117 - Fluoride Content of Still Bottled Water Available in the United States

Purpose: Dental caries remains a significant public health concern in the United States. In response, policymakers and health professionals have implemented various preventive strategies, most notably community water fluoridation. Fluoridated water has been shown to reduce caries in both deciduous and permanent dentition in numerous studies. However, growing concerns about tap water safety, whether due to contamination or perceived risk, have led many Americans to switch to bottled water as their main source of drinking water. The objective of this project is to identify bottled waters sold in the U.S, their fluoride concentrations, and create a database for use by health professionals and consumers.

Methods: An online search strategy included using AI (e.g. Chatgpt, Claude AI), Google, Certificates of Analysis (CoA) or Consumer Confidence Reports (CCR), FDA, online databases, manufacturers' websites, grocery store/DoorDash sites were searched using key words (e.g. bottled water, spring/artesian/distilled/alkaline). Brand name, water classification fluoride concentration and labeling claims (e.g. added fluoride) were entered into an Excel templated.

Results: A total of 207 waters were found, 153 (74%) of which self-identified in the name as a type of water. Fluoride concentration was obtained from 27 (13%) brands, ranging from 0.05-1.0 mg, (mean=0.29 +/- .266). Two waters exceeded the recommended fluoride concentration of 0.7. 45 (22%) were classified as "nondetectable", indicating that the manufacturer reported fluoride testing and found zero or so low that it was deemed nondetectable. 135 (65%) did not provide any indication/information of fluoride content or testing.

Discussion: Fluoride content varied widely (0.0 to 1.0 mg) across the 207 bottled waters. Type of water, spring, mineral, artesian, alkaline may greatly influence naturally occurring fluoride levels primarily attributable to geologic factors. Two common brands, (Arrowhead 100% Mountain Spring Water and Crystal Geyser Alpine Spring Water) exceeded the recommended .70mg concentration. Using highly fluoridated water to mix infant formula may lead to intake exceeding recommended .70 mg concentration. Using highly fluoridated water to mix infant formula may lead to intake exceeding recommended amounts for infants (Halo Effect). Limitations include reliance of data from multiple sources, as manufacturers are not required to disclose water quality test results/information on the label. State mandated regulations also affect product labelling.

Conclusion: These results demonstrate the variability across bottled waters, and non-standardized labelling. The growth in demand for bottled water may inadvertently increase consumer exposure to microplastics, thus, further studies in these areas are warranted.