drinking water fluoridation in washington state (wac 246-290-460) washington state board of health...
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Drinking Water Fluoridationin Washington State (WAC 246-290-460)
Washington State Board of HealthJune 18, 2015
Clark Halvorson, DirectorOffice of Drinking Water
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Office of Drinking Water’s Mission
We work with others to protect the health
of the people of Washington Stateby ensuring safe
and reliabledrinking water.
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Overview
• New recommendation from Health and Human Services.
• History of fluoridation in WA and the current WAC.
• How levels have been set in past and why a change now?
• Next steps.
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U.S. Department of Health and Human ServicesRecommendation for Community Water Fluoridation
• The new recommendation is for a single level of 0.7
milligrams of fluoride per liter of water.
• It updates and replaces the previous recommended range (0.7 to 1.2 milligrams per liter) issued in 1962.
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Fluoridation Definition
“Water fluoridation is the adjustment of the natural fluoride concentration of fluoride-deficient water to the level recommended for optimal dental health.”
—Fluoridation Facts, ADA, 2005
Natural F- in water + Added F- = 1.0 mg/L “Optimal Level”
(existing)
• 1 part per million (ppm) ≈ 1 milligram per liter (mg/L)
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Fluoride is Naturally Occurring
• Surface water (rivers)—typically low concentrations of 0.2 mg/L or less
• Groundwater (wells)—higher concentrations of 0.1 mg/L to over 5.0 mg/L
• Ocean water is typically 0.8 to 1.4 mg/L
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Washington State, 1950
Optimal Fluoride Levels, 1962
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WAC 246-290-460“Fluoridation of drinking water”
• Maintain concentration between 0.8 and 1.3 mg/L.
• Main elements of regulation include:– Review and approve system design.
– Operational requirements.
– Field monitoring.
– Lab monitoring.
– Monthly operations report.
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Why a New Recommendation from HHS for Community Water Fluoridation?
• Sources of fluoride have increased since the early 1960s. – Toothpaste and mouth rinses, prescription fluoride
supplements, and fluoride applied by dental professionals.
• Current evidence on fluid intake of children across various outdoor air temperatures.
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Fluid Intake and Climate
Mean Total Fluid Intake per Body Weight and Mean Daily Maximum Temperature
(NHANES III, 1988-94)
y = 0.13x + 74.3
(p=0.37, R2=0.001) 40
60
80
100
120
50 60 70 80 90Temperature (F)
(ml/k
g/d
ay)
Sohn W, Heller KE, Burt BA. Fluid consumption related to climate among children in the United States. J Pub Health Dent 2001; Vol.61;2; .
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Next Steps
• Communicate to utilities our recommendation for operation until the rule is updated.
– Develop draft rule text – July 2015
– Informal comment period – August. 2015
– Draft significant analysis – Nov. 2015
– Brief SBOH EH Committee – Nov. 2015
– SBOH public hearing – March 2016
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Questions?