076,195

<1 year

66

60

139

175

235

115

1,180,289

1-10 years

21

16

43

55

87

1,705

17,865,064

11-19 years

14

10

27

38

67

755

15,717,364

≥ 20 years

15

13

30

38

62

4,360

82,313,478

Females (all)

17

14

35

45

77

6,658

119,666,639

<1 year

72

69

139

169

203

119

1,259,405

1-10 years

21

17

45

61

98

1,688

16,731,906

11-19 years

12

9

26

32

48

752

15,031,443

≥20 years

17

14

33

41

63

4,099

86,643,885

Lactating women

26

20

54

55

57

33

940,375

Pregnant women

14

9

 

43

47

65

1,645,565

Women aged 15-44 years

15

12

32

39

66

2,126

54,000,618

SOURCE: EPA 2000a.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-9 Estimated Average Daily Water Ingestion (mL/kg of Body Weight per Day) from All Sources During 1994-1996 by Consumers of Water

Population

Mean

50th Percentile

90th Percentile

95th Percentile

99th Percentile

Sample Size

Population

All consumers

21

17

38

50

87

14,726

253,667,688

<0.5 year

92

87

169

196

239

149

1,465,837

0.5-0.9 year

65

58

120

164

185

147

1,688,423

1-3 years

31

26

60

74

118

1,732

11,603,245

4-6 years

27

23

51

68

97

1,103

11,556,872

7-10 years

20

17

36

44

70

873

14,329,604

11-14 years

16

14

33

40

60

786

15,116,291

15-19 years

15

12

29

38

66

806

17,564,502

20-24 years

18

14

34

44

86

668

18,224,524

25-54 years

20

17

37

46

69

4,813

110,938,819

55-64 years

20

18

35

42

59

1,513

20,646,201

≥65 years

21

19

34

39

54

2,136

30,533,370

Males (all)

20

16

38

49

86

7,532

125,266,552

<1 year

77

66

164

173

233

147

1,538,210

1-10 years

25

20

48

62

91

1,882

19,480,513

11-19 years

16

13

32

42

69

794

16,642,651

≥20 years

19

16

34

43

67

4,709

87,605,178

Females (all)

22

18

39

50

88

7,194

128,401,136

<1 year

79

72

158

170

200

149

1,616,050

1-10 years

26

21

50

66

104

1,826

18,009,208

11-19 years

15

13

29

36

56

798

16,038,142

≥20 years

21

18

37

45

69

4,421

92,737,736

Lactating women

28

25

53

57

70

40

1,141,186

Pregnant women

21

19

39

44

61

69

1,729,947

Women aged 15-44 years

20

16

36

46

77

2,258

57,164,907

SOURCE: EPA 2000a.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

they are appropriate for the present purpose of estimating the range of current exposures to fluoride. These estimates are based on a 2-day average, whereas for fluoride exposure, long-term averages of intake are usually more important. However, given the size of the population sampled, the likelihood that the entire sample represents days of unusually high or unusually low water intake is small. Thus, these values are considered reasonable indicators both of typical water consumption and of the likely range of water consumption from various sources on a long-term basis. However, they should not be used by themselves to estimate the number of individuals or percentage of the population that consumes a given amount of water on a long-term basis, especially not at the extremes of the range. Water intakes at the low end are not of major importance for the present report, and water intakes at the high end are considered separately (Chapter 2), with additional information beyond what is provided by EPA.

It may be helpful to compare the water intakes (all sources, Table B-7) with values for adequate intake3 (AI) of water recently published by the Institute of Medicine (IOM 2004; Table B-10). The AI for total water (drinking water, other beverages, and moisture contained in food) is set “to prevent deleterious, primarily acute, effects of dehydration, which include metabolic and functional abnormalities” (IOM 2004). “Given the extreme variability in water needs which are not solely based on differences in metabolism, but also in environmental conditions and activity, there is not a single level of water intake that would ensure adequate hydration and optimal health for half4 of all apparently healthy persons in all environmental conditions” (IOM 2004). The AI for total water is based on the median total water intake from U.S. survey data (NHANES III, 1988-1994; described by IOM 2004). Daily consumption below the AI is not necessarily a concern “because a wide range of intakes is compatible with normal hydration. Higher intakes of total water will be required for those who are physically active or who are exposed to [a] hot environment” (IOM 2004). For the intake values shown in Table B-10, approximately 80% of the intake comes from drinking water and other beverages (including caffeinated and alcoholic beverages).

