New Fluoride Technology Supports Rural Health

Gloved hand holding tablet of fluoride

This new tablet technology gives more than 32,000 small US public water systems, as well as systems worldwide, the option of providing fluoridated water and its oral health benefits to their communities.

New technology could bring fluoridated water to about 19 million people in the United States.

March 20 is World Oral Health Day. Oral health is critical to overall health, and oral diseases cause serious pain and infections that may lead to problems eating, speaking, and learning. More than 3.5 billion people suffer from oral diseases globally, according to the World Health Organization. The most common are untreated cavities, affecting an estimated 2.3 billion people, and gum disease—a major cause of total tooth loss—affecting 267 million people.

Drinking fluoridated water can prevent cavities and reduce their severity. To help reach rural areas that may not be able to fluoridate, CDC supported the development of a new tablet delivery system that could fluoridate nearly 32,000 small systems in the United States, bringing fluoridated water to about 19 million people.

Oral Disease Highlights Inequities

Differences in access to dental care and preventive services lead to higher rates of oral diseases in some populations. In the United States, people from low-income households are 2 to 3 times more likely to have untreated cavities than those from higher-income households.

Public health interventions such as community water fluoridation have greatly improved oral health outcomes for over 75 years. Drinking fluoridated water keeps teeth strong, reducing cavities by about 25% in children and adults. By preventing cavities, community water fluoridation saves money for both families and the US health care system. It is the most cost-effective way to deliver fluoride to people of all ages, education levels, and income levels in a community.

About 35% of people in the United States and most people around the world do not have access to properly fluoridated water. Some homes are not served by a public water system, and some public water systems lack the resources to fluoridate their water cost-effectively. Conventional fluoridation technology rarely serves communities with fewer than 1,000 people, and fluoridation becomes more expensive as service populations fall below 5,000. Nearly 19 million people in the United States are served by these small systems—often in rural areas with less access to high-quality health care.

New technology: three clear plastic columns hold fluoridated water for rural communities

Assembled water fluoridation tablet feeder system ready for installation.

CDC Identifies Need for New Technology to Reach Rural Areas 

The Centers for Disease Control and Prevention (CDC) has long recognized the need for a method that allows these smaller systems to optimally fluoridateexternal icon water. CDC theorized that fluoridation systems could use tablets like those already widely used in other low-volume water treatment applications, such as swimming pool chlorination.

To test this idea, CDC announced a Small Business Innovation Research (SBIR) funding opportunity in 2013 to develop a pill or tablet that small water systems could use to fluoridate water. Through a competitive, objective process, KC Industries (KCI) of Mulberry, Florida, received a CDC Phase I SBIR award in 2014 to study whether smaller public water systems could use compressed tablets of sodium fluorosilicate to fluoridate public water systems. They found that the concept would work, but the equipment currently used to add fluoride to water would not. A new feeder system would need to be created.

After competing for Phase 2 funding, KCI created a low-cost tablet and feeder system for systems that serve 50 to 10,000 people, filling a large gap. Throughout its development, health departments across the United States and abroad expressed interest in adopting this system to bring the benefits of fluoridated water to their communities.

A New Tablet System Can Help Communities Reach Fluoridation Goals

Girl drinking from water fountain in the park

Drinking fluoridated water keeps teeth strong and reduces cavities, resulting in less pain, fewer fillings or teeth pulled, and fewer missed days of work and school. However, more than 34,000 community water systems do not currently provide optimally fluoridated water. Of these, an estimated 32,000 are small systems, serving about 19 million people. This new tablet system could allow these small public utilities to contribute to the Healthy People 2030 goalexternal icon of providing 77.1% of the US population with access to fluoridated water.