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CDC-Sponsored Water Fluoridation Training

CDC offers limited training in water fluoridation engineering and operations and does not have the staff resources to provide special training for groups, organizations, or utility systems. CDC offers the following courses to assist with managing state fluoridation programs and water treatment facility operations. Enrollment in these courses is open to any state program official, water utility system staff, trainers of water facility operators and support personnel, and registered engineers.

Water Fluoridation: Principles and Practices presents basic information on community water fluoridation, including engineering and administrative guidance. The course is conducted over three days and is available periodically in Tennessee and California. Attendance is limited because of space and facility considerations, so pre-registration and approval are necessary, with preference given to state employees. There is no tuition fee for accepted state program employees, though attendees are responsible for their own travel and per diem expenses. CDC awards participants 1.7 Continuing Education Units (CEUs) or 17 professional development hours for completing the course.

Using the Water Fluoridation Reporting System (WFRS) is an optional half-day course (0.3 CEUs) for those responsible for maintaining state program records. This course immediately precedes the Water Fluoridation: Principles and Practices course.

Future training dates:

  • Murfreesboro, Tennessee:
    CDC will offer Water Fluoridation: Principles and Practices on September 19–22, 2016, at the Doubletree Hotel and the Julian R. Fleming Training Center in Murfreesboro, Tennessee. Murfreesboro is located in the southern sector of metropolitan Nashville. Course attendance is limited to 25.

  • Sacramento, California:
    CDC will offer Water Fluoridation: Principles and Practices from February 22–25, 2016. Training will be held at the Capitol Plaza Holiday Inn and at the City of Sacramento Fairbairn Water Treatment Facility. Course attendance is limited to 21.
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A 6-hour Water Fluoridation Training Course offers assistance to states in providing water treatment facility operator training. The template can be customized by individual state programs. CDC does not offer CEU credits for this course, but state program sponsors often do provide credit. Contact your state dental director, drinking water administrator, or trainers of water treatment facility operators to learn when this training will be offered in your state.

CDC has been reviewed and approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 8405 Greensboro Drive, Suite 800, McLean, VA 22102. CDC awards 0.3 CEUs to participants who successfully complete the WFRS training and 2.0 CEUs for completing Water Fluoridation: Principles and Practices training.

Contact CDC if you have questions about any training.


Sample Agenda

Water Fluoridation: Principles and Practices is a CDC-sponsored course on basic community water fluoridation. It is intended to build the skills needed to manage and operate a state water fluoridation program, as well as to train engineers in drinking water programs and water fluoridation specialists on the principles of fluoridation engineering.

Operators of water treatment facilities and engineers in private practice have also found this course to be useful in building their skills and knowledge. CDC awards 1.8 Continuing Education Units (CEU) or 18 Professional Development Hours to participants who complete it.

The training is normally preceded by an optional half-day course on the use of the Water Fluoridation Reporting System for those who are responsible for maintaining records for a state program.

The following is a sample three-day agenda for a typical course.

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Day 1expandcollapse

8:00 a.m.

Opening Remarks


Course Objectives

8:30 a.m.

Fluoridation and Public Health



The Problem of Tooth Decay

Fluoride's Mechanism of Action

Dental Benefits

Dental Fluorosis

10:45 a.m.

Fluoride Additives

Fluoride Compounds

Commonly Used Additives



1:00 p.m.

EPA Regulatory Perspective

EPA and Water Fluoridation

Maximum Contaminant Level (MCL) and Secondary Maximum Contaminant Level (SMCL)

Monitoring Requirements

Public Notification

2:00 p.m.

Fluoridation Equipment


Method of Feeding

Fluoride Additives

Metering Pumps

Fluoride Additive Equipment

Day Tanks

Ancillary Equipment

3:00 p.m.

Design of Fluoridation Systems

Water Treatment Context

Planning and Permitting

Design Basis


Selecting Pumps

4:00 p.m.

Risk Communication

Overview of Risk Communication

Communication Tips

Day 2expandcollapse

8:00 a.m.

Health Effects and Current Issues

Charges and Claims of the Opposition 

How to Address Allegations of Health Effects 

9:50 a.m. 

Chemistry of Fluoride Analysis 

SPANS Colorimetric Determination 

Specific Ion Electrode Determination 

Errors and Methodology Interferences 

10:50 a.m.

Laboratory Safety and Session Directions 

11:00 a.m.

Management of State Programs

How State Programs Are Organized 

Engineering and Administrative Recommendations for Water Fluoridation (EARWF) 

Association of State and Territorial Dental Directors (ASTDD) 

Best Practices 

11:30 a.m. 

Data Management and CDC Responses

General Information Water Fluoridation Reporting Systems (WFRS) 

Proficiency Testing 

My Water's Fluoride 

Oral Health Maps Program Support 


1:30 p.m. 

Laboratory Session 

Hands-on Testing of Fluoride Content in Water 

3:45 p.m.

Laboratory Discussion 

Results and Statistics 

4:15 p.m.

Water Treatment Plant Tour 

Context of Water Fluoridation


8:00 a.m. 

Operation of Water Fluoridation Systems 



Maintenance Inspections 

9:00 a.m. 

Operator Safety 

Planning for Safety in Fluoride 

Handling Fluoride Exposure 

Toxic Exposures: Chronic and Acute 

Personnel Safety Gear and Techniques 

9:45 a.m. 

Managing Fluoride Levels and Defluoridation 

Well Blending 

Alternative Sources 

Methods for Fluoride Removal 

10:15 a.m. 

Fluoridation Costs 

Equipment Costs 

Additive Costs 

Installation Costs 

10:40 a.m. 

Running Successful Community Fluoridation Campaigns 

Community Support Coalition and Program Capacity 

11:15 a.m. 

Implementing Improvements in Your State Program 


Course Closeout