Use of bottled water in the United States has at least doubled since 1990 (Grossman 2002), suggesting that more people use bottled water now than in 1994-1996 and/or that individuals use more bottled water per person.

3

“Adequate intake” is defined as “the recommended average daily intake level based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate—used when an RDA [recommended dietary allowance] cannot be determined” (IOM 2004).

4

The estimated average requirement (EAR) on which a recommended dietary allowance is based is defined as “the average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group” (IOM 2004).

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-10 Adequate Intake Values (L/day) for Total Water

 

Males

Females

Group

From Foods

From Beverages

Total Water

From Foods

From Beverages

Total Water

0-6 months

0

0.7

0.7

0

0.7

0.7

7-12 months

0.2

0.6

0.8

0.2

0.6

0.8

1-3 years

0.4

0.9

1.3

0.4

0.9

1.3

4-8 years

0.5

1.2

1.7

0.5

1.2

1.7

9-13 years

0.6

1.8

2.4

0.5

1.6

2.1

14-18 years

0.7

2.6

3.3

0.5

1.8

2.3

>19 years

0.7

3.0

3.7

0.5

2.2

2.7

Pregnancya

0.7

2.3

3.0

Lactationa

0.7

3.1

3.8

aWomen aged 14-50 years.

SOURCE: IOM 2004.

However, total water consumption per person from all sources combined probably has not changed substantially. Information for a few groups in the tables (children < 1 year of age, pregnant and lactating women) is based on relatively small sample sizes, and the confidence to be placed in specific percentile values is therefore lower. Sample sizes for some other population subgroups of potential interest (e.g., Native Americans with traditional lifestyles, people in hot climates, people with high physical activity, people with certain medical conditions) were not large enough to evaluate intake by members of the subgroup, although some people from those groups are included in the overall sample (EPA 2000a).

Tables B-11 to B-14 summarize fluoride intakes that would result from ingestion of community water (for the mean, 90th, 95th, and 99th percentiles of consumption estimated by EPA) at various levels of water fluoride (“optimal” fluoridation levels of 0.7, 1.0, or 1.2 mg/L, and the present secondary MCL [SMCL] and MCL of 2 and 4 mg/L, respectively). The SMCL and MCL are included for purposes of comparison; most people in the Unites States do not drink water with those fluoride levels. An average consumer below the age of 6 months would have an intake of 0.06-0.1 mg/kg/day from fluoridated water (0.7-1.2 mg/L), whereas an adult would ingest approximately 0.01-0.02 mg/kg/day. Individuals at the upper levels of water intake from EPA’s estimates (Table B-14) could have fluoride intakes in excess of 1 mg/day at the lowest levels of fluoridation up to about 6 mg/day for some adults, depending on age and level of water fluoridation. Persons in the high-water-intake groups described above could have even higher intakes.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-11 Estimated Intake of Fluoride from Community Water for Average Consumersa

 

 

Fluoride Level

 

Water Intake, mL/day

0.7 mg/L

1 mg/L

1.2 mg/L

2 mg/L

4 mg/L

Population

Intake, mg/day

All consumers

1,000

0.70

1.00

1.20

2.00

4.00

<0.5 year

529

0.37

0.53

0.63

1.06

2.12

0.5-0.9 year

502

0.35

0.50

0.60

1.00

2.01

1-3 years

351

0.25

0.35

0.42

0.70

1.40

4-6 years

454

0.32

0.45

0.54

0.91

1.82

7-10 years

485

0.34

0.49

0.58

0.97

1.94

11-14 years

641

0.45

0.64

0.77

1.28

2.56

15-19 years

817

0.57

0.82

0.98

1.63

3.27

20-24 years

1,033

0.72

1.03

1.24

2.07

4.13

25-54 years

1,171

0.82

1.17

1.41

2.34

4.68

55-64 years

1,242

0.87

1.24

1.49

2.48

4.97

≥65 years

1,242

0.87

1.24

1.49

2.48

4.97

 

