Drinking Water Fluoridation#
Fort Collins Utilities adds fluoride to its drinking water based on the recommendations of the U.S. Department of Health and Human Services (HHS), Colorado Department of Public Health and Environment (CDPHE) and the American Dental Association (ADA). City Code Sec. 26-50, states that City Council is authorized by public vote to fluoridate the water supply system to levels established by CDPHE.
For more than half a century, HHS and CDPHE have recommended adding fluoride to drinking water to help prevent tooth decay. The Centers for Disease Control (CDC) recognizes the widespread adoption of community fluoridation as one of the 10 greatest public health achievements of the 20th century. According to the CDC, "For 75 years, people in the United States have been drinking water with added fluoride and enjoying the benefits of better dental health. Drinking fluoridated water keeps teeth strong and reduces cavities (also called tooth decay) by about 25% in children and adults. By preventing cavities, community water fluoridation has been shown to save money both for families and for the US health care system."
Please consult your physician if you are sensitive to fluoride or fluoridation-related substances, or provide City water to an infant younger than six months of age.
In 1967, voters approved an ordinance authorizing City Council to direct Utilities to fluoridate the drinking water provided by Fort Collins Utilities. In 2005, an ordinance was presented to Fort Collins voters regarding the removal of fluoride from drinking water. The ballot initiative was defeated, with voters choosing to continue the addition of fluoride.
In April 2015, HHS and CDPHE recommended that water treatment plants change the recommended level of fluoridation from a range of 0.7 – 1.2 milligrams per liter (mg/L) to a single value of 0.7 mg/L. In May 2015, Fort Collins Utilities lowered fluoride levels in its drinking water to match the recommended level.
Fort Collins Utilities’ water comes from Horsetooth Reservoir and the Poudre River. The water has naturally occurring levels of fluoride typically between 0.15 and 0.20 mg/L. Fort Collins Utilities adds additional fluoride to the treated drinking water, to reach concentrations near 0.7 mg/L.
Fort Collins Utilities purchases high purity fluoride in the form of hydrofluorosilicic acid (HFS). Utilities’ standard practice and vendor contract require the HFS meet both the current American Water Works Association standard and NSF Standard 60 for products used in the treatment of drinking water.
Fort Collins Utilities' Water Treatment Plant follows stringent safety procedures when working with fluoride. The Water Treatment Plant performs multiple fluoride quality checks to ensure product safety, including:
- Requiring the fluoride supplier to provide certified laboratory results with the shipment, which are verified upon delivery. If anything in the certificate of analysis (COA) fails to meet Utilities’ established quality standards, further investigation is done before accepting the shipment.
- Testing the shipment’s physical properties to confirm that the material is correct before a driver is allowed to unload the fluoride delivery.
- Conducting a chemical analysis of the fluoride delivery sample to confirm that the fluoride’s purity matches the information provided in the vendor’s COA. If the laboratory test results raise any concerns, Utilities stops fluoridation until all concerns are addressed.
Finished drinking water is tested daily to ensure proper fluoride levels are maintained.
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- Studies by the HHS and others have established a cause-and-effect relationship between fluoridation and the prevention of tooth decay.
- Since 1950, the ADA and HHS, have endorsed the optimal fluoridation of community water supplies as a safe and effective public health measure for the prevention of dental decay.
- The ADA's policy on fluoridation is based on its continuing evaluation of the scientific research on the safety and effectiveness of fluoride. It continues to reaffirm its position of support for water fluoridation and has strongly urged that fluoride benefits be extended to communities served by public water systems.
- Today, fluoridation is the single most effective public health measure to prevent tooth decay and to improve oral health over a lifetime.
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- Contact the Councilmember in your district via email or phone to see if the Councilmember would request Council consideration. There is more information on this here.
- Attend a Regular Council Meeting and speak during Citizen Participation to garner support. See this link for more information.
- The City Charter grants registered electors the power to propose ordinances or resolutions via the initiative process. Citizens may circulate petitions for the purpose of getting a measure on the ballot. When the Council is presented with a petition containing enough signatures for placement on the ballot, the Council has the option to adopt the proposed ordinance or place the measure on the ballot. More information on the petition process can be found at here.
2024 Court Summary and Ruling#
The Fort Collins Utilities Water Production and Water Quality Services Divisions are aware of the ruling and have been following the robust and ongoing public discussion at the national level. The ruling specifically orders the Environmental Protection Agency (EPA) to further address the issue. The ruling is long and complex, and we are in the process of evaluating it and the related studies.
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The National Toxicology Program (NTP) released this Topic Overview in August 2024.
The monograph states, with moderate confidence, based on studies performed in 10 countries, including Mexico and Canada, that fluoride exposures that exceed 1.5 mg/L of fluoride are consistently associated with lower IQ of a few points in children.
However, because no studies of fluoride exposures and IQ have been performed in children in the United States, research that examines the association between fluoride exposure and children’s IQ in optimally fluoridated areas of the United States is needed to add clarity to the existing data.
The monograph also states that it does not address whether the sole exposure to fluoride added to drinking water in some countries (i.e., fluoridation, at 0.7 mg/L in the United States and Canada) is associated with a measurable effect on IQ. It additionally states that it does not assess benefits of the use of fluorides in oral health or provide a risk/benefit analysis.
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Food and Water Watch, Inc. sued the EPA in federal district court under the federal Toxic Substances Control Act. On September 24, 2024, the court ruled that water fluoridation at the currently prescribed optimal level (0.7 mg/L) presents an “unreasonable risk” of injury to public health. The court relied on studies showing a link between fluoride exposure and reduced IQ in children of a few points. The hazard level has been reported as either 4.0 mg/L or 1.5 mg/L. The court specifically did not rule that fluoridated water is actually injurious to public health, but just that there is a risk. The Court ordered the EPA take some regulatory action to respond to the risk, but the court did not rule what the EPA’s action should be.
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Following the ruling, the American Dental Association, the American Academy of Pediatrics, and the Centers for Disease Control all continue to support fluoridation of drinking water at 0.7 mg/L.
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Fort Collins City Code 26-50 states: “The City Council is authorized to fluoridate the water supply system of the City. The utility is directed to fluoridate its water to the levels established by the State Department of Public Health and Environment.”
Currently, Fort Collins Utilities fluoridates drinking water at 0.7 mg/L, as recommended by the Colorado Department of Public Health and Environment (CDPHE). The level is monitored continuously by automated equipment, which is checked for accuracy daily by laboratory analysis. Feed rates are continually adjusted to maintain optimum levels.
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The information contained in the ruling does not justify unilaterally ceasing fluoridation without direction from Council. Although the ruling suggests a risk, there is nothing establishing an acute risk or imminent injury. Our plan regarding this ruling is to continue fluoridating at 0.7 mg/L until direction is received from Council, EPA, or CDPHE to do otherwise. We are waiting for additional guidance from CDPHE, which we anticipate will be released soon.
We plan to share information with the public as it becomes available through our website at https://www.fcgov.com/utilities/what-we-do/water/water-treatment/treated-drinking-water/drinking-water-fluoridation.
Questions and requests for information should be directed to:
Gregg Stonecipher,
Director, Plant Operations
Fort Collins Water Utilities
(970) 221-6692
Leslie Hill
Director, Water Quality Services Division
Fort Collins Water Utilities
(970) 221-6907
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