AWWA M4-2016 Water Fluoridation Principles and Practices (Sixth Edition).pdf

1、Water Fluoridation Principles M4 Identifiers: LCCN 2016019717 | ISBN 9781625761705 Subjects: LCSH: Water-Fluoridation. Classification: LCC TD467 .C66 2016 | DDC 628.1/663-dc23 LC record available at https:/lccn.loc .gov/2016019717 ISBN-13 978-1-62576-170-5 eISBN-13 978-1-61300-383-1iii AWWA Manual M

2、4 Contents List of Figures, v List of Tables, vii Preface, ix Acknowledgments, xi Chapter 1 Water Fluoridation . 1 Introduction, 1 Occurence, 2 History of Use (Growth of Community Water Fluoridation), 2 Regulatory, 5 References, 8 Chapter 2 Health and the Human Body . 9 Fluoride in the Human Body, 9

3、 Discovery of the Benefi ts of Fluoride, 10 Fluoride Delivery, 15 References, 15 Chapter 3 Fluoride Products . 17 Chemical Characteristics, 17 Chapter 4 System Planning 25 Deciding Whether to Fluoridate, 25 Fluoride Application Point, 27 Project Permitt ing and Planning, 28 Process of Implementing F

4、luoridation, 29 Chapter 5 Design, Equipment, and Installation 37 Saturators, 37 Dry Feeders, 39 Solution Dissolving Tanks, 41 Fluorosilicic Acid Feed Systems, 42 Metering Pumps, 42 Flow Meters, 43 Scales, 43 Storage of Bulk Fluoride Products, 44 Day Tanks, 44 Bag Loaders, 45 Backfl ow Prevention Dev

5、ices, 45 Piping and Valves, 45 Corrosion Control, 46 Continuous Analyzers, 46 Injection Location, 47 Calibration Cylinders, 47 Wastewater Connections, 47 Facility Construction and Startup, 48 References, 50iv WATER FLUORIDATION PRINCIPLES & PRACTICES AWWA Manual M4 Chapter 6 Operations and Maintenan

6、ce 51 Operational Strategies, 51 Compliance Monitoring, 53 Fluoride (Manual) Ion Specific Electrode (ISE) Method, 55 Colorimetric SPADNS Method, 56 Ion Chromatography, 57 Relative Error, 58 Record Keeping and Documentation, 59 Operator Safety in Handling Fluoride Products, 60 References, 65 Chapter

7、7 Defluoridation and Managing Fluoride Levels .67 High Fluoride Levels, 67 Strategies for Managing Well Fluoride Levels, 68 Methods of Removal, 69 Point of UsePoint of Entry, 75 Chapter 8 Small Systems Considerations . 77 A Small Systems Decision Process, 77 Considerations for Simplified Systems, 78

8、 References, 81 Chapter 9 Community Outreach and Communication . 83 Customer Service and Communication, 83 Fluoride Communication Strategies, 84 Appendix A Materials Compatibility Lists .87 Appendix B Example Calculations 91 Appendix C Frequently Asked Questions 103 Appendix D Selected Sources of Sc

9、ientific Water Fluoridation Information .107 Appendix E Inspection Checklists 113 Appendix F Testing Checklists . 123 Index, 127 AWWA Manuals, 131v AWWA Manual M4 Figures 1-1 Growth of community water fl uoridation around the world, 4 2-1 The demineralization and remineralization process, 13 2-2 Den

10、tal caries and dental fl uorosis in relation to fl uoride in public water supplies, 14 3-1 Density of fl uorosilicic acid vs. percentage based on data provided by The Mosaic Company, 21 5-1 Upfl ow saturator, 38 5-2 Sodium fl uorosilicate feed system, 40 6-1 Simplifi ed process control scheme, 52 6-

11、2 Example chromatogram, 58 7-1 Activated alumina with pH adjustment fl uoride removal water treatment plant, 71This page intentionally blank.vii AWWA Manual M4 Tables 1-1 States requiring fl uoridation of public water supplies, 7 3-1 Trends in the use of fl uoride products over time, 18 3-2 Characte

12、ristics of fl uoride products, 22 4-1 Typical values of purity and available fl uoride ion (AFI), 31 6-1 Analytical methods currently approved for use for SDWA monitoring programs, 55 6-2 Interferences for ISE measurements, 56 6-3 Measured relative error for ISE method compared to SPADNS method, 59

13、6-4 Recommended overfeed actions, 63 B-1 Typical Values of Purity and Available Fluoride Ion (AFI), 92 B-2 Amount of additive product needed based on purity, 102This page intentionally blank.ix AWWA Manual M4 Preface The American Water Works Association has been an active partner in water fl uoridat

14、ion from the original pioneering studies on its implementation and eff ectiveness from 1945 through 1951, and has supported community water fl uoridation since 1951. In addition, from the 1940s to the 1960s, the US Public Health Service provided national leadership in water fl uoridation practice an