Water Intake, mL/kg/day

Intake, mg per kg body weight/day

All consumers

17

0.012

0.017

0.020

0.034

0.068

<0.5 year

88

0.062

0.088

0.106

0.176

0.352

0.5-0.9 year

56

0.039

0.056

0.067

0.112

0.224

1-3 years

26

0.018

0.026

0.031

0.052

0.104

4-6 years

23

0.016

0.023

0.028

0.046

0.092

7-10 years

16

0.011

0.016

0.019

0.032

0.064

11-14 years

13

0.009

0.013

0.016

0.026

0.052

15-19 years

12

0.008

0.012

0.014

0.024

0.048

20-24 years

15

0.011

0.015

0.018

0.030

0.060

25-54 years

16

0.011

0.016

0.019

0.032

0.064

55-64 years

17

0.012

0.017

0.020

0.034

0.068

≥65 years

18

0.013

0.018

0.022

0.036

0.072

aBased on water consumption rates estimated by EPA (2000a).

EXPOSURES FROM FLUORINATED ANESTHETICS

The sampled data in Table B-15 illustrate wide ranges of reported mean peak serum fluoride concentrations from the use of fluorinated anesthetics under various surgical conditions and for different age groups ranging from 22-day-old infants to people > 70 years old. These data are collected from studies conducted in many countries, including Australia, France, Finland, Germany, Ireland, Japan, the United Kingdom, and the United States. The

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-12 Estimated Intake of Fluoride from Community Water for 90th Percentile Consumersa

 

 

Fluoride Level

 

Water Intake, mL/day

0.7 mg/L

1 mg/L

1.2 mg/L

2 mg/L

4 mg/L

Population

Intake, mg/day

All consumers

2,069

1.45

2.07

2.48

4.14

8.28

<0.5 year

943

0.66

0.94

1.13

1.89

3.77

0.5-0.9 year

950

0.67

0.95

1.14

1.90

3.80

1-3 years

719

0.50

0.72

0.86

1.44

2.88

4-6 years

940

0.66

0.94

1.13

1.88

3.76

7-10 years

995

0.70

1.00

1.19

1.99

3.98

11-14 years

1,415

0.99

1.42

1.70

2.83

5.66

15-19 years

1,669

1.17

1.67

2.00

3.34

6.68

20-24 years

2,175

1.52

2.18

2.61

4.35

8.70

25-54 years

2,326

1.63

2.33

2.79

4.65

9.30

55-64 years

2,297

1.61

2.30

2.76

4.59

9.19

≥65 years

2,190

1.53

2.19

2.63

4.38

8.76

 

Water Intake, mL/kg/day

Intake, mg per kg body weight/day

All consumers

33

0.023

0.033

0.040

0.066

0.132

<0.5 year

169

0.118

0.169

0.203

0.338

0.676

0.5-0.9 year

116

0.081

0.116

0.139

0.232

0.464

1-3 years

53

0.037

0.053

0.064

0.106

0.212

4-6 years

45

0.032

0.045

0.054

0.090

0.180

7-10 years

33

0.023

0.033

0.040

0.066

0.132

11-14 years

27

0.019

0.027

0.032

0.054

0.108

15-19 years

26

0.018

0.026

0.031

0.052

0.104

20-24 years

31

0.022

0.031

0.037

0.062

0.124

25-54 years

32

0.022

0.032

0.038

0.064

0.128

55-64 years

32

0.022

0.032

0.038

0.064

0.128

≥65 years

32

0.022

0.032

0.038

0.064

0.128

aBased on water consumption rates estimated by EPA (2000a).

