Community water fluoridation

Communities that fluoridate water adjust and monitor fluoride in public water supplies to reach optimal fluoride concentrations. As of 2015, the US Public Health Service (US PHS) recommends that community drinking water contain .7 ppm of fluoride, down from the  previous standard, a range of .7 to 1.2 ppm, set in 1962 (US PHS-Fluoride, ). This change accounts for other sources of fluoride (e.g., toothpaste) and was intended to avoid the unwanted health effects of excessive fluoride (US PHS-Fluoride, EPA-Fluoride 2011).

Expected Beneficial Outcomes (Rated)

  • Reduced cavities

Evidence of Effectiveness

There is strong evidence that community water fluoridation (CWF) cost-effectively prevents cavities (CG-Oral health, , , CDC-Fluoridation, US PHS-Fluoride) across socio-economic groups (CG-Oral health). Effects are strongest in low income communities (), and in communities with poor oral hygiene and limited access to oral health care ().

CWF reduces cavities in children’s baby teeth and permanent teeth (). High fluoride intake can increase the risk of mild tooth staining from dental fluorosis (CG-Oral health, ), especially for infants who drink formula instead of breast milk (, CDC-Fluoridation). Additional study is needed to determine other potential adverse effects of excessive fluoride exposure (CG-Oral health, , Peckham 2014).

As of 2013, fluoridation cost an average of 11 cents per person in large US communities and $4.92 per person in very small communities (less than 1000); cost savings range from $29.23 to $73.50 per person in averted dental treatment and productivity losses (, CG-Oral health). 

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of 2012, 74% of Americans live in communities that fluoridate their water (CDC-Fluoridation).

Implementation Resources

CDC-Fluoridation - Centers for Disease Control and Prevention (CDC). Community water fluoridation.

CDC-CWF Resources - Centers for Disease Control and Prevention (CDC). Community water fluoridation (CWF): Resources for public health partners and professionals.

ADA-Fluoridation - American Dental Association (ADA). Mouth Healthy: Fluoridation information.

Pew-CWF - The Pew Charitable Trusts (Pew). Promoting community water fluoridation (CWF). 2015.

Citations - Evidence

* Journal subscription may be required for access.

Truman 2002* - 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. American Journal of Preventive Medicine. 2002;23(1 Suppl 1):21–54.

Pizzo 2007* - Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: A critical review. Clinical Oral Investigations. 2007;11(3):189–93.

Prystupa 2011* - Prystupa J. Fluorine - A current literature review. An NRC and ATSDR based review of safety standards for exposure to fluorine and fluorides. Toxicology Mechanisms and Methods. 2011;21(2):103–70.

CDC-Fluoridation - Centers for Disease Control and Prevention (CDC). Community water fluoridation.

Whelton 2004* - Whelton HP, Ketley CE, McSweeney F, O’Mullane DM. A review of fluorosis in the European Union: Prevalence, risk factors and aesthetic issues. Community Dentistry and Oral Epidemiology. 2004;32(Suppl 1):9–18.

Burt 2002* - Burt BA. Fluoridation and social equity. Journal of Public Health Dentistry. 2002;62(4):195–200.

Ran 2016* - Ran T, Chattopadhyay SK, Community Preventive Services Task Force. Economic evaluation of community water fluoridation: A community guide systematic review. American Journal of Preventive Medicine. 2016.

US PHS-Fluoride - US Department of Health and Human Services (US DHHS) Federal Panel on Community Water Fluoridation. US public health service (US PHS) recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Reports. 2015;130(4):318-331.

Cochrane Iheozor-Ejiofor 2015* - Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews. 2015;(6):CD010856.

Peckham 2014 - Peckham S, Awofeso N. Water fluoridation: A critical review of the physiological effects of ingested fluoride as a public health intervention. The Scientific World Journal. 2014;2014:293019

CG-Oral health - The Guide to Community Preventive Services (The Community Guide). Oral health.

Citations - Implementation Examples

* Journal subscription may be required for access.

CDC-Fluoridation - Centers for Disease Control and Prevention (CDC). Community water fluoridation.

Date Last Updated

May 2, 2016