Fluoride & Your Water

Community Water Fluoridation: A Public Health Milestone and its Ongoing Debate

Community water fluoridation (CWF) is regarded as one of the greatest public health achievements of the 20th century. Introduced in the United States in 1945¹, it has significantly reduced dental caries (tooth decay) across populations by providing a safe and controlled level of fluoride in public water supplies.² Despite its proven benefits, CWF remains a topic of controversy in some communities, with debates and votes determining its future. As dental providers, we advocate for community water fluoridation as a key strategy in preventing tooth decay.

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The History and Science Behind CWF

The story of CWF began in the early 20th century when researchers noticed that people living in areas with naturally high fluoride concentrations had fewer cavities.³ In 1945, Grand Rapids, Michigan, became the first city to adjust its water fluoride levels to a concentration of 1.0 parts per million (ppm).¹ The success from this experiment led to the widespread adoption of fluoridation across the U.S. and eventually the world.

Over the years, studies have refined the recommended levels of fluoride. In 2015, the U.S. Public Health Service (USPHS) established 0.7 ppm as the optimal concentration for preventing tooth decay while minimizing the risk of dental fluorosis;^1,4 this amount is equivalent to roughly 3 drops in 55 gallons.²

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Maintaining Fluoride Levels

Water treatment facilities carefully monitor and adjust fluoride levels to ensure they remain at the recommended level of 0.7 ppm.⁵ In some regions, fluoride occurs naturally in higher concentrations than the recommended level. In these areas, fluoride levels are reduced to stay within a safe yet protective range.⁶

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Endorsements from Public Health Authorities

Community water fluoridation is endorsed by a multitude of reputable health organizations, including:

• Centers for Disease Control and Prevention (CDC) – Recognizing CWF as "one of the 10 great public health achievements of the 20th century."²
• American Dental Association (ADA) – Supporting CWF as a safe and effective method to reduce tooth decay.⁷
• American Academy of Pediatrics (AAP) – Recommending CWF for its ability to benefit children’s dental health.⁸

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Controversy and Public Debates

Despite strong scientific support, community water fluoridation remains controversial in some areas. Critics often cite concerns about individual choice, potential health effects, and misinformation about fluoride’s safety. State and local municipalities decide whether to implement fluoridation by voting; ² as a result, some municipalities have held votes to determine whether to continue fluoridating their water supply.

Recent discussions have also been influenced by misinformation campaigns on social media. However, extensive research continues to affirm that fluoride at recommended levels is safe and effective for preventing dental decay. Prominent dental associations like the American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD) continue to support community water fluoridation as a safe and effective way to prevent tooth decay. However, a recent court ruling from a District Judge is prompting the Environmental Protection Agency (EPA) to consider increased regulation, adding new layers to the discussion on fluoride’s role in public health.

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The Benefits of Fluoridation

Fluoridation benefits everyone, regardless of age, socioeconomic status, or access to dental care. It is an example of a public health strategy that promotes health equity by ensuring widespread protection against tooth decay. Studies show that fluoridated water reduces cavities by 25% among children and adults.^2,9,10 It’s a cost-effective measure, saving approximately $32 in dental treatment per person per year by preventing further dental treatments through cavity prevention.¹¹

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Resources for Further Reading

If you are interested in learning more about CWF, consider the following resources:

• CDC’s Community Water Fluoridation Page: CDC - Community Water Fluoridation
• American Dental Association (ADA): Fluoridation in Water | American Dental Association
• The Story of Fluoridation from National Institute of Dental and Craniofacial Research: The Story of Fluoridation | National Institute of Dental and Craniofacial Research

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Our Professional Recommendation

As dental providers, we stand by the science and endorse community water fluoridation as a proven, effective strategy to combat dental caries. The long history of fluoridation demonstrates its safety and efficacy, and it remains a cornerstone of preventative dental care.

Informed decision-making is crucial for public health policies. We encourage communities to rely on peer-reviewed science and expert recommendations when evaluating the future of water fluoridation.

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References

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1. CDC. Timeline for Community Water Fluoridation. Community Water Fluoridation. May 23, 2024. Accessed December 12, 2024.
2. CDC. About Community Water Fluoridation. Community Water Fluoridation. September 12, 2024. Accessed December 12, 2024.
3. The Story of Fluoridation | National Institute of Dental and Craniofacial Research. Accessed December 12, 2024.
4. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep. 2015;130(4):318-331.
5. CDC. Fluoridation Resources Online. Fluoridation Engineering and Operations. May 23, 2024. Accessed December 12, 2024.
6. ASTDD Fluorides Committee. Association of State and Territorial Dental Directors Fact Sheet Naturally Occurring Fluoride in Drinking Water.; 2016.
7. Fluoridation in Water. Accessed December 12, 2024.
8. Jenco M, Editor NC. AAP, ADA stand by fluoride recommendations following court ruling. Published online September 26, 2024. Accessed December 12, 2024.
9. Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J Dent Res. 2007;86(5):410-415. doi:10.1177/154405910708600504
10. Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2015;2015(6):CD010856. doi:10.1002/14651858.CD010856.pub2
11. O’Connell J, Rockell J, Ouellet J, Tomar SL, Maas W. Costs And Savings Associated With Community Water Fluoridation In The United States. Health Aff (Millwood). 2016;35(12):2224-2232. doi:10.1377/hlthaff.2016.0881

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Related topics: dental fluorosis, cavity prevention strategies, other forms of fluoride relating to dental health