Dental Caries - Fact Sheets - Community Water Fluoridation

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Department of Health and Human Services
Centers for Disease Control and Prevention

Using Fluoride to Prevent and Control Tooth Decay in the United States

Although there have been notable declines in tooth decay among children and adults over the past three decades, tooth decay remains the most common chronic disease of children aged 6 to 11 years (25%), and of adolescents aged 12 to 19 years (59%). Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15%).

This summary guidance explains how to achieve protection from tooth decay throughout life, while reducing the chances of developing dental fluorosis. Dental fluorosis is a change in the appearance of the tooth surface and most commonly appears as barely noticeable white spots. Dental fluorosis can only develop during the time that the teeth are forming under the gums—generally from birth through age 8.

Drink tap water with optimal amounts of fluoride. Water fluoridation has been accepted as a safe, effective, and inexpensive method of preventing tooth decay. Adding fluoride to municipal drinking water is an efficient strategy to reduce dental disease among Americans of all social strata. It is the most cost-effective way to prevent tooth decay among populations living in areas with adequate community water supply systems.

To find out more about the fluoride level in your drinking (tap) water—

If you are on a community water system, call your water utility company and request a copy of the utility’s most recent Consumer Confidence Report.

If you live in a state that participates in CDC’s My Water's Fluoride, you can go online and find information on your water system’s fluoridation status.

Brush at least twice daily with fluoride toothpaste. Daily and frequent exposure to small amounts of fluoride best reduces tooth decay for all age groups. Drink water with optimal levels of fluoride and brush at least twice a day with fluoride toothpaste—preferably after each meal.

If you have children younger than 2 years, do not use fluoride toothpaste unless advised to do so by your doctor or dentist. You should clean your child’s teeth every day as soon as the first tooth appears by brushing without toothpaste with a small, soft-bristled toothbrush and plain water.

If you have children younger than 6 years, supervise their tooth brushing. For children aged 2 to 6 years, apply no more than a pea-sized amount of fluoride toothpaste to the brush and supervise their tooth brushing, encouraging the child spit out the toothpaste rather than swallow it. Up to about age 6, children have poor control of their swallowing reflex and frequently swallow most of the toothpaste placed on their brush.

Use prescription fluoride supplements and high concentration fluoride products wisely. Fluoride supplements may be prescribed by your dentist or physician if your child is at high risk for decay, and lives in a community with a low fluoride concentration in their drinking water. If the child is younger than 6 years, however, then the dentist or physician should weigh the risks for developing decay without supplements with the possibility of developing dental fluorosis. Other sources of fluoride, especially drinking water, should be considered when determining this balance. High concentration fluoride products, such as professionally applied gels, foams, and varnishes, also may benefit children who are at high risk of decay.

Know some of the factors that can increase your child’s risk for tooth decay. These include the following:

Older brothers, sisters, or parents who have had decayed teeth.
Taking in a lot of sugary foods and drinks, like soda, especially between meals.
Not brushing teeth daily.
Not using a fluoride toothpaste if older than age 2.
Your usual source of drinking water has a very low fluoride content.
Presence of special health care needs.
No family dentist or regular source of dental care.
Wearing braces or orthodontic or oral appliances.