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Iowa Department of Health and Human Services

OHDS - Water Fluoridation Operations

Water Operator Testing Water

Community Water Fluoridation is a small portion of the public health work water operators do to keep water safe, but they may not realize the impact they have on the oral health of their community.  The Iowa Department of Public Health wants to ensure water operators have the tools and information necessary to do their job well.  The following information includes the most up to date resources on national and Iowa-specific information that can help assist in ensuring the health and safety of the communities they serve.

What is Community Water Fluoridation?

Community Water Fluoridation (CWF) is a safe and effective public health intervention that prevents 25% of tooth decay for all age groups.  CWF is the adjustment of the fluoride level to just the right amount to prevent tooth decay and is considered one of the ten greatest public health achievements of the 20th century - on par with vaccinations and public sanitation - and has done more to prevent tooth decay than any other public health intervention.  Over 75 years of research has shown and the CDC affirms water fluoridation is safe, effective and a cost savings to families as well as the US healthcare system. The protective effects of CWF cannot be effectively replicated by brushing and flossing alone.

Infographic: Communities Benefit From Water Fluoridation pdf637302699573336754

How does Community Water Fluoridation Work?

Fluoride occurs naturally in all water; however, the amount is usually not enough to prevent tooth decay.  That is where Community Water Fluoridation comes in.

Fluoride has been proven to protect teeth from cavities.  When a person eats sugar containing foods, bacteria is produced in the mouth and forms an acid.  That acid begins eating away minerals on the tooth's surface, weakening the tooth and over time cavities can develop.  Fluoride helps to rebuild and strengthen the teeth.  Water fluoridation works by providing frequent and consistent contact with low levels of fluoride to the teeth in order to reduce tooth decay. 

The Center for Disease Control and Prevention (CDC) recommends all public drinking water supplies contain low levels of fluoride to provide a barrier against tooth decay.  The current CDC recommended level of fluoride concentration in water is 0.7 mg/L.  Water operators closely monitor and adjust these levels on a daily basis.  Are you unsure if your water system is fluoridating at the right level or if fluoridation should be provided in your community?  Click here to find out. 

How Fluoride Works pdf637302699573336754

Why What You Do Matters

Check out this video to learn more about how water operators help to improve the oral health of Iowans in their community.

Water Operator Fluoridation Video

Community Water Fluoridation in Iowa

The Iowa Department of Public Health (IDPH) monitors fluoride levels in community water systems by working with local water operators providing relevant education and technical assistance to city officials, water municipalities, public health professionals, and the public. The Iowa Department of Natural Resources (DNR) is the regulatory agency for water fluoridation in Iowa and ensures fluoride levels do not exceed secondary and maximum contaminant levels and water systems are tracking daily fluoride levels when added to the water system.  This partnership has shown to be a key factor in the success of Community Water Fluoridation in Iowa.

Community Water Fluoridation started in Iowa in 1951 with the city of Waukon, and the city is still fluoridating their water today.  2021 data shows that 89.15% of Iowans have access to fluoridated drinking water, over 2.3 million people.  However, only about 80% have access to optimally fluoridated water which is assessed by tracking daily fluoride levels that must range between 0.60mg/L-1.00mg/L with the recommended level being 0.70mg/L.  IDPH works with the Iowa DNR and local water operators to continue to improve those who receive optimally fluoridated water.

Iowa Resources

Monthly Operating Report

IDPH requests submission of a monthly operating report (MOR) from all adjusted water systems to assess the fluoridation rates in Iowa.  If you are unsure where to email your MOR, contact Sarah Petersen, Community Water Fluoridation Coordinator at (515)204-3450 or by email.

Water Fluoridation Quality Awards

Many public water systems are recognized by the CDC with an annual Water Fluoridation Quality Award.  To be eligible in Iowa, public water systems must meet each of the following criteria: CDC Water Fluoridation Quality Award Criteria  Below you can see past recipients as well as systems who have been awarded 50 year awards presented by the CDC, the American Dental Association, and the Association of State and Territorial Dental Directors for their dedication to fluoridating for 50 years.

