4 Regulations and Recommendations for Fluoride in Drinking Water

Drinking water is, in most places, the primary source of F in the diet. Teeth and bones are particularly sensitive to aqueous F concentrations and 0.7 to 1 mg/L is estimated to be optimal to prevent dental caries in the developing teeth of children without causing dental fluorosis (Heller et al., 2007).

The World Health Organization (WHO) guideline value for fluoride in drinking water is 1.5 mg/L and this has been adopted as the national standard in most countries across the world, although higher limits are set in some countries with particular fluoride challenges (Table 1). As noted above, the US Environmental Protection Agency (EPA) has set the primary standard, the maximum contaminant level (MCL), for fluoride in US public drinking water at 4 mg/L, with the secondary standard at 2 mg/L. Tanzania adopted in the 1970s a temporary standard for fluoride in drinking water of 8 mg/L, which was reduced to 4 mg/L four decades later in 2014 (EWURA, 2014). China has adopted a national standard of 1 mg/L (Wen et al., 2013) as shown in Table 1.

Table 1 Regulations and recommendations for fluoride in drinking water from a number of organizations or countries (after Edmunds and Smedley, 2013).

Limit/Guideline Value (mg/L) Comment
WHO Guideline value (GV) 1.5 Fourth edition (2011) guidelines, as previous
US EPA Maximum contaminant level guideline (MCL) 4 Enforceable regulation
US EPA Secondary standard 2 Guideline intended to protect against dental fluorosis; not enforceable
US PHS Recommendation 0.7 Recommended upper limit for fluoridation
EC Maximum admissible concentration (MAC) 1.5 1998 regulations
Canada National standard 1.5
India National standard 1.5 ‘Acceptable’ limit 1.0 mg/L
China National standard 1
Tanzania National standard 4


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