Water Fluoridation: Institutional Arrangements and Regulatory Mechanisms in Three Selected Countries

OBJECTIVE: To describe and compare regulatory processes for quality control of community water fluoridation (CWF) in three selected countries. METHODS: Documentary analysis of printed and online resources; correspondence with key informants from Brazil, the United States of America (USA), and England; countries with tradition in water fluoridation implementation for dental caries prevention. RESULTS: The target and maximum allowable concentration of fluoride in drinking water was 0.7/4.0 mg/L in the USA; 0.7/1.5 mg/L in Brazil, and 1.0/1.5 mg/L in England. Concentration monitoring by the water companies varied; collection of samples at several points of the distribution network was required in England and the USA, while Brazil demanded only one point at the end of the water treatment. England and the USA relied on data generated by companies responsible for water treatment, while Brazil adopted an independent surveillance system that used data collected in the distribution network by the local health authority. A common point between the USA and Brazil was the construction of a nationwide information system under principles of health surveillance that could be disseminated for stakeholders. In England, annual quality reports for each water supply zone were accessible but not routinely collated and published. CONCLUSION: Institutional arrangements, regulatory mechanisms, and control, surveillance, and information disclosure procedures varied substantially among countries. There is potential for exchanging procedural and outcome information in order to improve the performance of fluoridation services.