After 60 Years of Success in Fighting Dental Decay, Water Fluoridation is Still Lacking in Many Communities

American Dental Association, Centers for Disease Control and Prevention Encourage Communities to Adopt Single-Most Effective Tooth-Decay Fighter

Even 60 years after the introducing community water fluoridation—one of the great public health successes of the 20th Century—about one third of Americans still don’t have access to this most economical method of fighting dental disease.

“It’s dismaying that so many communities have failed their residents in this fashion,” said ADA President Richard Haught, DDS. “Community water fluoridation benefits everyone, including those people who, tragically, lack access to appropriate dental care.”

Single most effective public health measure to prevent tooth decay

“Community water fluoridation is the single most effective public health measure to prevent dental decay and improve oral health over a lifetime for both children and adults,” says former U.S. Surgeon General Dr. Richard H. Carmona. “I join previous Surgeons General in acknowledging the continuing public health role for community water fluoridation in enhancing the oral health of all Americans.”

As the ADA and Centers for Disease Control and Prevention encourage communities to adopt water fluoridation, they will commemorate the 60th anniversary of this important public health measure in Chicago. The commemoration includes opening ceremonies at Millennium Park on July 13 and scientific and policy sessions at ADA headquarters on July 14 and 15.

“Studies prove water fluoridation continues to be effective in reducing dental decay by 20 to 40 percent,” says ADA president Dr. Haught. “This is true even in an era where there is widespread availability of fluoride from other sources, such as fluoride toothpaste.”

“Because it reaches all people in a community regardless of education or income level, it is a powerful strategy in our efforts to eliminate differences in oral health among our citizens,” explains William R. Maas, D.D.S., M.P.H., director, CDC Division of Oral Health.

How fluoride works to prevent decay

Tooth decay is an infectious and transmissible bacterial disease. When a person eats sugar, or other refined carbohydrates, some oral bacteria produce acid that removes minerals from the surface of the tooth, a process known as demineralization. If the demineralization process continues for a period of time, it leads to a cavity. Fluoridation helps reverse the demineralization process, preventing the cavity.

Water Fluoridation Initiated in 1945

In 1945, Grand Rapids, Mich., became the first community to adjust the fluoride content in the public water system to the level effective for preventing tooth decay. Since then, some 170 million Americans, including residents of 44 of the nation’s 50 largest cities, have benefited from optimally fluoridated water.

Supports expansion of community water fluoridation
The CDC Division of Oral Health supports expanding community water fluoridation throughout the nation by providing technical assistance to state water programs on fluoridation implementation and practices. The CDC monitors the extent and quality of fluoridation through the Water Fluoridation Reporting System, which also provides the public with information on the level of fluoride in water systems. This information is available on the My Water’s Fluoride Web site, which allows consumers in 31 participating states and two Native American tribes to obtain basic information about their water system, including the number of people served by the system and the target fluoridation level (http://apps.nccd.cdc.gov/MWF/Index.asp).

The nonprofit ADA is the nation's largest dental association, representing more than 152,000 members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer and professional products. For more information about the ADA, visit the Association's Web site at www.ada.org.*
 

Key Facts About Community Water Fluoridation

• Water fluoridation is the addition of fluoride to adjust the natural concentration of a community’s water supply to the level recommended by the U.S. Public Health Service for optimal dental health—0.7 to 1.2 parts per million (equivalent to about 1 inch in 16 miles or 1 cent in $10,000).
   
• Dental caries, commonly known as tooth decay or cavities, is an infectious multifactorial disease in which acid from bacteria dissolve the enamel of a tooth. This often results in pain and loss of tooth structure. Fluoride works by facilitating remineralization of the tooth’s enamel, keeping the tooth strong by preventing the loss of minerals from the enamel as well as by enhancing the re-uptake of minerals into the tooth.¹
   
• Fluoridation of the public water supply was first instituted on January 25, 1945, in Grand Rapids, Michigan. Studies in eight communities (four implemented fluoridation and four did not) comparing rates of tooth decay documented persuasive evidence of its effectiveness in decreasing tooth decay in children. As a result, other U.S. cities rapidly adopted this preventive intervention.^2-5
   
• A recent review by the U.S. Task Force on Community Preventive Services strongly recommended community water fluoridation . For the many studies reviewed, there was a median 29% reduction of decay among children and adolescents. ⁶
   
• Community water fluoridation benefits everyone, especially those without access to regular dental care. It is the most efficient way to prevent one of the most common childhood diseases – tooth decay (5 times as common as asthma and 7 times as common as hay fever in 5-to-17-year-olds). Without fluoridation, there would be many more than the estimated 51 million school hours lost per year in this country because of dental-related illness. ⁷
   
• Currently, 67% of Americans on public water systems receive optimally fluoridated water.⁸
   
• Fluoridation is cost effective. For most U.S. communities, every dollar spent on community water fluoridation results in a savings of $38 in costs to repair (fill) a decayed tooth. ⁹

References

1. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR, August 17, 2001; 50(RR-14):1–42.
2. Blaney JR, Tucker WH. The Evanston Dental Caries Study. II. Purpose and mechanism of the study. Journal of Dental Research, 1948;27:279–286.
3. Ast DB, Finn SB, McCaffrey I. The Newburgh-Kingston Caries Fluorine Study. I. Dental findings after three years of water fluoridation. American Journal of Public Health, 1950;40:716–724.
4. Dean HT, Arnold FA, Jay P, Knutson JW. Studies on mass control of dental caries through fluoridation of the public water supply. Public Health Reports 1950;65:1403–1408.
5. Hutton WL, Linscott BW, Williams, DB. The Brantford fluorine experiment: Interim report after five years of water fluoridation. Canadian Journal of Public Health 1951;42:81–87.
6. Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-related Craniofacial Injuries: A Report on the Recommendations of the Task Force on Community Preventive Services. MMWR, November 30, 2001;50(RR-21):1–13.)
7. Gift HC. 1997. Oral health outcomes research: Challenges and opportunities. In Slade GD, ed., Measuring Oral Health and Quality of Life (pp. 25–46). Chapel Hill, NC: Department of Dental Ecology, University of North Carolina.
8. CDC Water Fluoridation Reporting System, 2002. Available at http://apps.nccd.cdc.gov/nohss/FluoridationV.asp.
9. Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. Journal of Public Health Dentistry 2001;61(2):78–86.

* 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.

Historical Document
Page last reviewed: March 30, 2009
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion