EPA neither endorses nor opposes the addition of fluoride to drinking water. The decision to add fluoride is made on a local basis. EPA set a maximum contaminant level (MCL) of 4.0 mg/L to protect against adverse health effects. According to the Consumer Confidence Report (CCR) rule, as amended by the Public Notification rule (40 CFR Part 141, Appendix A to Subpart O), "Some people who drink water containing fluoride in excess of the MCL over many years could get bone disease, including pain and tenderness of the bones. Fluoride in drinking water at half the MCL or more may cause mottling of children's teeth, usually in children less than nine years old. Mottling, also known as dental fluorosis, may include brown staining and/or pitting of the teeth, and occurs only in developing teeth before they erupt from the gums." Because children may get mottled teeth at levels above 2.0 mg/L, EPA has set a secondary maximum contaminant level (SMCL) of 2.0 mg/L. EPA does not require water systems to meet this SMCL; however, EPA does require public water systems to notify their users (by mail or hand delivery and by a legal notice in the newspapers that serve the area) if the fluoride level is over 2.0 mg/L.
What is EPA's position on fluoridation of drinking water?
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