15、d issued periodic technical advisories on water fl uo- ridation. The US Environmental Protection Agency (USEPA) provided support and guidance on technical practice from 1972 to 1978 until the Centers for Disease Control and Prevention (CDC) assumed responsibility for providing support to state water

16、 fl uoridation programs in 1978. These organizations wealth of knowledge gained through the experiences and manage- ment of several thousands of fl uoridation process installations can improve future installations and enhance successful continued operations to provide improved health for our communi

17、ties. This manual is a resource to assist decision makers planning to use fl uoridation treatment, engineers designing and installing these facilities, and water utility personnel managing water operations. The manual presents guidelines and is not intended to take the place of expert advice. Anyone

18、 planning or using fl uoridation should carefully consider fl uoride research, regulations, and methods. State or provincial regulatory requirements should always be the fi rst point of reference for water fl uoridation design and practices to improve the health of the citizens. The fi rst edition o

19、f the American Water Works Association M4 Water Fluoridation Principles & Practices was prepared from material supplied and previously published by the USEPA. The second edition was updated and revised using additional technical collaboration with the US Centers for Disease Control and Prevention. T

20、he third, fourth, and fi fth editions were updated and revised incrementally by section. This sixth edition represents a substantial updating and revising of the manuals content to remain consistent with industry practices and to refl ect changes in regulatory and public health guidance and the expe

21、rience of contributing authors. This page intentionally blank.xi AWWA Manual M4 Acknowledgments This manual was revised by the AWWA Treatment Plant Operations and Maintenance C o m m i tt e e . The following committ ee members served as the editorial review board in the preparation of this edition o

22、f the manual: Ari Copeland, Chair, Black & Veatch Corporation, Waterbury, Conn. David Baker, Enprotec / Hibbs & Todd, Inc., Colorado Springs, Colo. Angela Kana-Spitz , Short Elliott Hendrickson Inc., Denver, Colo. Barbara Melcher, CDM Smith, Carlsbad, Calif. Michael Wentink, Nebraska DHHS, Division

23、of Public Health, Offi ce of Drinking Water and Environmental Health, North Platt e, Neb. Additional contributing committ ee members, M4 Water Fluoridation Principles & Practices : Dr. Katherine Ann Alfredo, Staten Island, N.Y. Charly C. Angadicheril, City of Fort Worth, Fort Worth, Texas John A. Co

24、nsolvo, City of Philadelphia, Philadelphia, Penn. Stephen Gasteyer, Michigan State University, East Lansing, Mich. Michael S. Grimm, Happy Valley, Ore. Kimberly Gupta, Portland Water Bureau, Portland, Ore. David Heumann, Los Angeles Department of Water and Power, Los Angeles, Calif. Daniel Huggins,

25、City of London Water Operations, London, Ont., Canada Dr. Alisha Knowles, Halifax Water, Halifax, N.S., Canada Hoy Yi (Mandy) Lai, CDM Smith, Walnut Creek, Calif. Brian John Leto, Pasadena, Calif. Edward A. Moreno, DDS, West Liberty, Iowa Tom Napier, Dept. of State Health Services, Austin, Tex. Brya

26、n R. Phinney, Keller Associates, Inc., Pocatello, Idaho Chet V. Shastri, City of Fort Wayne, Fort Wayne, Ind. Preeti Shridhar, City of Renton, Renton, Wash. Steve H. Via, AWWA, Washington, D.C. Dr. June M. Weintraub, San Francisco Dept. of Public Health, San Francisco, Calif. Jason Yoshimura, CDM, C

27、arlsbad, Calif. Molly Beach, former Manuals Specialist, Mindy Burke, current Manuals Specialist, and Steven J. Posavec, Standard Methods Manager, provided AWWA staff support. The editorial review committ ee would like to acknowledge the contribution of Kip Duchon, National Fluoridation Engineer for

28、the Centers for Disease Control and Prevention, for his assistance during the editing process.This page intentionally blank.AWWA MANUAL M4 Chapter 1 1 Water Fluoridation INTRODUCTION The goal of this manual is to assist with the planning and operation of fl uoridation sys- tems by decision makers, d

29、esign engineers, and water utility personnel. This chapter discusses fl uoride occurrence, growth of community water fl uoridation, and legal issues surrounding fl uoridation. The regulatory requirements of community water fl uoridation are also addressed, including both federal regulations and the

30、varying approaches states have used to implement fl uoridation programs. Additionally, fl uoridation outside of the United States is discussed. Fluoridation in this manual refers to the addition of fl uoride to drinking water to maintain a recommended level to improve oral health. Fluoridation was n

31、amed as one of the Ten Great Public Health Achievements in the 20th Century by the Centers for Disease Control and Prevention (CDC) along with the use of chlorine for disinfection of public water supplies (CDC Morbidity and Mortality Weekly Report, April 2, 1999). Control of infectious diseases has

32、resulted from clean water and improved sanitation. Infections such as typhoid and cholera transmitt ed by contaminated water, a major cause of illness and death early in the 20th century, have been reduced dramatically by improved sanita- tion. Water fl uoridation was fi rst implemented in 1945, and

33、 in 1951, the National Research Council (NRC) of the National Academy of Sciences (NAS), the US Surgeon General, and professional organizations including the American Water Works Association (AWWA) and the American Dental Association (ADA) recommended that communities implement water fl uoridation.

