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Board of Health issues statement in regards to ADA advisory

LONGMEADOW - The town of Longmeadow, in response to a Board of Health order and a subsequent voter referendum confirming these orders, began fluoridating the public water supply in 1989. Since that time the Longmeadow Board of Health has continued to review the medical literature to verify the safety and efficacy of fluoridation for the residents of Longmeadow. Within the last few weeks it has come to the attention of the Board of Health that the Centers for Disease Control and the American Dental Association have posted public advisories on their websites in regard to infants and fluoridation. These advisories state that the results of some recent studies reviewed by their organizations suggest that further research should be initiated to assess a possible increased risk of mild to very mild tooth mottling (fluorosis) for infants whose primary source of nutrition prior to age one is infant formula that is diluted with water containing fluoride (i.e. formula purchased in dry or in liquid concentrate form).

There does not appear to be an increased risk warranting further research at this time for infants who are primarily breast-fed; breast feeding is endorsed by these organizations as the nutritionally-preferred nutrition source for this age group. There also does not appear to be an increased risk for tooth mottling for infants whose primary source of nutrition is commercial "ready to feed" liquid formulas; such formulas contain no fluoride or minute trace concentrations that are not considered to pose a risk.

Until the results of further research become available, the American Dental Association and the Centers for Disease Control web guidance documents suggest that infant formula purchased in dry or liquid concentrate form for use as the primary source of nutrition for infants under one year of age be reconstituted with water, that does not contain fluoride. Bottled water can be used for this purpose; most, but not all brands of bottled water are fluoride-free. Therefore, parents and caregivers should examine labels of bottled water to verify that the bottled water product is fluoride-free or low in fluoride. Bottled water that is labeled as purified, deionized, demineralized, or distilled generally has a very low concentration of fluoride.

The Board is in the process of informing local pediatricians regarding these web postings. Parents should refer questions regarding their infant's intake of fluoride to their family's healthcare providers. In particular, parents may want to discuss the applicability of these guidelines to babies under one year of age whose primary source of nutrition has progressed to commercially produced baby foods or "table food" and for whom infant formula has become a "secondary" nutrition source.

Parents may wish to read the referenced web documents posted on the following web addresses: and

The Longmeadow public water supply has been fluoridated since 1989 at a maximum concentration of one part/million. Since the inception of this program, the town of Longmeadow Water Department has received several commendations from the Massachusetts Department of Environmental Protection for its exceptional precision in the operation of the community fluoridation program within the optimal fluoride concentration range. Although fluoridation of community systems is less common in western Massachusetts, over 60 percent of the citizens of the Commonwealth are served by public water suppliers that fluoridate their systems. In other states, the percent of residents served by public water suppliers that fluoridate their systems primarily range from 90 to 100 percent.

The U.S. Centers of Disease Control, the Massachusetts Department of Public Health, the American Academy of Pediatrics, the American Dental Association, the American Medical Association, and the World Health Organization have endorsed and continue to endorse the fluoridation of public water supplies at the fluoride concentration added by Longmeadow as a safe and effective public health measure for preventing dental caries (i.e. cavities) in all age groups. These guidelines address the possibility of increased risks for minor tooth mottling (fluorosis) among infants and toddlers. Fluorosis is a cosmetic effect. This advisory does not suggest that there is an increased risk of systemic toxicity to any age group associated with the sodium fluoride compound when added to the public water supply in the aforementioned concentration.

Since the initiation of the fluoridation of the Longmeadow Public Water Supply in 1989, the Longmeadow Board of Health has not received any reports from area health professionals or parents of tooth mottling in infants or toddlers residing in Longmeadow.