Oral Health Issue Brief

Fluoride for Texas

2021 Legislative Priority Issue

Community Water Fluoridation

The Healthy People 2030 (HP 2030) initiative is federal health officials’ way of identifying the nation’s
most important health priorities. One of the newly released HP 2030 objectives calls for increasing the
overall percentage of Americans who have access to fluoridated tap water. For Texas and other states to assess their progress in this area, it is essential that local water systems submit appropriate data to state health officials.

For this reason, the Texas Oral Health Coalition requests a mandatory requirement for both Public
Water Systems (PWSs) that contain a naturally high fluoride level and Community Water Systems
(CWSs) that add fluoride to submit monthly data to the Texas Fluoridation Department (TFP). We further request the above identified CWSs maintain fluoride levels within the safe operating range (0.6 ppm – 1.2 ppm) as the CDC has proposed to ensure that as many Texans as possible benefit from optimally fluoridated water and our state saves on Medicaid dental costs. In addition, research shows that the average resident of a fluoridated community saves $32.19 annually because their dental treatment needs are reduced.

The Texas 75th Legislature passed House Concurrent Resolution 145 requiring the Texas Department of State Health Services to conduct a study on the costs of publicly financed dental care in relation to community water fluoridation. The report, “Water Fluoridation Costs in Texas: Texas Health Steps (EPSDTMedicaid)” states, “Statistical analysis of dental care costs and county water fluoride levels showed that for an initial one part per million rise in water fluoride level (from 0.0 to 1.0 ppm fluoride), the average cost of dental care per child declined $24 per year. This estimated cost savings in public dental care could be realized if water fluoridation was provided in communities with less than optimal water fluoride levels. Approximately 30% of Texas citizens currently experience less than optimal levels.”

Treatment needs overlaying fluoridation rates in TexasUnder-Fluoridated Texas Counties mapThe maps to the right show the areas that are under-fluoridated in Texas that also correspond with the areas showing overall early and urgent treatment needs.


Maintaining a fluoride level of 0.7 L/mg to 1.0 L/mg shows a cost savings of $16-$24/Medicaid enrollee/year. As of March 2020, Texas shows 4,174,195 enrolled in Medicaid or CHIP. If Texas were to follow the DSHS study recommendations, the state may be able to save over $65 million annually.

No appropriations for this bill are required. Legislators are not implementing CWF anywhere where it does not currently exist. This bill leaves the CWF decision process in the hands of local consumers and policymakers.


The TFP updates the CDC’s Water Fluoridation Reporting System (WFRS) monthly with data collected from participating PWSs. PWSs email their data to TFP using reporting forms that the program provides.

The TFP follows CDC guidance for community water fluoridation and recommends that PWSs who adjust fluoride, maintain a fluoride operating range between 0.6 ppm – 1.2 ppm. We are finding some PWSs that contain a naturally high level of fluoride being diluted to sub-optimal levels each month that benefit no one.

Unfortunately, many CWSs that contain naturally high fluoride or add fluoride do not submit monthly data or maintain their fluoride levels in the optimal range recommended by the CDC. Additionally, this promotes transparency in government; local water consumers across Texas have the right to know relevant information about the quality and content of their drinking water. In order to ensure reporting compliance, the Texas Commission on Environmental Quality (TCEQ) may want to implement fines for noncompliance.

For more details on CDC guidance for community water fluoridation, please visit and


Copyright © 2022 TXOHC: Fluoride for Smiles.