Publication Date: 
Wednesday, July 31, 2019

The Problem: Tooth decay, also known as dental caries, remains a major public health problem. Though largely preventable, it is the most common chronic disease for kids aged 6 to 11 years old and teens aged 12-19 years old. . CDC Dental Caries Fact Sheet. Advanced tooth decay can cause significant pain and loss of the teeth, and can be costly to treat. CDC: Oral Health: At a Glance: 2009.

The Law: State and local laws authorize or require community water fluoridation (CWF). Fluoride is a mineral that has been proven effective at preventing tooth decaCy. The American Dental Association and the Centers for Disease Control have endorsed water fluoridation as safe, cost effective and beneficial to the entire community.  CDC & ADA: Nature’s Way to Prevent Tooth Decay: Water Fluoridation. Yet, fluoridation remains controversial.  For an example of a state law authorizing CWF, see 111 MGL 8c (Massachusetts). For an example of a state law requiring CWF, see Minnesota Statutes § 144.145 (Minnesota).

The Evidence: A Community Guide Task Force systematically reviewed 21 studies assessing the effectiveness of CWF in reducing the incidence of tooth decay. Task Force on Community Preventive Services. Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev Med 2002;23(1S):16-20. The publication dates of the studies ranged from 1956 to 2000 and covered a wide range of geographic locations, including the UK, the Netherlands, Finland, Japan, and Australia. The studies examined children ranging from age 4-17 years old, were longitudinal in design, and controlled for access to dental care and dentist-to-patient ratios, socio-economic status, and total number of persons living in an area, among other factors. Based on the underlying studies, the Community Guide reviewers observed that starting or continuing CWF is effective in reducing dental caries by as much as 30-50 percent in both the primary and permanent teeth of children. Discontinuing CWF in regions where other sources of fluoride are insufficient, the reviewed observed, results in an increase in dental caries.

The Bottom Line: In the judgment of a Community Guide expert panel, there is significant evidence to support water fluoridation as an effective public health intervention aimed at reducing tooth decay.

Additional Information: The Centers for Disease Control provide online access to information on community water fluoridation.

Additional Resources: Centers for Disease Control and Prevention

Impact: Effective