Cost Savings of Community Water Fluoridation

Community water fluoridation is recognized as one of the most cost-effective, equitable, and safe measures communities can take to prevent cavities and improve oral health. That’s why it was named 1 of 10 great public health achievements of the 20th century.1

Various methods may be utilized for determining costs and benefits of community water fluoridation. Newer studies have been able to make use of actual costs from water systems rather than relying primarily on expert estimates. The fact that multiple studies using different methods reach the same conclusion increases confidence in the general finding that community water fluoridation can be cost saving for communities.

Economic Impact

Economic evaluations reaffirm the cost benefits of community water fluoridation. Studies continue to show that widespread community water fluoridation prevents cavities and saves money, both for families and the health care system.

An economic review of multiple studies found that savings for communities ranged from $1.10 to $135 for every $1 invested.2 Per capita annual costs for community water fluoridation ranged from $0.11 to $24.38, while per capita annual benefits ranged from $5.49 to $93.19.

A recent 2016 economic analysis found that for communities of 1,000 or more people, the savings associated with water fluoridation exceeded estimated program costs, with an average annual savings of $20 per dollar invested.3 Additionally, individuals in communities that fluoridate water save an average of $32 per person by avoiding treatment for dental caries.Nationwide, this same study found, community water fluoridation programs have been estimated to provide nearly $6.5 billion dollars a year in net cost savings by averting direct dental treatment costs (tooth restorations and extractions) and indirect costs (losses of productivity and follow-up treatment).3

The 2016 study, “Costs and Savings Associated with Community Water Fluoridation in the United States,” used documented program costs to determine:
• The costs of installing and maintaining necessary equipment and operating water plants;
• the expected effectiveness of fluoridation; estimates of expected cavities in non-fluoridated communities;
• direct and indirect costs of treating cavities; and
• time lost visiting the dentist for initial and follow-up treatment over a lifetime to maintain a treated tooth.

Consistent with prior analyses, this study supports the finding that community water fluoridation remains one of the most cost-effective methods of delivering fluoride to all community members regardless of age, educational attainment, or income level.

Halo Effect

In addition to providing an oral health benefit for people with access to fluoridated water, a related analysis found that children living in communities that do not adjust fluoride may still receive partial benefits of fluoridation from eating foods and drinking beverages processed in fluoridated communities. The study, “Quantifying the Diffused Benefit from Water Fluoridation,” examined the differences in tooth decay rates in 12-year-old children who live in states where at least 50% of the communities have fluoridated water and those in states where less than 25% of communities practice fluoridation.4
The study found that the children residing in the higher fluoridated states experienced less decay each year than children who live in states where water fluoridation is less common.4
“Widespread community water fluoridation prevents cavities even in neighboring communities that are not fluoridated,” according to Dr. Susan Griffin, the study’s main author. “For instance, a 12-year-old child who has lived in a non-fluoridated community in a state with a higher proportion of fluoridated water systems would typically have one fewer cavity than a child in a low-fluoridated state.”


Tooth decay contributes to reduced quality of life and increased need for costly restorative dental care.5 People who consume fluoridated water experience fewer and less severe cavities, resulting in a reduced need for fillings and removing or replacing teeth, and less time taken off from school or work because of dental problems or pain.1,5-7 Water fluoridation benefits all members of a community by preventing tooth decay, improving oral health and saving money for everyone.


1. Centers for Disease Control and Prevention. Achievements in public health, 1900-1999: fluoridation of drinking water to prevent dental caries. MMWR. 1999;48(41):933-940. View report
2. Ran, T., S.K. Chattopadhyay, and Community Preventive Services Task Force, Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review. Am J Prev Med, 2016. 50(6): p. 790-6. View abstract on PubMedexternal icon
3. O’Connell JM, Rockwell J, Ouellet J, Tomar SL, Maas W. Costs and Savings Associated with Community Water Fluoridation in the United States. Health Affairs. 2016. 1;35(12):2224-2232. View abstract on PubMed external icon
4. Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. J Publ Health Dent 2001;61(2):78–86. View abstract on PubMedexternal icon
5. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. View Reportexternal icon
6. Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J Dent Res. 2007;86:410-415. View abstract on PubMedexternal icon
7. Guarnizo-Herreno CC, Wehby GL. Children’s dental health, school performance, and psychosocial well-being. J Pediatr. 2012;161:1153-9. View abstract on PubMedexternal icon