Mississippi Community
Water Fluoridation Plan
2022-2025
M
ISSISSIPPI
S
TATE
D
EPARTMENT
OF
H
EALTH
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Mississippi Community Water Fluoridation Plan
A guide for optimizing the fluoride level in drinking water so that all
Mississippians have improved oral health.
2022-2025
Prepared for:
Mississippi State Department of Health
(Offices of Environmental Health and Oral Health)
Authored by:
The American Fluoridation Society
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This report was made possible by funding from the Centers for Disease
Control, Preventive Health and Health Services (PHHS) Block Grant
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Table of CONTENTS
Topic Page #
–
ACKNOWLEDGEMENTS 3
–
INTRODUCTION 4
–
FLUORIDE: NATURE’S GIFT OF PREVENTION 6
–
AN OVERVIEW OF FLUORIDE IN MISSISSIPPI’S WATER 8
–
HEALTHY PEOPLE 2030 GOALS 11
–
COMMUNITY WATER FLUORIDATION OPERATIONS 12
–
GOALS, OBJECTIVES, AND ACTION PLAN 17
–
PROGRAM MANAGEMENT 22
–
REFERENCES 25
NOTE: Throughout this plan and the terms community water fluoridation and optimally
fluoridated water are considered to mean the U.S. Public Health Service recommended level
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of 0.7 parts of fluoride per million of water (ppm). CWF can also be referred to in milligrams
per liter (mg/L) of water.
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Acknowledgments
This document is designed to create a shared understanding of the role that Community
Water Fluoridation (CWF) has in supporting the ability to achieve good oral and overall
health for the people of Mississippi through optimal fluoride levels. It was prepared under
contract by the American Fluoridation Society (AFS), the Community Water Fluoridation
Subject Matter Experts (CWF SME) for the Mississippi Oral Health Program, Department of
Environmental Health.
Primary Author- American Fluoridation Society:
• Johnny Johnson, DMD, MS, President
• Tanya Dorf Brunner, Consultant
• Kathy Hunt, RDH, Consultant
The authors would like to thank the people from communities across Mississippi for their
contributions of time, energy, and passion in helping to craft this Community Water
Fluoridation Plan and the Ad Hoc Committee for their vision in preparing goals around CWF
that will help improve the oral health of everyone in our state:
MS CWF Advisory Board Committee Members
• Dr. Angela Filzen - Dental Director, MSDH Office of Oral Health Department
• Ralph Hayes - Engineering Director, MSDH, Bureau of Public Water Supply
• Lester Herrington – Director, Environmental Health (MSDH Office of Environmental
Health)
• Bill Moody – Bureau Director, Public Water Supply (MSDH Office of Environmental
Health)
• Andre’ Johnson – Special Projects Officer, CWF Liaison (MSDH Office of Oral Health)
• Dr. Johnny Johnson – President, American Fluoridation Society
• Dr. Brad Jenkins – President, MS Dental Association
• Shannon Coker – MS Dental Association
• Harry Gong – Mississippi Engineering Society (MS Bureau of Public Water Supply)
• Kirby Mayfield – CEO, MS Rural Water Association
• Kyla Rice – MS Municipal League
• Dr. Melissa Bradley – MS Dental Society
• Dr. Sreenivas Koka – Dean, University of MS Medical Center, School of Dentistry
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Introduction
Almost three million people call Mississippi home. With over 97% of our state made up of
rural land, Mississippians can boast that we are the most rural state in the union. Half of our
population lives in rural areas.
We are wonderfully diverse and have the largest percentage of Black residents in the United
States. We’re known for our “southern charm” and mouthwatering catfish and cornbread.
We also care about our family, friends, and neighbors. We work together to create
communities where we can all enjoy good health and wellbeing.
A critical part of overall health is a healthy mouth, which includes the ability to eat, speak,
and smile. When oral health is not a priority, tooth decay (cavities) can occur. Why do
healthy teeth matter? Tooth decay is one of the most common chronic diseases among
children in America, and it can negatively impact the overall quality of life at any age:
• Adults with poor oral health find it more difficult to get higher paying jobs and to keep a
job.
1
• The high cost of dental treatment can leave families with less money to pay for other
basic needs such as food, housing, and childcare.
2
• Children who have poor oral health tend to miss more school days and receive lower
grades than children with good oral health.
3
• As we experienced in 2007 with the death of a 6-year-old Mississippi child, dental
disease can also have tragic consequences.
4
Social determinants of health, conditions in the places where people are born, live, learn,
work, and play, can lead to poor oral health. A 2018 survey of third grade students across
Mississippi found that nearly two of every three children have experienced tooth decay.
One of every four children in Mississippi have active, untreated cavities in their teeth. The
survey also shows that children with poorer oral health were more likely to be Black and
living in poverty.
5
In Mississippi, not everyone has access to the care they need to have good oral health. We
are the poorest state in America, with one out of five of our residents living in poverty.
Living in poverty is the number one reason that oral health services are difficult to access,
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but anyone living in a rural area may also struggle to access dental care. When a
Mississippian suffers with dental pain, sometimes going to an emergency department may
be the only option available. Unfortunately, most emergency departments are not set up to
treat dental disease, and often people are only prescribed antibiotics and pain relievers to
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relieve the symptoms that will return without treatment of the disease itself. In the U.S., the
cost of emergency department visits for dental pain (not related to trauma) is estimated to
be more than $2 billion every year.
6
Mississippi is experiencing a dental professional workforce shortage, which is another
reason it can be hard to find dental care in our state. The Mississippi Primary Care Needs
Assessment reports that only 45.82% of the oral health needs of people in our state are
being met and the Health Resources and Services Administration (HRSA) Bureau of Health
Workforce indicates that 248 additional dentists are needed to eliminate the dental
workforce shortage designations across our state.
7
Prevention of dental disease is a key strategy to address this shortage. The good news is
that community water fluoridation (CWF) is a proven low-cost prevention strategy that can
reduce cavities. CWF is defined as water that contains the optimal amount of fluoride to
reduce tooth decay and has played a big part in improving of our nation’s oral health for
more than 75 years.
8
The purpose of this fluoridation plan is to reaffirm Mississippi’s commitment to promote,
implement, and maintain consistency of community water fluoridation in our drinking water
so that we can all enjoy improved oral and overall health for life.
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Fluoride:
Nature’s Gift of Prevention
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The mineral fluoride occurs naturally on earth and is released from rocks into the soil,
water, and air. All water contains some fluoride. Usually, the fluoride level in water is not
enough to prevent tooth decay; however, some groundwater and natural springs can have
naturally high levels of fluoride.
Fluoride benefits teeth in two ways.
1. Topical fluoride (applied on the outside of the tooth surface) strengthens the teeth of
adults and children, making them more resistant to decay. Fluoridated toothpaste and
fluoride varnish are examples of topical fluoride.
2. Systemic fluoride (ingested into the body) becomes incorporated into the developing
tooth structure of permanent teeth of young children while the teeth are still under the
gums. CWF is an example of a systemic fluoride.
It is important to note that CWF also provides topical protection for children and adults
because fluoride from water contacts the teeth while in the mouth and is also incorporated
into saliva, which continuously bathes the teeth.
Scientific evidence demonstrating the effect of fluoride on teeth became available
beginning in the early 1900s. Fluoride has been proven again and again to protect teeth
from decay by rebuilding and strengthening the tooth’s enamel surface. Optimal fluoride
levels in drinking water prevent tooth decay by ensuring teeth have frequent and consistent
contact with low levels of fluoride. CWF is one of the most effective and inexpensive ways to
ensure that an entire community has access to this naturally occurring, cavity-preventing
mineral.
8
In most parts of the country, naturally occurring levels of fluoride in water are too low to be
able to reduce tooth decay, while other communities have naturally occurring fluoride levels
that are too high. CWF is the process of adjusting the amount of fluoride in drinking water
[up or down] to the optimal level recommended for preventing tooth decay. The U.S. Public
Health Service has set 0.7 parts per million (ppm) of fluoride as the recommended optimal
level for CWF.
9
Fluoride that occurs naturally at 0.7 ppm is also considered optimal.
9
Everyone who uses tap water in a community that is optimally fluoridated benefits. Given
the dramatic decline in tooth decay in the 75 years since community water fluoridation
began, the Centers for Disease Control and Prevention (CDC) named CWF as one of ten
great public health interventions of the 20th century.
8
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Studies of CWF prove it is beneficial because it:
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• Is effective- CWF reduces dental decay by 25% over a
person’s lifetime. This includes both adults and children. One
community found that discontinuing community water
fluoridation led to a 51% increase in cavities and emergency
dental needs for children under the age of six.
10
• Is safe- Other than occasional minor cosmetic effects in tooth
enamel, research shows no clear evidence of adverse health
impacts from consuming optimally fluoridated water.
11
• Saves money- CWF reduces the need for fillings and other
dental treatment. On average, communities save $20 for
every dollar invested in CWF.