34、The US Public Health Service (USPHS) recommended a range of 0.7 to 1.2 mg/L (based on annual average ambient temperature) as part of the 1962 Drinking Water Standards. In 2011, the US Department of Health and Human Services (USHHS) proposed changing the recommended fl uoride level in drinking water

35、to a single value of 0.7 mg/L. According to national health surveillance statistics reported by the USPHS and the CDC, the number of people with access to fl uoridated water continues to increase and in 2012, 210.6 million people in the United States had access to fl uoridated water.* * 2012 Water F

36、luoridation Statistics from the US Centers for Disease Control (CDC).2 WATER FLUORIDATION PRINCIPLES & PRACTICES AWWA Manual M4 OCCURRENCE Fluorine, a gaseous halogen, is the 13th most abundant element in the earths crust. Fluorine is also the most electronegative element, so it is not found in its

37、free elemental form in nature. Instead, it exists as a mineral such as fluorosilicates in granites, calcium fluorides in some ores, along with other mineral forms, or as a dissolved reduced ionic form in solution. Fluoride ion solubility varies, but the sodium and potassium salts of fluoride are hig

38、hly water soluble. There are both natural and anthropogenic sources of fluoride. Natural sources of fluoride include volcanic and geothermal activity emissions, weathering of certain types of rocks, wind-blown erosion of soils, and marine origin. Commercial ore deposits of flu- orspar, fluorapatite,

39、 and cryolite are the source for most fluoride products. Anthropogenic releases of fluoride occur predominantly because of the burning of coal for power pro- duction and are also caused by manufacturing, steel and aluminum production, and oil refining. Fluoride is ubiquitous in the environment and t

40、herefore likely to be present to some extent in all water sources. Seawater contains approximately 1.2 to 1.5 mg/L of fluoride. The concentration present in source water is often equal to the fluoride in rainfall, which is typically 0.1 to 0.2 mg/L. However, natural levels in proximity to volcanic s

41、ources can be significantly higher because volcanic emissions are recognized as a significant envi- ronmental source. The naturally occurring concentrations in surface waters are gener- ally lower than those needed to promote good dental health. Fluoride concentrations in groundwater can be more var

42、iable than in surface water, with the concentration depen- dent on the geological setting. In the United States, groundwater levels typically range from nondetectable levels to greater than 4 mg/L. However, elevated levels of naturally occurring fluoride are not common. Based on reported natural flu

43、oride levels in commu- nity public water systems, the CDC estimates that less than 0.5% of the US population served by public water systems has natural fluoride levels exceeding 2 mg/L, and less than 0.1% of the population served by public water supplies has naturally occurring fluoride in excess of

44、 4 mg/L. The US Geological Survey (USGS), in a survey of private groundwater wells, estimated that up to 4% of private wells exceed 2 mg/L and up to 1.2% exceed 4 mg/L (Quality of Water from Domestic Wells in the United States, Leslie DeSimone et al. November 2009). Private wells can have a higher i

45、ncidence of elevated fluoride as many homeowners do not test their wells for contaminants, while public water supplies are required to report on contaminants levels and have worked to identify alternate sources when possible. HISTORY OF USE (GROWTH OF COMMUNITY WATER FLUORIDATION) The importance of

46、fluoride as a nutrient for good oral health resulted from environmental observations of communities with naturally occurring fluoride. In the 1920s and 1930s, fluoride was identified as a factor in tooth development. Investigations showed that in communities having naturally fluoridated water, fluor

47、osis (mottled or discolored teeth) occurred when the fluoride content of the water was abnormally high. However, these teeth also showed decreased incidence of tooth decay or dental caries, which was unusual considering the large prevalence of tooth decay in that era. During the 1930s, studies con-

48、cluded that the beneficial range of fluoride to prohibit dental caries while still minimizing risk of dental fluorosis was 1.0 mg/L to 1.5 mg/L, with an optimum concentration of 1.0 mg/L to achieve the beneficial level while remaining below the higher levels that could stain teeth. Starting in 1945, initial community trials were held to test the theories that fluoride reduced tooth decay formulated over the preceding decades. In each of these trials, one