Water operators, you play an important role in the public’s health. It is your responsibility to ensure safe water supplies. One component of this responsibility might be adjusting the fluoride concentration of fluoride-deficient water supplies to the optimal level. This responsibility plays an enormous role in improving the oral health of residents with access to fluoridated water. Below are resources to assist you in fluoridation engineering/operations and in answering questions about the safety and effectiveness of community water fluoridation.

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Engineering & Operation

Optimal Fluoride Level Recommendations

Adding fluoride to drinking water is a safe, inexpensive and effective method of preventing cavities and improving the health of communities. This fact sheet from the Wisconsin Department of Health Services outlines the optimal fluoride level recommendations and explains the importance of community water fluoridation for the State of Wisconsin.

Wisconsin Department of Natural Resources: Chapter NR 809 Safe Drinking Water

Chapter NR 809 of the Wisconsin Administrative Code includes information on compliance requirements for public water systems that fluoridate water, including the recommended optimal level of fluoride in drinking water, the maximum contaminant levels and the secondary drinking water standard. There is also information on sample collection, analytical requirements, requirements for fluoride containers, violation categories and information on situations that require public notification.
NR 810

Wisconsin Department of Natural Resources: Chapter NR 810 Requirements for the Operation and Maintenance of Public Water Systems

Chapter NR 810 of the Wisconsin Administrative Code governs the general operation and maintenance of all public water systems. This section includes valuable information on monitoring, reporting and recordkeeping requirements.

Wisconsin Department of Natural Resources: Chapter NR 811 Requirements for the operation and design of community water systems

Chapter NR 811 of the Wisconsin Administrative Code includes information on fluoride storage, chemical feed installations, secondary controls, dust control, protective equipment, testing equipment and dilution equipment.

Annual Water Fluoridation Training

The Centers for Disease Control and Prevention offers biannual water fluoridation engineering and operations training. The three-day training presents basic information on community water fluoridation, including engineering and administrative guidance.

Engineering & Administrative Recommendations for Water Fluoridation

The Centers for Disease Control and Prevention’s Engineering and Administrative Recommendations for Water Fluoridation (EARWF) provides technical and administrative guidelines and/or recommendations for correcting inconsistencies in fluoridated water supply systems.

U.S. Department of Health & Human Services, Optimal Fluoride Level Recommendation

The U.S. Public Health Service provides recommendations for the optimal fluoride level in community water systems to effectively reduce tooth decay. This recommendation was updated in 2015. View this press release to learn more.

Water Fluoridation Principles and Practices

This comprehensive fluoride manual, published by the American Water Works Association (AWWA), provides specific recommendations for water fluoridation, including administration, monitoring, technical requirements and safety procedures. The table of contents may be viewed and the manual purchased at the AWWA’s online store.

Fluoridation Engineering Fact Sheets

This is a link to the Center for Disease Control and Preventions’ Engineering Fact Sheets including Water Fluoridation Additives, Corrosion of Pipes and Calculating Fluoridation Statistics.

Recommended Standards for Water Works

The Great Lakes-Upper Mississippi River Board of State and Provincial Public Health and Environmental Managers published Recommended Standards for Waterworks, commonly referred to as the Ten States Standards. Part 5 of this document pertains to fluoride application in general, with ss. 5.4.7 pertaining specifically to fluoride application.

Talking Water Fluoridation

Wisconsin Fluoridation Supporters

Many respected organizations support community water fluoridation as a public health activity. This graphic shows some of the many Wisconsin supporters of community water fluoridation.

American Dental Association’s Fluoridation Facts

The American Dental Association’s Fluoridation Facts provides detailed answers to frequently asked questions about community water fluoridation, including topics of effectiveness, safety, practice and cost-effectiveness. Fluoridation Facts is an in-depth document that can provide scientific information to help guide your conversations with community members and leaders.
Myths & Facts-1

Myths & Facts

Water operators are often considered the local authority for water fluoridation and are expected to field questions from residents and community leaders. This document from ilikemyteeth.org outlines the facts of community water fluoridation and answers the most frequently asked questions.

Public Communication Toolkit

The American Water Works Association has put together a public communications toolkit, housing all of their information on public communication. Use this toolkit to assist in conversations about community water fluoridation with the public.

Water Fluoridation Quality Award

2013 Water Fluoridation Quality Award Recipients

Each year, Wisconsin drinking water programs strive to qualify for the Centers for Disease Control and Prevention (CDC) Water Fluoridation Quality Award. Here you will find the list of Wisconsin CDC award winners.

Water Fluoridation Quality Award

The Centers for Disease Control and Prevention (CDC) recognizes public water systems that consistently achieve optimal fluoridation levels with an annual Water Fluoridation Quality Award. View this document to find out how your community can be eligible for the CDC’s water fluoridation quality award.

Other Resources

Wisconsin Rural Water Association

The Wisconsin Rural Water Association’s (WRWA) mission is: “To educate the water and wastewater industry through training and technical assistance.” Visit the WRWA’s website to learn more about membership, training opportunities and resources for water operators.

American Water Works Association - Wisconsin Section

The Wisconsin Section of the American Water Works Association’s mission is: “To ensure a safe, reliable and environmentally responsible drinking water by providing education, timely information and networking opportunities for membership and the Wisconsin drinking water community at large.” Visit their website to learn more about membership, training opportunities and resources for water operators.
State of Science

State of Science: Community Water Fluoridation

According to a Water Research Foundation report released October 16, 2015, “drinking optimally fluoridated water is a good way to decrease the risk of tooth decay.” The report describes the history and science of community water fluoridation and examines the current practices of community water fluoridation in the United States.