Preventing Dental Caries: Community Water Fluoridation

Task Force Finding*

Community water fluoridation (CWF) is the controlled addition of a fluoride compound to a public water supply to achieve an optimal fluoride concentration. Since 1962, the U.S. Public Health Service has recommended that community drinking waters contain 0.7 to 1.2 ppm of fluoride. In 1992, more than 144 million people in the United States (56% of the population and 62% of those receiving municipal water supplies) were being supplied with water containing enough fluoride to protect teeth from caries. In 2000, a total of 38 states and the District of Columbia provided access to fluoridated public water supplies to ≥50% of their populations. A national objective aims to ensure that at least 75% of the population will be served by community water systems providing optimal levels of fluoride by the year 2010.

CWF is strongly recommended based on its effectiveness in reducing the occurrence of dental caries within communities. Other positive effects mentioned, but not systematically evaluated, include (1) reducing disparities in caries risk and experience across subgroups defined by socioeconomic status, race or ethnicity, and other predictors of caries risk; and (2) the “halo” or “diffusion” benefits to residents of nonfluoridated communities by means of exposure to processed food and beverages made from fluoridated water.

The safety of fluoride is well documented and has been reviewed comprehensively. Enamel fluorosis (visible discoloration of tooth enamel) is one of the potential adverse effects seen in children who ingest too much fluoride from any and all sources while tooth enamel is forming. Most cases of enamel fluorosis seen today are of the mildest form, which does not affect aesthetics or function. The most recent review of potential adverse effects of CWF showed no clear association between water fluoridation and incidence of mortality from bone cancers, thyroid cancer, or all cancers. Program costs of CWF are affordable. Median cost per person per year ranges from $2.70 among 19 public water systems serving ≤5000 people to $0.40 among 35 systems serving populations ≥20,000. Estimated cost-effectiveness ratios (i.e., net cost per tooth surface spared from decay) indicate that CWF is cost saving (i.e., saves money from a societal perspective and also reduces caries).

*From the following publication:

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.

Review completed: October 2000