8
• Reduces disparities- CWF is available to everyone, which
makes it the most effective and practical method for achieving
equitable outcomes in reducing rates of tooth decay.
12
Surgeon General Regina
Benjamin, MD, said
“Fluoridation’s effectiveness
in preventing tooth decay
is not limited to children,
but extends throughout life,
resulting in fewer and less
severe cavities. Each
generation born since the
implementation of water
fluoridation has enjoyed
better dental health than
the generation that
preceded it.”
• Improves quality of life- CWF reduces pain and suffering related to tooth decay, time
lost from school and work, and money spent to restore, remove, or replace decayed
teeth.
13
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An Overview of Fluoride in Mississippi Water
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As a resident of the state of Mississippi, the tap water you drink most likely comes from a
groundwater (well) source. Groundwater provides over 90% of Mississippi’s drinking water
supply. The 1,200 public water systems operating in the state use 3500 wells and only four
surface water sources (lakes, rivers, and reservoirs).
14
According to the 2018 U.S. Census,
12.8% (approximately 382,000) of people in our state have their own private wells.
15
Fluoride-related Laws & Regulations
Water fluoridation in Mississippi is influenced by several laws and regulations at the federal,
state, and local levels.
• Federal/EPA: The Environmental Protection Agency (EPA) provides regulatory oversight of
the 1974 Safe Water Drinking Act (SDWA) and ensures safe public drinking water
supplies throughout the nation. Under SDWA, surface water sources are tested for
fluoride annually, and groundwater sources once every three years.
16
The EPA does not
provide guidance on adjusting fluoride levels to reduce tooth decay. Its focus is on
identifying source waters that have extremely high fluoride concentrations that are
associated with potential risks to human health. Currently, the maximum amount allowed
for fluoride is set at 4.0 mg/L. All water systems in Mississippi have far lower levels of
fluoride.
• Federal/Military Bases: In 2011, the U.S. Department of Defense adopted a policy
directing all military bases that own or operate their own water system to provide
optimally fluoridated water to military personnel and other residents of their bases,
stating that CWF “helps to improve and sustain the military readiness and health of
military personnel.”
• State: The Mississippi State Department of Health oversees the regulations governing
fluoridation of community water supplies (Source: Miss. Code Ann. § 41-26-6, p 35-39)
Mississippi Fluoridation Status
The level of naturally occurring fluoride in Mississippi is much lower than in other areas of
the U.S. Some public water systems in our state adjust their water supplies so that
communities can reap the full preventive benefits of CWF, but others do not. In recent years
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there has been some confusion about the value of CWF that resulted in fewer communities
having access to CWF. Studies have shown that decay rates increase when CWF is stopped.
10
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Fortunately, there are large amounts of recent and historical evidence from credible sources
that continue to show optimal amounts of fluoride are effective and safe.
According to recent data from the Mississippi Department of Health, 47.5%, or 1.5 million
people living in Mississippi currently receive optimally fluoridated water. That statistic ranks
Mississippi 41st in the nation.
Knowing the amount of fluoride that is currently in our state’s drinking water systems can
assist with collaboration, engagement, and collective action at the community level to
increase the number of Mississippians who have access to optimally fluoridated water. The
tables below show the amount of fluoride that is found in Mississippi public water systems
along with any recommended actions for optimal health.
Table 2
Suboptimal Range (less than 0.6 ppm)
Number of water systems reporting: 956*
Number of fluoridating water systems reporting: 44*
Number of people served by these water systems:
1,679,208
Recommendation: Adjust amount of naturally occurring fluoride to optimal levels.
*For f luoridating water systems and consecutive water systems that purchase their water f rom a
f luoridating water system, data is compiled f rom samples collected by water system personnel between
January - December 2021 and analyzed by the Mississippi State Department of Health (MSDH). For non- f
Table 1
Optimal Range (0.6 - 1.2 ppm)
Number of water systems reporting: 235* (1 water system not included for reporting 1.34
ppm)
Number of fluoridating water systems reporting: 155 (1 water system not included for
reporting 1.34 ppm)
Number of people served by these water systems: 1,519,955 Recommendation:
No action needed.
*For f luoridating water systems and consecutive water systems that purchase their water f rom a
f luoridating water system, data is compiled f rom samples collected by water system personnel between
January - December 2021 and analyzed by the Mississippi State Department of Health (MSDH). For non- f
luoridating water systems, data was compiled f rom Physical Chemistry samples providing natural f luoride
levels collected by MSDH Bureau of Public Drinking Water Supply staff between 2015 - 2021.
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Table 3
Greater or equal to 2.0 ppm
Number of water systems reporting: 0*
Number of people served by these water systems:
0
Recommendation: Reduce amount of naturally occurring fluoride to optimal levels.
*For f luoridating water systems and consecutive water systems that purchase their water f rom a
f luoridating water system, data is compiled f rom samples collected by water system personnel between
January - December 2021 and analyzed by the Mississippi State Department of Health (MSDH). For non-
f luoridating water systems, data was compiled f rom Physical Chemistry samples providing natural f luoride
levels collected by MSDH Bureau of Public Drinking Water Supply staff between 2015 - 2021.
Table 4
Water System Figures in Mississippi
Number of active water systems as of September 2022: 1,192
Number of people served by these water systems: 3,199,163
Percentage of this population receiving fluoride served by an optimal water system:
47.5%*
Percentage of this population receiving fluoride served by a suboptimal water system:
52.4%**
* Not all water systems listed in the optimal range are actively adding f luoride to the water system. Some
systems in Mississippi have natural f luoride levels that fall within the optimal range. In this case, a sys tem
does not need to add any additional f luoride to the drinking water.
** The majority of water systems in Mississippi do not have optimal natural f luoride levels. These water
systems need to add additional f luoride to raise the levels to the optimal range of 0.6 - 1.2 ppm. Some
systems reporting suboptimal f luoride results are f luoridating water systems that do add f luoride to the
system but fell below optimal standards in 2021.
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Healthy People 2030
Healthy People is a nationwide initiative focused on achieving health promotion and disease
prevention goals set by the United States Department of Health and Human Services. Every
decade, a new set of science-based national objectives are created with the goal of
improving the health of all U.S. residents.
Healthy People 2030 (HP2030) acknowledges the importance of oral health to overall health
by setting objectives to reduce tooth decay, including the proportion of adults, children, and
older adults with active and untreated tooth decay. HP2030 also recognizes that
community-level interventions like community water fluoridation can help improve oral
health by emphasizing health equity. As of 2018, nearly 75% of U.S. residents on public
water systems had access to optimally fluoridated water. The HP2030 national target is to
increase that percentage to 77.1%.
17
In 2018, the CDC reported that over 60% of Mississippi’s drinking water had optimal
fluoridation levels. That number is currently less than 48%, so we have a lot of room for
improvement. By working together, communities can reverse this unhealthy trend by
adjusting the fluoride in their community water systems to optimal levels.
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Community Water Fluoridation
Operations
As with most public and private health strategies, it is essential that the principles and
practices are monitored to ensure that communities are enjoying the maximum health
benefits. The Mississippi Public Water Supply Program, under the Mississippi State
Department of Health (MSDH), ensures safe drinking water to the 2.8 million residents of
Mississippi who utilize the state’s public water supplies. They do this by strictly enforcing
the requirements of the Federal and State Safe Drinking Water Acts (SDWAs).
This section will share information and links to further
information on how community water systems manage and
monitor CWF. Currently, Mississippi does not have a
mandated process or requirement for managing and
monitoring privately-owned wells that do not meet the
definition of a community public water system under the
Safe Drinking Water Act. If the owner is proactive and pays
for testing, that will be the only way to verify the level of
naturally occurring fluoride in privately-owned wells.
“Community water fluoridation
is one of the most practical,
cost- effective, equitable and
safe measures communities can
take to prevent tooth decay
and improve oral health.”
Vivek H. Murthy, M.D.,
M.B.A., U.S. Surgeon General
Surveillance Data
The Mississippi State Department of Health monitors and reports various indicators of oral
health status of our state’s population, including access to fluoridated water. The Mississippi
Public Water Supply Program receives information on fluoride levels from water systems. As
of 2022, the Mississippi State Department of Health is in the process of updating the records
and will then upload the data into the CDC’s Water Fluoridation Reporting System (WFRS).
The WFRS database provides many benefits to our state:
• Serves as the basis for national surveillance reports describing the percentage of the U.S.
population on community water systems that receive optimally fluoridated drinking water.
• Provides information that local decision-makers and the public can use to help define
progress toward decreasing oral health problems.
• Displays fluoridation information for the public through the CDC’s My Water’s Fluoride
website.
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• Allows water system operators to review and validate their operational results. The data
can also be used to identify areas for improvement and to make recommendations to
comply with the optimal level of fluoride in water.
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• Qualifies Mississippi for awards and recognition for the operational quality of its water
fluoridation activities, when used in accordance with CDC recommendations and
guidelines.
Quality Control & Monitoring
CWF is an effective, safe, and evidence-based public health measure. In 2015, the U.S.
Public Health Service recommended the optimal level for fluoride in water be set at 0.7 ppm
to realize the full benefits of water fluoridation while minimizing the risk of mild dental
fluorosis, which may appear as barely noticeable white spots on the tooth surface and do
not affect dental function. Most cases of dental fluorosis in the U.S. are very mild to mild.
For water systems to maintain optimally fluoridated water at 0.7 ppm, the CDC has set an
interim operational range of 0.6-1.0 ppm.
Routine monitoring of fluoridation levels has the benefit of measuring and providing
documentation that optimal levels of fluoride are maintained. Monitoring of community
water systems for fluoride content in Mississippi is conducted based on the type of water
system.
Quality control measures include inspections of water fluoridation facilities to verify
equipment function, reliability, suitability, and recommendations for managing inventory of
current and future equipment and system infrastructure needs to ensure facility compliance
and sustainability.
Fluoride Additives
Community water systems in the U.S. currently use one of three additives for water
fluoridation that are either water-based or salt-based. Decisions on which additive to use
are based on product and space availability, cost of product, product-handling
requirements, and equipment.
All water treatment additives, including those coming from outside the U.S., must meet
National Sanitation Foundation International/American National Standards Institute (NSF
International/ANSI) Standard 223, a national safety standard managed by NSF
International.
18
New Fluoridation Technology Supports Rural Health
Equipment costs can make it difficult for smaller water systems to implement CWF, but in
what has been hailed as a game-changer in fluoridation, a new fluoride delivery system has
been developed that is less expensive and easier to use. It is the first system in the past 40
years to be introduced onto the U.S. market.
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The New Wave Fluoridation System, which is CDC approved and meets strict NSF
International Standards. It is made in the U.S., uses a tablet similar in size and shape to a
chlorine tablet for swimming pools and is designed specifically for water systems serving
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populations of 50-10,000 people. Water operators are excited about this system because
the tablets are easy to handle, and the mechanics of the system are easy to monitor.
Mississippi has 964 water systems that are the perfect size for implementing the New Wave
Fluoridation System. Over 1.4 million additional Mississippians would have access to
healthy, optimally fluoridated water if their public water systems implemented this
affordable and easy-to-use system.
Overfeed protections
Water operating systems have a variety of safety measures in place to prevent an
“overfeed” of fluoride—meaning too much fluoride added into the local water. These
include day tanks, metering pumps, backflow preventers and residual analyzers.
Occurrences of overfeeds are very rare. When an overfeed does occur, it typically does not
pose a health risk as the overfeed is a temporary event.
De-fluoridation
The Safe Drinking Water Act (SDWA) regulates drinking water and sets standards to limit
possible contaminants. While optimal amounts of fluoride in the water protect our teeth,
significantly higher levels of fluoride can lead to unwanted health effects. Some water
systems with naturally occurring fluoride greater than 4.0 ppm must treat their water supply
to remove the excess fluoride to comply with SDWA limits and protect public health. Water
systems can use a variety of methods to reduce the amount of fluoride to levels that
provide protection from tooth decay.
This chart summarizes fluoride levels in water and what, if any, actions are needed.
Fluoride Level
Description
Action
Less than 0.6 ppm
Little to no prevention against tooth
decay as fluoride approaches zero
Adjust the fluoride level to
optimal of 0.7
0.7 ppm
Optimal level for preventing tooth
decay. No health risks. Slight risk for
mild cosmetic fluorosis.
None
>2.0 ppm
EPA Secondary Maximum
Contaminant Level- long term
consumption may result in severe
dental fluorosis in children by age 8
Notify users
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years of age
>4.0 ppm
EPA Primary Maximum
Contaminant Level- long term
consumption at or above this level
may result in skeletal fluorosis
(serious bone disorder)
Reduce fluoride levels to the
optimal fluoride level of 0.7
ppm
>- greater than or equal to
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The independent, non-governmental Community Preventive Services Task Force has noted
that research shows community water fluoridation does not result in any unwanted health
effects other than dental fluorosis, a condition that causes primarily cosmetic changes in the
appearance of tooth enamel.
8
It may result when children regularly consume higher levels
of fluoride than is found in optimally fluoridated water during the teeth-forming years, age
8 and younger. Most dental fluorosis found in the U.S. is very mild to mild, appearing as
white spots on the tooth surface that may be difficult to see except by trained dental health
professionals and does not affect dental function. There is no evidence that CWF results in
severe fluorosis.
11
Consistent exposure to high amounts of fluoride over a lifetime may cause skeletal fluorosis.