minimum alveolar concentration per hour (MAC-hr) ranged from short-term (e.g., for cesarean section as reported by Abboud et al. 1989) to prolonged (e.g., >10 hours as reported by Murray et al. 1992 and Obata et al. 2000) surgery and up to 7 days of continuous exposure for critically ill patients (e.g., as reported by Osborne et al. 1996). Test subjects included healthy males who underwent 3-9 hours of anesthesia (Munday et al. 1995), female smokers (Laisalmi et al. 2003), infants and children (age as indicated

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-13 Estimated Intake of Fluoride from Community Water for 95th Percentile Consumersa

 

 

Fluoride Level

 

Water Intake, mL/day

0.7 mg/L

1 mg/L

1.2 mg/L

2 mg/L

4 mg/L

Population

Intake, mg/day

All consumers

2,600

1.82

2.60

3.12

5.20

10.40

<0.5 year

1,064

0.74

1.06

1.28

2.13

4.26

0.5-0.9 year

1,122

0.79

1.12

1.35

2.24

4.49

1-3 years

952

0.67

0.95

1.14

1.90

3.81

4-6 years

1,213

0.85

1.21

1.46

2.43

4.85

7-10 years

1,241

0.87

1.24

1.49

2.48

4.96

11-14 years

1,742

1.22

1.74

2.09

3.48

6.97

15-19 years

2,159

1.51

2.16

2.59

4.32

8.64

20-24 years

3,082

2.16

3.08

3.70

6.16

12.33

25-54 years

2,926

2.05

2.93

3.51

5.85

11.70

55-64 years

2,721

1.90

2.72

3.27

5.44

10.88

≥65 years

2,604

1.82

2.60

3.12

5.21

10.42

 

Water Intake, mL/kg/day

Intake, mg per kg body weight/day

All consumers

44

0.031

0.044

0.053

0.088

0.176

<0.5 year

204

0.143

0.204

0.245

0.408

0.816

0.5-0.9 year

127

0.089

0.127

0.152

0.254

0.508

1-3 years

68

0.048

0.068

0.082

0.136

0.272

4-6 years

65

0.046

0.065

0.078

0.130

0.260

7-10 years

39

0.027

0.039

0.047

0.078

0.156

11-14 years

36

0.025

0.036

0.043

0.072

0.144

15-19 years

32

0.022

0.032

0.038

0.064

0.128

20-24 years

39

0.027

0.039

0.047

0.078

0.156

25-54 years

40

0.028

0.040

0.048

0.080

0.160

55-64 years

38

0.027

0.038

0.046

0.076

0.152

≥65 years

37

0.026

0.037

0.044

0.074

0.148

aBased on water consumption rates estimated by EPA (2000a).

in Table B-15), and patients with renal insufficiency (Conzen et al. 1995). In general, higher MAC-hr resulted in higher peak serum inorganic fluoride concentration. None of the studies presented in Table B-15 shows clear evidence of renal impairment as a result of the increased serum fluoride concentration, except transient reduction in renal function among the elderly (>70 years) reported by Hase et al. (2000). Higher peak serum concentration

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-14 Estimated Intake of Fluoride from Community Water for 99th Percentile Consumersa

Population

Water Intake, mL/day

Fluoride Level.

 

0.7 mg/L

1 mg/L

1.2 mg/L

2 mg/L

4 mg/L

 

 

Intake, mg/day

All consumers

4,273

2.99

4.27

5.13

8.55

17.09

<0.5 year

1,366

0.96

1.37

1.64

2.73

5.46

0.5-0.9 year

1,529

1.07

1.53

1.83

3.06

6.12

1-3 years

1,387

0.97

1.39

1.66

2.77

5.55

4-6 years

1,985

1.39

1.99

2.38

3.97

7.94

7-10 years

1,999

1.40

2.00

2.40

4.00

8.00

11-14 years

2,564

1.79

2.56

3.08

5.13

10.26

15-19 years

3,863

2.70

3.86

4.64

7.73

15.45

20-24 years

5,356

3.75

5.36

6.43

10.71

21.42

25-54 years

4,735

3.31

4.74

5.68

9.47

18.94

55-64 years

4,222

2.96

4.22

5.07

8.44

16.89

≥65 years

3,668

2.57

3.67

4.40

7.34

14.67

 

