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Preventing Dental Caries: Community Water Fluoridation

Included Studies - Effectiveness Review

The Community Preventive Services Task Force recommendation on community water fluoridation is based on evidence from the following:

  • 28 studies about the effect of CWF on caries; 16 about oral health disparities, and 117 about dental fluorosis -- most of which were included in an existing systematic review (McDonagh 2000, search period 1966-1999; 26 studies on caries; 13 on oral health disparities; 88 on fluorosis)
  • 2 studies on caries; 3 on oral health disparities and 29 on fluorosis (search period 1999-2012)


Systematic Review of Public Water Fluoridation

McDonagh M, Whiting P, Bradley M, Cooper J, Sutton A, Chestnutt I, Misso K, Wilson P, Treasure E, Kleinjen J. A Systematic Review of Public Water Fluoridation. National Health Service Centre for Reviews and Dissemination. York(UK): University of York; 2000. Available at URL:

Studies from the Updated Search

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Acharya S. Dental caries, its surface susceptibility and dental fluorosis in South India. International Dental Journal 2005;55(6):359–64.

Alarcon-Herrera M, Martin-Dominguez I, Trejo-vazquez R, Rodriguez-Doza S. Well water fluoride, dental fluorosis, bone fractures in the Guadiana Valley of Mexico. Fluoride 2001;34(2):134–49.

AlDosari AM, Akpata ES, Khan N. Associations among dental caries experience, fluorosis, and fluoride exposure from drinking water sources in Saudi Arabia. Journal of Public Health Dentistry 2010;70(3): 220–6.

Awadia A, Birkeland J, Haugejorden O, Bjorvatn K. Caries experience and caries predictors - a study of Tanzanian children consuming drinking water with different fluoride concentrations. Clinical Oral Investigations 2002;6(2):98–103.

Beltrán-Aguilar ED, Griffin SO, Lockwood SA. Prevalence and trends in enamel fluorosis in the United States from the 1930s to the 1980s. Journal of the American Dental Association 2002;133;157–65.

Chandrashekar J, Anuradha KP. Prevalence of dental fluorosis in rural areas of Davangere, India. International Dental Journal 2004;54:235–9.

Ekanayake L, Van Der Hoek W. Dental caries and developmental defects of enamel in relation to fluoride levels in drinking water in an arid area of Sri Lanka. Caries Research 2002;36(6):398–404.

Ermiş RB, Koray F, Akdeniz BG. Dental caries and fluorosis in low- and high-fluoride areas in Turkey. Quintessence International 2003;34(5):354–60.

Franzolin SdeO, Gonçalves A, Padovani CR, Francischone LA, Marta SN. Epidemiology of fluorosis and dental caries according to different types of water supplies. Ciencia Saude Coletiva 2010;15 Suppl 1: 1841–7.

Gray MM, Davies-Slowik J. Changes in the percentage of 5-year-old children with no experience of decay in Dudley towns since the implementation of fluoridation schemes in 1987. British Dental Journal 2001;190:30–2.

Grobleri SR, Louw AJ, van Kotze TJ. Dental fluorosis and caries experience in relation to three different drinking water fluoride levels in South Africa. International Journal of Paediatric Dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children 2001;11(5): 372–9.

Harding MA, Whelton H, O'Mullane DM, Cronin M, Warren JJ. Primary tooth fluorosis in 5-year-old schoolchildren in Ireland. European Journal of Paediatric Dentistry Official Journal of European Academy of Paediatric Dentistry 2005;6:155–61.

Indermitte E, Saava A, Karro E. Exposure to high fluoride drinking water and risk of dental fluorosis in Estonia. International Journal of Environmental Research and Public Health 2009;6:710–21.

Kanagaratnam S, Schluter P, Durward C, Mahood R, Mackay T. Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand. Community Dentistry and Oral Epidemiology 2009;37(3):250–9.

Machiulskiene V, Baelum V, Fejerskov O, Nyvad B. Prevalence and extent of dental caries, dental fluorosis, and developmental enamel defects in Lithuanian teenage populations with different fluoride exposures. European Journal of Oral Sciences 2009;117(2):154–60.

Macpherson LMD, Conway DI, Gilmour WH, Petersson LG, Stephen KW. Photographic assessment of fluorosis in children from naturally fluoridated Kungsbacka and non-fluoridated Halmstad, Sweden. Acta Odontologica Scandinavica 2007;65:149–55.

Maupomé G, Clark DC, Levy SM, Berkowitz J. Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 2001;29(1):37–47.

McGrady MG, Ellwood RP, Srisilapanan P, Korwanich N, Worthington HV, Pretty IA. Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 1: assessing fluorosis risk, predictors of fluorosis and the potential role of food preparation. BMC Oral Health 2012;12(1):16.

Narbutaité J, Vehkalahti MM, Milciuviené S. Dental fluorosis and dental caries among 12-yr-old children from high- and low-fluoride areas in Lithuania. European Journal of Oral Sciences 2007;115(2): 137–42.

Peres MA, Antunes JLF, Peres KG. Is water fluoridation effective in reducing inequalities in dental caries distribution in developing countries? Recent findings from Brazil. Sozial und Praventivmedizin 2006;51:302–10.

Pontigo-Loyola AP, Islas-Márquez A, Loyola-Rodríguez JP, Maupome G, Marquez-Corona ML, Medina-Solis CE. Dental fluorosis in 12- and 15-year-olds at high altitudes in above-optimal fluoridated communities in Mexico. Journal of Public Health Dentistry 2008;68(3):163–6.

Riordan PJ. Dental fluorosis decline after changes to supplement and toothpaste regimens. Community Dentistry and Oral Epidemiology 2002;30(3):233–40.

Ruan JP, Yang ZQ, Wang ZL, Astrøm AN, Bårdsen A, Bjorvatn K. Dental fluorosis and dental caries in permanent teeth: rural schoolchildren in high-fluoride areas in the Shaanxi province, China. Acta Odontologica Scandinavica 2005;63:258–65.

Stephen KW, Macpherson LM, Harper Gilmour W, Stuart RA, Merrett MC. A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland. Community Dentistry and Oral Epidemiology 2002;30(1):70–9.

Sudhir KM, Prashant GM, Subba Reddy VV, Mohandas U, Chandu GN. Prevalence and severity of dental fluorosis among 13- to 15-year-old school children of an area known for endemic fluorosis: Nalgonda district of Andhra Pradesh. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2009; 27(4):190–6.

Tabari ED, Ellwood R, Rugg-Gunn AJ, Evans DJ, Davies RM. Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy. Br Dent J 2000; 189(4):216–20.

Warren JJ, Levy SM, Kanellis MJ. Prevalence of dental fluorosis in the primary dentition. Journal of Public Health Dentistry 2001;61(2):87–91.

Whelton H, Crowley E, O'Mullane D, Donaldson M, Kelleher V, Cronin M. Dental caries and enamel fluorosis among the fluoridated and non-fluoridated populations in the Republic of Ireland in 2002. Community Dental Health 2004;21(1):37–44.

Whelton H, Crowley E, O'Mullane D, Donaldson M, Cronin M, Kelleher V. Dental caries and enamel fluorosis among the fluoridated and non-fluoridated populations in the Republic of Ireland in 2002. Community Dental Health 2006;21(1),37–44.