We do not see these health effects in the United States. The U.S. EPA has set a Maximum
Contaminant Level of 4.0ppm to prevent against skeletal fluorosis and a Maximum
Contaminant Level of 2.0ppm to prevent against severe dental fluorosis. The highest
average fluoride levels in Mississippi’s public water supplies reported in 2021 was 1.38.
A contaminant referred to by the U.S. EPA is to anything in water except H
2
O (water
formula) molecules.
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Sustainability
The key to the long-term success of CWF is sustainability. Various long-term strategies
should be considered to ensure that our drinking water continues to be effective and safe
decades in the future.
• Funding
o Ensure adequate funding for fluoridation equipment. There is a once in a generation
opportunity available in 2022 through federal infrastructure funding.
o Provide competitive salaries for water operators to attract and retain staff for these
vital positions.
• Education
o Provide support for water operators. As science evolves and new treatment
techniques are developed, it is critical to include the new science in training and
work plans for both new and experienced water operators.
o Promote the use of CWF training available from the CDC and state training
programs.
o Provide continuing education credit for water operators who participate in CWF
training.
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Goals, Objectives & Action Plan
Goal setting is a powerful tool. Goals help to focus attention and define what we want to
achieve and how to get there. The overarching goal for Mississippi’s Fluoridation Plan is to
improve oral health outcomes across all our communities through access to optimally
fluoridated drinking water.
A successful CWF program is driven by compassion, coordinated efforts, and achievable
goals. The current downward trend of optimally fluoridated water systems is a serious
concern. The following goals, objectives and activities were developed by a committed
group of Mississippians who identified data driven actions that can be realistically obtained
in the 3-year timeframe of this plan. Each of these steps are designed to provide guidance
so that communities can come together and engage with their neighbors to promote CWF
for their water systems to establish this public health strategy that will result in better oral
and overall health outcomes for their families, friends, and neighbors.
Goal 1: Mississippi has a
network of stakeholders
across the state who
collaborate effectively to
promote community water
fluoridation
Objective 1-1: By 2025, the
Mississippi Community
Water Fluoridation Advisory
Committee membership
will include at least 80% of
the groups included on the
committee matrix
• Create a matrix to identify the
organizations and populations
that should be represented
on the Community Water
Fluoridation Advisory
Committee
• Identify diverse populations
and communities that can
help make progress on
increasing number of
communities with optimal
fluoridation
• Create and disseminate
stakeholder recruitment
materials
• Articulate a clear delineation
of roles and responsibilities
between the state and water
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systems
Objective 1-2: By 2024,
establish a Statewide Water
Action Team pilot program
• Define the Statewide Water
Action Team’s (SWAT) role in
identifying and addressing
initiation and discontinuation
efforts
• Identify a central point of
contact and create a phone
tree system to receive and
disseminate alerts from the
SWAT members
• Identify a region or small
group of counties in which to
establish a pilot SWAT
program
• Create and disseminate
stakeholder recruitment
materials
• Develop a plan to send
community water fluoridation
updates to the team and the
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frequency to send them
Objective 1-3: By 2025, the
Mississippi Community
Water Fluoridation Advisory
Committee will strengthen
partnerships with water
operators to improve access
to community water
fluoridation
• Develop a plan to integrate
CWF into ongoing training
and technical assistance for
water operators.
• Create and disseminate
messages, such as a pocket
guide, about the effectiveness
and safety of community
water fluoridation
• Conduct research to
determine water operators’
views on community water
fluoridation
• Conduct research and share
resources to procure
fluoridation materials and
equipment
• Designate a central point of
contact for CWF information
and technical assistance for
water operators
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Goal 2: Mississippians
understand the benefits of
community water
fluoridation
Objective 2-1: By 2025,
conduct a media campaign
on the benefits and safety
of optimally fluoridated
drinking water
• Create a public awareness
plan
• Identify the different
audiences to whom the
campaign will be directed
• Develop relatable messages
that use oral health disease
data
• Identify strategies to deploy
the messages, such as social
media
• Secure funding to implement
the campaign statewide
Objective 2-2: By 2025,
create and deliver science-
based messages on the
importance and safety of
optimally fluoridated
drinking water
• Identify specific groups to
target (dental, medical, water
operator, policymakers, etc.)
• Design specific content for
each targeted group
• Publish the MS community
water fluoridation flip chart
• Provide community trainings
about how to talk to water
boards
• Attend and present at
summits and conferences to
discuss community water
fluoridation
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Goal 3: Community water
fluoridation is available to
future generations
Objective 3-1: By 2025,
identify means to ensure
the provision and
management of community
water fluoridation within
the state system and across
communities.
