Bottled Water and Fluoride
Consumers drink bottled water for various reasons, including as a taste preference or as a convenient means of hydration. Bottled water may not have a sufficient amount of fluoride, which is important for preventing tooth decay and promoting oral health.
Some bottled waters contain fluoride, and some do not. Fluoride can occur naturally in source waters used for bottling or it can be added. This fact sheet answers common questions about bottled water and fluoride.
Who regulates fluoride in bottled water?
The Federal Food, Drug, and Cosmetic Act provides the U.S. Food and Drug Administration (FDA) broad regulatory authority over food, including bottled water, which is introduced or delivered for interstate commerce (produced and sold in more than one state). Bottled water that is in intrastate commerce is under the jurisdiction of the state in which the bottled water is produced and sold. Contact the manufacturer to ask if their product is under FDA jurisdiction or state jurisdiction.
Why doesn't the EPA have jurisdiction over the quality of bottled water since it regulates drinking water?
The Environmental Protection Agency (EPA) and the FDA have a 1979 Memorandum of Agreement specifying that the EPA regulates safe drinking water in accordance with the Safe Drinking Water Act, and that the FDA regulates bottled water as a consumer beverage under the Food, Drug, and Cosmetic Act (Federal Register, Volume 44, No. 141, July 20, 1979).
What FDA regulations apply to bottled water?
The FDA has strict regulations on standards of quality, identity, and good manufacturing practices that bottled water must meet. Its regulations for governing the standards of "quality and identity" for bottled water are found in the Code of Federal Register 21 CFR 165.110. The FDA standards of quality state that domestic bottled water with no added fluoride may contain between 1.4 and 2.4 milligrams per liter (mg/L) fluoride, depending on the annual average daily air temperatures at the location where the bottled water is sold. Domestic bottled water with added fluoride can contain between 0.8 and 1.7 mg/L fluoride, depending on the annual average daily air temperatures where the bottled water is sold. Imported bottled water with no added fluoride may not contain more than 1.4 mg/L fluoride, and imported bottled water with added fluoride may not contain more than 0.8 mg/L fluoride.
Is the amount of fluoride in bottled water always listed on the label?
The FDA does not require bottled water manufacturers to list the fluoride content on the label, but it does require that fluoride additives be listed. In 2006, the FDA approved labeling with the statement, "Drinking fluoridated water may reduce the risk of tooth decay," if the bottled water contains from 0.6 mg/L to 1.0 mg/L.
Does drinking bottled water without fluoride lead to more cavities?
Your oral health—specifically, how many cavities you have—depends on many factors, one of which is how much fluoride you receive in the form of toothpaste, mouthwash, water, food, and professional fluoride products applied by dental professionals. Other factors include how often and how thoroughly you brush your teeth and floss, what you eat, and whether you receive regular dental care. If you mainly drink bottled water with no or low fluoride, and you are not getting enough fluoride from other sources, you may get more cavities than you would if fluoridated tap water were your main water source.
Will the fluoride content change if the bottled water is stored for a long time?
Fluoride will not react with other minerals present in the water during storage, nor will it react with its plastic or glass container. The FDA considers bottled water to be safe indefinitely if produced in accordance with quality standard regulations, and if stored in an unopened, undamaged, and properly sealed container. Many bottlers list an expiration date, however. Note that if there is no expiration date, bottled waters should not be used more than two years after the date of purchase because the packaging may have hard-to-see deterioration.
Can I use bottled water for mixing infant formula?
Yes, you can reconstitute (mix) powdered or liquid concentrate formulas with bottled waters, but be aware that the fluoride content in bottled water varies. If your child is exclusively consuming infant formula reconstituted with water that contains fluoride, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula. These bottled water products are labeled as de-ionized, purified, demineralized, or distilled, unless they specifically list fluoride as an added ingredient. For more information, see Overview: Infant Formula and Fluorosis.