Water Intake, mL/kg/day

Intake, mg per kg body weight/day

All consumers

79

0.055

0.079

0.095

0.158

0.316

<0.5 year

240

0.168

0.240

0.288

0.480

0.960

0.5-0.9 year

170

0.119

0.170

0.204

0.340

0.680

1-3 years

112

0.078

0.112

0.134

0.224

0.448

4-6 years

95

0.067

0.095

0.114

0.190

0.380

7-10 years

60

0.042

0.060

0.072

0.120

0.240

11-14 years

54

0.038

0.054

0.065

0.108

0.216

15-19 years

62

0.043

0.062

0.074

0.124

0.248

20-24 years

80

0.056

0.080

0.096

0.160

0.320

25-54 years

65

0.046

0.065

0.078

0.130

0.260

55-64 years

58

0.041

0.058

0.070

0.116

0.232

≥65 years

53

0.037

0.053

0.064

0.106

0.212

aBased on water consumption rates estimated by EPA (2000a).

was reported for smokers (Cousins et al. 1976; Laisalmi et al. 2003) and is associated with alcohol, obesity, and multiple drug use (Cousins et al. 1976). Because the reference point for the potential nephrotoxicity in these studies was the peak serum fluoride concentration, data are generally not available for an estimation of the total fluoride load or the area under the curve from the use of these anesthetics.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-15 Serum Inorganic Fluoride Concentration from Fluorinated Anesthetic Agents

 

 

 

Mean Serum Inorganic Fluoride, μM

 

Age (range)

No. of Subjects

MAC-houra

Baseline

Peak

References

Isoflurane

 

 

 

 

 

51 years

13

NA

NA

No change

Hara et al. 1998

NA

90

NA

NA

3

Groudine et al. 1999

>70 years

6

3.7

NA

4

Hase et al. 2000

55.5 years

26

NA

about 2.5

5

Goldberg et al. 1996

57 years

24

1.1

3.8

5.4

Newman et al. 1994

28 years

11

9.2

<2

5.5

Higuchi et al. 1995

28 yearsb

20

0.06

5.6

5.6

Abboud et al. 1989

27.7 yearsb

20

0.14

5.9

5.6

Abboud et al. 1989

48.5 years

20

15.9

NA

7.4

Obata et al. 2000

53.7 years

7

4.8

NA

8

Matsumura et al. 1994

26-54 years

5

NAc

2.1-2.4

8.4-27.9

Osborne et al. 1996

20-75 years

9

19.2

3.5-3.8

43.2

Murray et al. 1992

Enflurane

 

 

 

 

 

22 days to 11 years

40

0.3-0.7

NA

2-8

Oikkonen and Meretoja 1989

 

 

0.7-1.5

NA

4-10

Oikkonen and Meretoja 1989

 

 

1.5-3.3

NA

6-10

Oikkonen and Meretoja 1989

22 day

1

0.6

NA

3

Oikkonen and Meretoja 1989

29 day

1

1.5

NA

7

Oikkonen and Meretoja 1989

3 months

1

1.6

NA

11

Oikkonen and Meretoja 1989

4 months

1

1.6

NA

11

Oikkonen and Meretoja 1989

9 months

1

2.0

NA

7

Oikkonen and Meretoja 1989

1-9 years

8

NA

1.7

10.5

Hinkle 1989

47-60 years

5

4-6.8

about 2-3

7

Sakai and Takaori 1978

63.9 years

20

1.07

NA

13.3

Conzen et al. 1995

48 years(27-58 years)