• Provide technical assistance
to water systems to access
federal infrastructure funding
for water system upgrades
• Research methods to
implement CWF initiations
and reduce discontinuations
• Update the action plan for
discontinuation and
temporary stoppages
• Update the discontinuation
plan that is already in place,
including differentiating the
action to take for
discontinuation and
temporary stoppages
Objective 3-2: By 2025,
establish systems to
improve water operators’
ability to easily fluoridate
• Conduct an environmental
scan about the water
operator workforce, including
workforce adequacy
the water in their
communities
• Partner with water
departments to create a plan
to recruit, train, and support
water operators
• Determine a way to simplify
fluoridation data reporting
mechanisms
• Set strategies to ensure
continuous and timely access
to appropriate fluoride
chemicals, such as mapping
for availability/pricing and
exploring new types of
fluoride
• Receive continuing education
credit for taking the
Fluoridation on-line training
Page 32 | Mississippi Community Water Fluoridation Plan | 2022
and other education on CWF.
Objective 3-3: By 2025,
Increase access to the
tablet fluoridation system.
• Identify and launch a tablet
system in at least one
community
Page 33 | Mississippi Community Water Fluoridation Plan | 2022
Goal 4: Communities in
Mississippi have access to
data they need to promote
and protect community
water fluoridation.
Objective 4-1: By 2025,
Mississippi-specific data will
be made available to
support communities with
community water
fluoridation promotion
• Make WFRS data public
through the My Water’s
Fluoride website
• Collect and make available
Emergency Department data
on number and costs of non-
traumatic dental visits
• Update Mississippi
Department of Health
website to reflect most recent
and accurate information
regarding community water
fluoridation
• Synchronize Mississippi
Department of Health
fluoridation data with other
oral health and water
websites in the state
• Teach medical and dental
professionals how to read
average monthly fluoride
report in My Water’s Fluoride
• Teach medical and dental
professionals how to use and
interpret the natural fluoride
levels report in My Water’s
Fluoride
• Identify people in the state
who can troubleshoot CWF
issues.
• Explore options to provide
tablet computers for real-
time data collection in the
field
Page 34 | Mississippi Community Water Fluoridation Plan | 2022
Goal 5: The Mississippi
Community Water
Fluoridation Plan has an
evaluation system to
provide accountability and
demonstrate plan progress
Objective 5-1: By 2025, the
Mississippi Community
Water Fluoridation Advisory
Committee will establish
and deploy an evaluation
system
• Identify outside or internal
evaluators to lead a process
to evaluate progress with the
state fluoridation plan
• Identify evaluation measures
such as social media
impressions and website
traffic
• Determine which partners
will track progress on the
state fluoridation plan
• Set a schedule to launch the
evaluation plan
• Establish a process to review
the evaluation results and
make appropriate
adjustments to the state
fluoridation plan
Page 35 | Mississippi Community Water Fluoridation Plan | 2022
Program Management
The management of the community water fluoridation program resides with the Bureau of
Public Water Supply in the Mississippi State Department of Health, but CWF requires the
collaboration and expertise of many people and organizations across state government and
our communities. By working together, the state CWF program, local leaders, and oral
health champions can provide support to engage in community-driven grassroot efforts to
promote CWF and ensure healthy communities.
Strong Partnerships
An effective CWF program brings together and embraces working partnerships that are
aligned and guided by a central plan. Through collaboration, oral health champions across
Mississippi can ensure that a shared vision is achieved and improvements, especially
regarding equitable access, are made. The diagram below illustrates the entities involved in
ensuring that Mississippi has safe and healthy drinking water.
Community Engagement
While agencies and organizations can serve as important resources for a community, the
key to a successful CWF program is engaging a community of diverse partners. Interested
parties can work together to create a community coalition to develop local strategies to
Page 36 | Mississippi Community Water Fluoridation Plan | 2022
promote the benefits of community water fluoridation. Dental and medical providers are
generally well-respected by the public and are an important part of a local coalition, but it is
Page 37 | Mississippi Community Water Fluoridation Plan | 2022
C
important to also find others in the community to be involved. Understanding what each
partner brings to the table will maximize the reach and contributions of the network.
Additional community champions may be found among:
o School principals
o Children’s advocates
o Local health department
o Parents
o Civic activists
o Local decision makers
o Community leaders
o Faith community leaders
o Young leader
Effective Communication
When highlighting the benefits of optimal water fluoridation, it is important to understand
that different audiences have different informational needs.
• Community members need to understand that CWF is effective and safe.
