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Activity 5b: Coordinate Community Water Fluoridation Programs

Infrastructure Development Tools


A state water fluoridation program is a collective effort to promote, implement, and maintain consistency of community water fluoridation efforts within a state. The state water fluoridation program also helps to plan, implement, and evaluate educational and promotional materials to advocate for and create awareness of community water fluoridation.

This program may be jointly managed by the state oral health program and the state drinking water administrator. These entities should collaborate to plan, implement, and evaluate fluoridation oversight and management activities.

State water fluoridation program management should:

  • Develop a state fluoridation plan and submit annual status reports;
  • Conduct and report monthly monitoring through the Water Fluoridation Reporting System (WFRS) or an equivalent state system;
  • Update Public Water Systems (PWS) information within WFRS on new PWS, deleted PWS, correct consecutive PWS relationships changed fluoridation status, fluoride chemical used, and natural fluoride level;
  • Track progress toward incorporating into practice, as appropriate, the CDC Engineering and Administrative Recommendations for Water Fluoridation (EARWF); see Engineering and Administrative Recommendations for Water Fluoridation, 1995 [PDF–337K].
  • Report on water systems receiving new or replacement fluoridation equipment and the communities and populations affected;
  • Measure and report progress toward reaching or exceeding the Healthy People 2010 objective for 75% of the population using community water to receive fluoridated water. Identify water systems that, if fluoridated, would enable the state to meet or exceed the Healthy People 2010 objective;
  • Establish a water fluoridation quality-control program;
  • Provide technical training for fluoridation engineers and water plant operators;
  • Identify communities and water systems that need replacement fluoridation equipment for water treatment plants, and develop a replacement plan with funding;
  • Evaluate community water fluoridation program accomplishments, including advances in population coverage and systems where implemented;
  • Participate in a fluoride proficiency testing program

States with advanced capacity in this area may:

  • Enhance or expand existing fluoridation program management to a comprehensive level that meets or exceeds Healthy People 2010 objectives;
  • Encourage attendance by the state fluoridation coordinator, engineers, and/or specialists at the CDC fluoridation training or equivalent;
  • Conduct comprehensive inspections of all adjusted fluoridated water systems every three years to assure that all the technical recommendations, including the safety requirements of EARWF, are followed;
  • Increase percentage of fluoridated water systems consistently maintaining optimal levels of fluoride as defined by the state and consistent with recommendations outlined in EARWF; and
  • Promote fluoridation to policymakers and the public as appropriate.


Additional Resources

Healthy People 2010: Oral Health Objectives

Guide to Community Preventive Services [Community Guide] – Oral Health


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