16

1

NA

13.8

Laisalmi et al. 2003

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

44 years (35-39 years)d

17

1

NA

18.7

Laisalmi et al. 2003

59.3 years

40

2.8

1.2

16.75

Blanco et al. 1995

47.8 years

8

1.24

2-2.5

18

Cousins et al. 1987

40.2 years

10

2.7

1.8

22.2

Cousins et al. 1976

18-35 years

5

6

 

28.1

Munday et al. 1995

18-35 years

5

 

NA

27.5

Munday et al. 1995

Halothane

 

 

 

 

 

41.5 years

10

4.9

1.9

1.6

Cousins et al. 1976

6.2 years (1-12 years)

40

2.6

NA

1.8

Sarner et al. 1995

42-57 years

5

2.9-4.9

2-3

3

Sakai and Takaori 1978

50 years

8

2.5

2-2.5

4

Cousins et al. 1987

28.9 years

20

0.07

5.9

5.6

Abboud et al. 1989

9.2 years (5-12 years)

25

2.2

NA

6

Taivainen et al. 1994

20-75 years

10

19.5

3.8

12.6

Murray et al. 1992

Sevoflurane

 

 

 

 

 

12 months (7.7-25 months)

41

4.7

NA

13.8

Lejus et al. 2002

6.2 years (1-12 years)

40

2.6

NA

14.7

Sarner et al. 1995

>70 years

7

5.1

NA

18

Hase et al. 2000

8.8 years

25

2.2

NA

21

Taivainen et al. 1994

50 years

25

0.8

3.8

23

Newman et al. 1994

67.4 years

21

1.01

NA

25

Conzen et al. 1995

60.5 years

40

2.9

1.2

27.7

Blanco et al. 1995

52.7 years

24

NA

about 2.5

28

Goldberg et al. 1996

18-35 years

5

3

NA

30.5

Munday et al. 1995

 

5

6

 

31-34

 

 

5

9

 

36.6

 

29 years

15

9.9

<2

36.8

Higuchi et al. 1995

53 years

13

3.7

NA

about 31

Hara at al. 1998

NA

98

2.9

NA

40

Groudine et al. 1999

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

 

 

 

Mean Serum Inorganic Fluoride, μM

 

Age (range)

No. of Subjects

MAC-houra

Baseline

Peak

References

26.6 years (19-49 years)

11

10.6

NA

41.9

Higuchi et al. 1994

56.8 years

10

18.0 high flow

NA

47.1

Obata et al. 2000

62.0 years

10

16.7 low flow

NA

53.5

Obata et al. 2000

54.9 years

8

6.1

NA

54

Matsumura et al. 1994

24 years

8

14.0

<2

57.5

Higuchi et al. 1995

aMAC is the minimum alveolar concentration, or the mean end-tidal anesthetic concentration. When MAC-hr is not reported, it is estimated as MAC-hr = (mean percent concentration) x (anesthesia time).

bCesarean section patients with induction to delivery time of 7.4-8.4 minutes.

cCritically ill patients under anesthesia for 5-7 days at 0.6-1.2% isoflurane.

dSmoking > 10 cigarettes a day.

ABBREVIATION: NA, not applicable.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-16 Summary of Estimated Safe and Adequate Daily Dietary Intakesa of Fluoride

Age, years

Weight, kgb

Range, mg/day

Range, mg/kg/dayc

0-0.5

6

0.1

0.5

0.017

0.083

0.5-1

9

0.2

1.0

0.022

0.11

1-3

13

0.5

1.5

0.038

0.12

4-6

20

1.0

2.5

0.050

0.13

7-10

28

1.5

2.5

0.054

0.089

Males

11-14

45

1.5

2.5

0.033

0.056

15-18

66

1.5

2.5d

0.023

0.038

19-24

72

1.5

4.0e

0.021

0.056

25-50

79

1.5

4.0

0.019

0.051

51+

77

1.5

4.0

0.019

0.052

Females

11-14

46

1.5

2.5

0.033

0.054

15-18

55

1.5

2.5d

0.027

0.045

19-24

58

1.5

4.0e

0.026

0.069

25-50

63

1.5

4.0

0.024

0.063

51+

65

1.5

4.0

0.023

0.062

aThe term “safe and adequate daily dietary intake” was used by the NRC (1989b) “when data were sufficient to estimate a range of requirements, but insufficient for developing [a Recommended Dietary Allowance].” This category was to be accompanied by “the caution that upper levels in the safe and adequate range should not be habitually exceeded because the toxic level for many trace elements may be only several times usual intakes.” Use of this term should not be taken to imply that the present committee considers these intakes to be safe or adequate.