• Decision makers need to understand that CWF benefits the entire community and
provides a positive return on investment.
• Water treatment professionals need to understand the importance, effectiveness, and
safety of CWF so they can explain it to others.
Promotional Resources
There are many readily available, evidence-based, and culturally appropriate resources that
can be used to create a shared understanding of the benefits of CWF. Additional tools and
resources specific to Mississippi can be created on how to get involved in promoting CWF.
Infographic materials from CDC
These resources are downloadable and printable for electronic posting or distribution.
Page 38 | Mississippi Community Water Fluoridation Plan | 2022
DC
Social media messages from
Community Benefits How Fluoride Works
Spanish
CWF Fact Sheet
Page 39 | Mississippi Community Water Fluoridation Plan | 2022
These resources are designed for electronic posting to Facebook or Twitter.
Creates a strong surface Protects teeth all day long
Rebuilds tooth surfaces
Additional Resources
Learning the science behind the oral health benefits of fluoride and CWF plays an essential
role in helping Mississippians have healthy teeth and good overall health. Below is a listing
of evidence-based resources that provide reliable information about CWF.
• American Dental Association
o Fluoridation Facts
o For consumers
o For health professionals
• American Academy of Pediatrics- Information on water fluoridation for parents
• American Fluoridation Society- Science-based education about water fluoridation and
CWF support for communities across the United States
• Campaign for Dental Health- Evidence based facts about oral health and preventive
strategies like fluoride
• Centers for Disease Control and Prevention
o Community Water Fluoridation- General information
o My Water's Fluoride (MWF)- Access to information about drinking water fluoridation
levels in specific communities.
o Fluoridation Online (FLO)- Free online training course to help increase knowledge
and skills to implement and maintain community water fluoridation programs.
• Fluoride Legislative User Information Database- Electronic search engine for case law,
legislation, and journal articles related to fluoridation laws and regulations.
• National Institutes of Health- Fluoride fact sheet
o For Health Professionals
o For Consumers
With tooth decay present in every community across the state and because there is not
enough naturally occurring fluoride in most of Mississippi’s water, now is the time for
communities and their oral health champions to promote the adjustment of the fluoride in
their drinking water (up or down) to optimal levels. This plan serves as a roadmap for
advancing CWF in our state so that every community can secure the benefits of good oral
and overall health and well-being for generations to come.
Page 40 | Mississippi Community Water Fluoridation Plan | 2022
References
1. U.S. Department of Health and Human Services. Oral Health in America: A Report of the
Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National
Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
2. Righolt AJ, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic
impacts of dental diseases in 2015. J Dent Res. 2018;97(5):501–507.
3. Naavaal S, Kelekar U. School hours lost due to acute/unplanned dental care. Health Behav
Policy Rev. 2018;5(2);66–73.
4. WLOX, A Gray Media Group, Inc. Station, “Health Care Official Elaborate on Septic
Shock, Ailment that Killed Local 6-Year-Old”, March 2007
5. Mississippi State Department of Health, “Every Smile Counts The Oral Health of Mississippi
Children 2018 ”, November 2018
6. Texas A&M University School of Public Health, “ Emergency Dental Visits Take A Bite Out Of
Everyone’s Wallets” October 2020
7. Mississippi State Department of Health, “Mississippi Primary Care Needs Assessment”,
March 2021
8. Centers for Disease Control and Prevention, “Community Water Fluoridation” Accessed
September 2022
9. U.S. Public Health Service, “U.S. Public Health Service Recommendation for Fluoride
Concentration in Drinking Water for the Prevention of Dental Caries” Accessed September
2022
10. BMC Oral Health 2018, “Consequences of community water fluoridation cessation for
Medicaid-eligible children and adolescents in Juneau, Alaska,” Accessed September 2022
11. National Library of Medicine, “Systematic review of water fluoridation”
Accessed September 2022
12. National Library of Medicine, “Cost-Effectiveness of Caries Prevention in Practice: A
Randomized Controlled Trial,” Accessed September 2022
13. National Library of Medicine, “Costs and Savings Associated with Community Water
Fluoridation Programs in Colorado”
14. Mississippi State Department of Health, “Groundwater Protection” September 2022
15. Mississippi State University, “Mississippi Private Well Populations”, September 2022
16. U.S. Environmental Protection Agency, “Safe Drinking Water Act Compliance Monitoring”,
Accessed September 2022
17. U.S. Department of Health and Human Services, “Healthy People 2030,” Oral Conditions
Accessed September 2022
18. Centers for Disease Control and Prevention, “Water Fluoridation Additives” Accessed
September 2022
