1. Drinking Water Fluoridation in Washington State (WAC 246-290-460) Washington State Board of Health June 18, 2015 Clark Halvorson, Director Office of Drinking Water

2. 2 Office of Drinking Water’s Mission We work with others to protect the health of the people of Washington State by ensuring safe and reliable drinking water.

3. 3 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.

4. 4 U.S. Department of Health and Human Services Recommendation 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.

5. 5 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)

6. 6 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

9. 9 Washington State, 1950

10. Optimal Fluoride Levels, 1962

11. 11 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.

12. 12 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.

13. 13 Fluid Intake and Climate 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;.

14. 14 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

15. 15 Questions?