Water fluoridation
Health and dental organizations worldwide have endorsed its safety and effectiveness. Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water. Further research showed that moderate fluoridation prevents tooth decay.
Drinking water quality in the United States
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 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. In 1986, EPA established a maximum allowable concentration for fluoride in drinking water of 4 milligrams per liter (mg/L). After reviewing research on various health effects from exposure to fluoride, the Committee on Fluoride in Drinking Water of the National Research Council concluded in 2006 that EPA's drinking water standard for fluoride does not protect against adverse health effects. Just over 200,000 Americans live in communities where fluoride levels in drinking water are 4 mg/L or higher. Children in those communities are at risk of developing severe tooth enamel fluorosis, a condition that can cause tooth enamel loss and pitting. It can also increase the risk of bone fractures. The report concluded unanimously that the present maximum contaminant level goal of 4 mg/L for fluoride should be lowered.