Benefits

Since community water fluoridation began in 1945, it has been demonstrated to be a safe and cost-effective way to prevent tooth decay. Fluoridation protects teeth in two ways:

• When delivered through the water supply to children during the tooth forming years.
• Through direct contact with teeth throughout life.

From this page you will be able to review more detailed information on the following topics in community water fluoridation:

• Background on the history of community water fluoridation
• Selected reports and journal articles that demonstrate the benefits of community water fluoridation
• Cost effectiveness analyses of the economic factors in community water fluoridation
• Systematic and evidence-based reviews done in the United States and other countries that critically examine the body of scientific evidence to make recommendations on the benefits of community water fluoridation

Surgeons General Statements on Community Water Fluoridation
The past five Surgeons General supported community water fluoridation and encouraged communities to fluoridate their water. Here are the most recent three statements.

• 2004, Richard H. Carmona, MD, MPH, FACS, VADM, USPHS
   
• 2001, David Satcher, MD, PhD
   
• 1995, Audrey F. Manley, MD, MPH

Provides general information on the history and benefits of community water fluoridation.

Background on Water Fluoridation
An overview and history of community water fluoridation.

The Benefits of Fluoride
The key benefits of community water fluoridation.

The Halo Effect: Quantifying the diffused benefit from water fluoridation in the United States
Griffin SO, Gooch BF, Lockwood SA, Tomar SL. Community Dent Oral Epidemiol 2001;29:120–129.
Demonstrates the total contribution of water fluoridation, not just to fluoridated communities but to surrounding nonfluoridated communities as well. This article helps to:

• Explain the reason for the decrease in measurable effectiveness of fluoridation efforts over time.
• Explain that rates of dental disease between fluoridated and nonfluoridated communities underestimate the effectiveness of community water fluoridation because nonfluoridated communities are receiving benefits from neighboring fluoridated communities.
• Quantify the diffused benefit of community water fluoridation.
• Explain increases in dental decay if fluoridation is discontinued by taking into account the diffusion effect.

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The following selected reports and journal articles provide more detailed evidence supporting the benefits of community water fluoridation (see also Systematic Reviews).

Oral Health in America: A Report of the Surgeon General
Chapter 7 presents the evidence for community water fluoridation for prevention of tooth decay.

Achievements in Public Health 1900–1999—Fluoridation of Drinking Water to Prevent Dental Caries
MMWR, October 22, 1999;48(41);933–940.
Recognizes community water fluoridation as one of the 10 great public health achievements of the 20th century, provides a brief history of water fluoridation, and describes the historical decline in tooth decay.

Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride* (PDF 126KB)
Describes the dietary reference intakes for specific nutrients known to be beneficial to health, including fluoride. As is the case with all nutrients, there are recommendations for both adequate intake and tolerable intake levels. This report addresses both benefits and safety.

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Includes general information on the cost effectiveness of community water fluoridation and a review of the cost difference in pediatric dental treatment for fluoridated and nonfluoridated communities in Louisiana.

An Economic Evaluation of Community Water Fluoridation. (PDF 1.0Mb)
Griffin SO, Jones K, Tomar SL. J Publ Health Dent 2001;61(2):78–86. An analysis of the most current data available on the effectiveness and costs of water fluoridation.  The study compares average per person cost of community water fluoridation with the cost of prevented disease.  This study:

• Demonstrates that fluoridation not only is cost-effective, but also is cost saving, which is rare for public health interventions.
• Shows that the reduction in costs of fillings (dental restorations) greatly exceeds the cost of water fluoridation in communities of any size.
• Illustrates the annual per person water fluoridation costs for communities of various sizes.
• Determines an average cost savings, which ranges from $15.95 per person per year in a small community to $18.62 per person per year in a larger community.

Cost Savings of Community Water Fluoridation
Studies continue to show that widespread community water fluoridation prevents cavities and saves money, both for families and the health care system.

Water Fluoridation and Costs of Medicaid Treatment for Dental Decay—Louisiana, 1995–1996
MMWR, September 3, 1999;48(34):753–757.
Findings suggest that Medicaid-eligible children in communities without community water fluoridation had an increased cost for dental treatment per child that was twice as high as those children living in fluoridated communities.

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Comprehensive reviews on the science available to determine the benefits and effectiveness of community water fluoridation.

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR, August 17, 2001;50(RR–14):1–42. Also available as a PDF file (PDF 373K).
Provides guidance to health care providers, public health officials, policymakers, and the general public on how to achieve maximum protection against tooth decay while using dental care resources efficiently and minimizing any cosmetic concerns.

Reviews of Evidence on Interventions to Prevent Dental Caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries*
From the Task Force on Community Preventive Services, provides information on the studies used in the evidence review on community water fluoridation, the suitability of the study designs, and quality of the evidence used to determine the magnitude of effectiveness of community water fluoridation.

Summary Report
Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries
MMWR, November 30, 2001;50(RR21);1–13.
Reinforces the evidence-based prevention activities of community water fluoridation and school-based or school–linked dental sealant programs.

A Systematic Review of Public Water Fluoridation *
Done by the University of York in the United Kingdom, this is a systematic review of the best available evidence on positive and negative effects of community water fluoridation.

Review of Fluoride: Benefits and Risks
Comprehensive review and evaluation of the public health benefits and risks of fluoride from drinking water and other sources by the U.S. Public Health Service.

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One or more documents on this Web page is available in Portable Document Format (PDF). You will need Acrobat Reader to view and print these documents.

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

Date last reviewed: September 26, 2007
Date last updated: August 9, 2007
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion