Water Quality Impacts Health Disparities: Is your Water Sufficiently Fluoridated?

by Pranav Golla
3 mins read

Until recently, my view of clean water was a given. Water is from a clean source, properly treated, tested, and then sent through pipes to us. Turns out, it’s not that simple. Most people in America rely on public water systems regulated by the EPA, however research demonstrates that EPA regulations are always followed, so many public water systems are exposed to contaminants. After coming across Columbia University’s Drinking Dashboard tracking tool noting contaminant concentration estimates in community water systems across the US, I was energized to learn more about the ‘health’ of our water. 


In reviewing water sources, not only did I learn that not all water across our state is fluoridated, but also, water fluoridation levels recommended by the CDC and numerous public health and medical organizations, including the American Medical Association, American Dental Association, American Academy of Pediatric Dentistry, and World Health Organization are not followed. Water fluoridation is the process of adjusting naturally occurring fluoride levels to prevent tooth decay and unfortunately, only 70% of the US population lives in communities served by fluoridated water. The task of setting water quality standards at a national level is allocated to the EPA (they regulate 90% of water purchased in the US and 10% comes from private wells). Some states may have additional quality standards that need to be met in their state. My research reveals that with the California Assembly Bill 733 (1995), water systems with 10,000 or more service connections in California must fluoridate their water supply, but only when funding becomes available.

According to Calwater, fluoride levels in the water they serve can range from 0.1 mg/l to 1.0 mg/L based on location and time of year. This is because they purchase water from MWD and mix it with local sources for most customers. This changes the composition of Fluoride in every customer’s water which can lead to health disparities depending on the area you live in. Fluoride is a neurotoxin and can be harmful if taken in high doses. It can also lead to tooth discoloration and bone problems if people are exposed to it too much. Certain types of toothpaste contain fluoride and calling the poison control center is recommended if more than a pea sized amount is swallowed. On the other hand, many recent studies have shown that insufficient fluoride levels can increase the number of cavities. Communities that had more than 1.0mg/l of fluoride in their water had less cavities than people who had less fluoride in their water. The studies conclude that the optimal fluoride level to prevent tooth decay is 0/7mg/. These are just some of the side effects of taking too little or too much fluoride and shows why maintaining its level in water systems is important. EPA regulations call for a maximum of 4.0 mg/l of fluoride which is over 5 times the amount that is generally recommended and safe for drinking, 0.7mg/l.

Although health risks to communities, as a whole, are apparent and inadequate fluoride can lead to health disparities, only fluoridating when federal funding will eventually reduce community public health standards. If we do not urge politicians to bring change in these policies, we could continue to be risking our health through a universal right, clean water. 



Alameda County Water District, Water Quality Report.

Annie Nigra, “Assessing Quality to Eliminate Environmental Injustice and Health Disparities” 26 July 2021 available at https://datascience.columbia.edu/news/2021/…

California Assembly Bill 733 (1995),

City of San Francisco Public Utilities Commission and Santa Clara Valley Water District Water Quality Report.
Columbia University Drinking Dashboard is available at //msph.shinyapps.io/drinking-water-dashboard/.


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1 comment

Aadi S July 24, 2022 - 5:15 pm

I have a lot of memories as a child about going to the dentist feeling alright and leaving with stomachaches that would last for hours, wondering if I had eaten too much candy. As an adult, I now know that these stomachaches were caused by the fluoride I unintentionally swallowed every time the dentist put fluoride paste on my teeth. If that little amount of fluoride causes stomach pain, then what would larger amounts do? Shouldn’t I be against its use altogether?

Perhaps someone would think so, but as you said, fluoride has a large number of quantifiable benefits, primarily that it helps protect against tooth decay. And this claim seems to make sense. Before the introduction of fluoride into our water systems, tooth decay was rampant. Now, it’s somewhat of a minor problem that can be stopped with good oral hygiene (and to some extent, good genes). I can attest to both, in fact, and incidentally have not had a single cavity in my entire life.

I believe that it’s very important to keep the amount of fluoride in our water heavily regulated. In doses too high, it can cause a host of health issues. In doses too low, it won’t help our teeth. In the correct dosage, however, it can help prevent tooth decay. As you said yourself, “if we do not urge politicians to bring change in these policies, we could continue to be risking our health.”


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