Bottled Water’s Fluoride Content Is a Cloudy Issue

It used to be simple: You’re thirsty, you get a drink from the tap.

But today, water comes in other forms, including tap water filtered in the home and a wide variety of bottled waters. And health officials caution that consumers--especially parents--need to evaluate the qualities and benefits these products may be missing.

A major health advance of the past half century was the addition of fluoride to public water supplies, which dramatically cut the number of cavities among children in the United States. Recent studies have also shown that fluoride also has beneficial effects on adults’ dental health.

Some bottled water comes naturally with fluoride, other brands add it, but most brands have very low fluoride levels. Manufacturers are required only to declare the addition of fluoride, not the level the water contains. Yet for nearly 10% of American children, the primary source of water is bottled, and many others use it frequently. Could they be paying a price in cavities later?

Some health officials think so, and counsel people using bottled water to check the fluoride level and supplement it if needed.

Researchers in Ohio highlighted the dilemma in a report this month in which they compare bottled water with Cleveland’s drinking water. They found that 95% of bottled water samples had fluoride levels short of state recommendations. In addition, they reported in the Archives of Family Medicine, city water had low bacterial counts, but the counts in the bottled water were widely variable. Thirty-nine of the 57 samples of bottled water were purer than tap, and three were basically the same. But 15 samples contained significantly more bacteria than tap water and six of those contained 1,000 times more.

The International Bottled Water Assn. in Alexandria, Va., said the study sensationalized the findings. It pointed out that none of the bacteria was dangerous, and all levels were within ranges allowed in foods. On fluoride, the association suggests concerned people contact dentists or doctors for advice.

Dental officials agreed that parents using bottled water at home shouldn’t automatically give their children prescription fluoride supplements. Children often get fluoride from other sources, such as soft drinks and juices that are reconstituted by manufacturers using tap water, according to John Stamm, dean of the University of North Carolina School of Dentistry and a spokesman for the American Dental Assn. In addition, fluoridated toothpaste and topical dental treatments can prevent tooth decay, although they are not as effective in helping a broad population as fluoride in the water. The ADA recommends supplements only in communities without fluoridated water.

The problem for consumers is knowing what’s in their water. Few bottled water companies put fluoride information on the label. So the only way to know for sure is to have the water independently tested, which can cost from $10 to $20 per sample.