bMedian for age group.

cCalculated from range (mg/day) and weight (kg) given for age groups.

dUpper limit for children and adolescents (upper age not specified).

eUpper limit for adults.

SOURCE: NRC 1989b.

REFERENCE INTAKES OF FLUORIDE

Table B-16 provides the median weight and range of fluoride intake (mg/day; safe and adequate daily dietary intake5), by age group, from the National Research Council (NRC 1989b). Table B-17 provides the reference

5

The term “safe and adequate daily dietary intake” was used by the NRC (1989b) “when data were sufficient to estimate a range of requirements, but insufficient for developing [a Recommended Dietary Allowance].” This category was to be accompanied by “the caution that upper levels in the safe and adequate range should not be habitually exceeded because the toxic level for many trace elements may be only several times usual intakes.” Use of this

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×

TABLE B-17 Summary of Dietary Reference Intakes of Fluoride

 

Reference Weight, kg

Adequate Intake

Tolerable Upper Intake

Age, years

mg/d

mg/kg/daya

mg/d

mg/kg/daya

0-0.5

7

0.01

0.0014

0.7

0.10

0.5-1

9

0.5

0.056

0.9

0.10

1-3

13

0.7

0.054

1.3

0.10

4-8

22

1

0.045

2.2

0.10

9-13

40

2

0.050

10

0.25

Boys 14-18

64

3

0.047

10

0.16

Girls 14-18

57

3

0.053

10

0.18

Males 19+

76

4

0.053

10

0.13

Females 19+

61

3

0.049

10

0.16

aCalculated from intake (mg/day) and weight (kg) given for age groups by IOM (1997) and ADA (2005).

SOURCES: IOM 1997; ADA 2005.

weight and range of fluoride intake (mg/day; dietary reference intake), by age group, from the Institute of Medicine (IOM 1997) and the American Dental Association (ADA 2005). In both tables, the intakes in terms of mg/ kg/day were calculated from the cited information as indicated.

term should not be taken to imply that the present committee considers these intakes to be safe or adequate.

Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 416
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 417
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 418
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 419
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 420
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 421
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 422
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 423
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 424
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 425
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 426
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 427
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 428
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 429
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 430
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 431
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 432
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 433
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 434
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 435
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 436
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 437
Suggested Citation:"Appendix B Measures of Exposure to Fluoride in the United States: Supplementary Information." National Research Council. 2006. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: The National Academies Press. doi: 10.17226/11571.
×
Page 438
Next: Appendix C Ecologic and Partially Ecologic Studies in Epidemiology »
Fluoride in Drinking Water: A Scientific Review of EPA's Standards Get This Book
×
Buy Paperback | $76.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Most people associate fluoride with the practice of intentionally adding fluoride to public drinking water supplies for the prevention of tooth decay. However, fluoride can also enter public water systems from natural sources, including runoff from the weathering of fluoride-containing rocks and soils and leaching from soil into groundwater. Fluoride pollution from various industrial emissions can also contaminate water supplies. In a few areas of the United States fluoride concentrations in water are much higher than normal, mostly from natural sources. Fluoride is one of the drinking water contaminants regulated by the U.S. Environmental Protection Agency (EPA) because it can occur at these toxic levels. In 1986, the EPA established a maximum allowable concentration for fluoride in drinking water of 4 milligrams per liter, a guideline designed to prevent the public from being exposed to harmful levels of fluoride. Fluoride in Drinking Water reviews research on various health effects from exposure to fluoride, including studies conducted in the last 10 years.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!