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Fluoride in Drinking Water



Authors as Published

Authored by by Erin Ling, Sr. Research Associate, Leigh-Anne Krometis, Associate Professor, Jett Katayama and Nicole Chapman, BSE undergraduate researchers, and Christy Meek, MPH.

What is fluoride?

A naturally occurring mineral found in water and soil and is beneficial for dental health.1

Public drinking water vs private well water

Fluoride has been added to most public drinking water in the U.S. since 1945.2 However, private wells have different amounts of fluoride and are not regulated.3

Community water fluoridation reduces tooth decay by 25% in adults and children.2

Everyone living in a fluoridated community saves $32 yearly in avoided dental costs.4

Fluoridation helps oral health in 2 ways: strengthening teeth as they are forming and protecting them against decay.5

The right amount of fluoride

0-0.5 mg/L = Too little won’t prevent tooth decay.

0.6-1.0 mg/L = Ideal for dental health. This is fluoridation.2

>2.0 mg/L = Too much can lead to dental fluorosis.

>4.0 mg/L = High amounts can lead to skeletal fluorosis.

Does your water have the right amount?

Tooth decay (cavities): Teeth are more likely to get cavities when drinking water that has too little fluoride.5

The right amount (0.6-1.0 mg/L): Teeth are stronger, lowering the chance of tooth decay.5

Too much fluoride (>2.0 mg/L): This can cause dental fluorosis. This type of fluorosis may appear as white spots on teeth that may be barely noticed.

Even higher fluoride can result in skeletal fluorosis, which can cause joint pain and weaken bones. Skeletal fluorosis is rare in the U.S.5

Fluoride in Virginia Drinking Water

19% of Virginians rely on private water supplies; maintenance and testing is the responsibility of the owner.6

81% of Virginians rely on community water systems which are regulated and monitored. Most of these systems are fluoridated.6

The majority of households in 60 of Virginia’s 95 counties rely on private water systems.7

Homeowners with private water systems are responsible for monitoring the quality of their water.7

Private water supply fluoride concentrations

Homeowner collected well and spring water samples from VAHWQP 2008-2022 (n=23,940) show that:

Private water supplies in Suffolk, Isle of Wight, Northumberland, Lancaster and Middlesex counties tested higher in fluoride than the recommended amount of 0.6-1.0 mg/L.8

The average amount of fluoride in the majority of counties tested lower than the recommended amount.8 Fluoride levels may vary locally. Testing is the best way to know your fluoride level.

If fluoride is >2.0 mg/L (too high):

Talk with your doctor or dentist and consider using a water filter or use another source of water.

If fluoride is <0.6 mg/L (too low):

Talk with your doctor or dentist about other ways to get enough fluoride.

Test your water! For more information:

Contact Virginia Household Water Quality Program at to find out where to get your water tested.

For a full reference list, visit

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Publication Date

March 25, 2024