2018 CDC Quality Award Recipients PDF

2018 50 Year Award Recipients 

2019 CDC Quality and 50 Year Award Press Release

Fluoridation Equipment Needs

Fluoridation equipment is not made to last forever.  Luckily, our partners at Delta Dental of Iowa Foundation have funding opportunities for updating and installing fluoride equipment for communities in Iowa.  If you are interested or have questions regarding funding, please call Sarah Petersen, Community Water Fluoridation Coordinator at (515)204-3450.  The Community Fluoridation Award template includes criteria for qualifying and questions that will be asked on the application for funding to be considered.  Questions specific to funding may be directed to Maren Lenhart, Delta Dental of Iowa Foundation, (515)261-5590.

DNR Permits and Administrative Rules

The Iowa Department of Natural Resources (DNR) requires certain construction permits when fluoridation equipment is being installed or updated. Contact the Water Supply Engineering section of the DNR for more details on specific permits or they can be found at the Iowa DNR website. 

There are Iowa Administrative codes related to Community Water Fluoridation and can be found here.  The Iowa DNR website can also be accessed for complete Administrative Rule information.

Training and Educational Opportunities

Are you new to water operations or interested in learning more about how community water fluoridation works?  A FREE CWF Training is available from the CDC and includes in depth information on background, fluoridation system design and operations, fluoride additives, including dosage, feed rates and daily sampling.  Even better, water operators in Iowa can receive 4 CE credits for completing the course.

The American Water Works Association publishes a manual that includes essential information for decision makers planning fluoridation installations, engineers designing them, and water utility personnel operating them. The manual contains history of use, health effects, calculating dosage and managing levels as well as equipment considerations (installation, operation, and maintenance). The manual can be found here.

Fluoridation Facts is the American Dental Association's premier resource on fluoridation, answering frequently asked questions about community water fluoridation and the latest scientific research.  The eBook can be downloaded for FREE.

Local Contacts

Your local I-Smile Coordinator is a great resource and has been trained on the public health benefits of community water fluoridation. Coordinators can answer questions regarding CWF or any other oral health related topics or questions you may have. Your I-Smile Coordinator can be found here.

Statewide Data

2017 CWF Census Summary 

2018 CWF Census Summary 

County level fluoridation data can be accessed on the My Water's Fluoride website.

Educational Materials

Community Water Fluoridation has been well documented as a safe and effective public health practice for over 75 years; however, some people may question the practice or even oppose it. As a water operator, you may be confronted with questions from the customers you serve. The information below may help answer questions you or the community may have. 

Websites - Valuable Information Specific to your Role as a Water Operator

CDC - Community Water Fluoridation for Water Operators and Engineers

American Fluoridation Society - Common Myths about Community Water Fluoridation

Fluoride Exposed - High Quality, Detailed Science on Fluoride and Water Fluoridation

Facts Sheets and Infographics

Community Water Fluoridation in Iowa 

Fluoridation Information to Answer Customer Questions 

Bottled Water vs. Tap Water 

Say This, Not That:Tips for talking about Community Water Fluoridation 

Natural Fluoride in Drinking Water  

Fluoride Notification Law Information

House File 390 was signed into law by Governor Kim Reynolds on April 30, 2021 and went into effect on July 1, 2021.  This law requires any public water system to provide notification AT LEAST 90 days prior to taking any action to permanently discontinue fluoridation of its water supply. Notification includes the Bureau of Oral and Health Delivery Systems, established in section 135.15 and public water system's customers. 
  • To review the state law: House File 390
  • The owner and/or operator of the water system must place a notice on the customer's water bill and/or provide notice in a way that is reasonably calculated so that all customers will receive the notice.
  • The Notification of Fluoride Discontinuation Form must be filled out and sent to the Bureau of Oral and Health Delivery System. The form can be found here.