Preventing Dental Caries: Community Water Fluoridation

Community water fluoridation involves adding fluoride (which prevents tooth decay) to community water sources, then adjusting and monitoring the amount of fluoride to ensure that it stays at the desired level.

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force  recommends community water fluoridation based on strong evidence of effectiveness in reducing tooth decay.

Task Force Finding

Results from the Systematic Reviews

Twenty-one studies qualified for review.

• Decay rates measured before and after water fluoridation: median decrease of 29.1% among children ages 4 to 17 years when compared with control groups (21 study arms).
• Decay rates measured after water fluoridation only: median decrease of 50.7% among children ages 4 to 17 years when compared with control groups (20 study arms).
• Fluoridation was found to help decrease tooth decay both in communities with varying decay rates and among children of varying socioeconomic status.

Nine studies qualified for review of the economic efficiency of community water fluoridation programs.

• Median cost per person per year for 75 water systems receiving fluoridated water: $2.70 among 19 systems serving < =5000 people to $0.40 among 35 systems serving >=20,000 people (7 studies).
• Community water fluoridation was cost saving (5 studies).
• In smaller communities (5000 to 20,000 residents), fluoridation was estimated to be cost-saving where decay incidence in the community exceeds 0.06 tooth surfaces per person annually.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to oral health.

Supporting Materials

• Analytic framework [PDF - 2.52MB]- See Figure 1 on page 24
• Research gaps
• Summary evidence table [PDF - 2.52MB]- See Appendix B on pages 47-52
• Included studies

Publications

Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. [PDF - 2.52MB] Am J Prev Med 2002;23(1S):21-54.

Task Force on Community Preventive Services. Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. [PDF - 69KB] Am J Prev Med 2002;23(1S):16-20.

Task Force on Community Preventive Services. Promoting oral health: interventions for preventing dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries: A Report on Recommendations of the Task Force on Community Preventive Services. MMWR 2001;50(RR21):1-13.

Task Force on Community Preventive Services. Oral health. [PDF - 359KB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:304-28.

More Community Guide publications about Oral Health

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing dental caries: community water fluoridation. www.thecommunityguide.org/oral/fluoridation.html. Last updated: MM/DD/YYYY.

Review completed: October 2000