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1. What do we know about fluoride and fluoridation?

• Fluoride exists naturally in nearly all water supplies. Water is “fluoridated” when a public water system adjusts the fluoride to a level that is optimal for preventing tooth decay.
• About 75 percent of Americans whose homes are connected to public water systems receive fluoridated water. However, more than 72 million Americans do not have access to drinking water that is fluoridated to prevent decay.

2. Does fluoridated water prevent tooth decay?

• Yes. Research proves that fluoridation reduces tooth decay by about 25 percent. As the rate of fluoridation steadily increased in the U.S., the average number of decayed, filled or missing teeth among 12-year-olds fell 68 percent between 1966 and 1994.
• The evidence supporting fluoridated water’s effectiveness has been building for decades—and recent studies strengthen earlier findings:
  • A New York study (2010) revealed that low-income children in less fluoridated counties needed 33 percent more fillings, root canals, and extractions than those in counties where fluoridated water was common.
  • A study of Alaskan children (2011) showed that kids living in non-fluoridated areas had a 32 percent higher rate of decayed, missing or filled teeth than kids in fluoridated communities.
  • A Nevada study (2010) examined teenagers’ oral health and found that living in a community without fluoridated water was one of the top three factors associated with high rates of decay and other dental problems.
  • A study of Illinois communities (1995) reviewed changes in decay rates during the 1980’s. This study concluded that water fluoridation was “the dominant factor” in the decline of cavities.
  • Teenagers living in non-fluoridated areas of Ireland had an average rate of decay or related dental problems that was 52 percent higher than those living in fluoridated communities.

• Research demonstrates the long-term benefits of fluoridation. A 2010 study confirmed that the fluoridated water consumed as a young child makes the loss of teeth (due to decay) less likely 40 or 50 years later when that child is a middle-aged adult. The coauthors wrote that this study “suggests that the benefits of [fluoridation] may be larger than previously believed and that [fluoridation] has a lasting improvement in racial/ethnic and economic disparities in oral health.”

3. Decay is more of a problem for low-income people. Does fluoridated water help address this gap in oral health?

• Yes, it does. Fluoridation reduces the disparities in tooth decay rates that exist by race, ethnicity and income.
• A 2002 study called water fluoridation “the most effective and practical method” for reducing the gap in decay rates between low-income and upper-income Americans. The study concluded, “There is no practical alternative to water fluoridation for reducing these disparities in the United States.”

4. Does fluoridation also benefit adults or only children?

• Tooth decay is a health problem throughout one’s lifespan. Nearly all (96 percent) of middle-aged adults have had tooth decay and the rate of new decay per year is at least as high for adults as it is for children.
• Fluoridation benefits people of all ages. A 2007 report examined 20 studies to estimate fluoride’s impact on adult teeth, and the report concluded that fluoridated water reduced decay by 27 percent.
• Seniors benefit from fluoridation, partly because it helps prevent decay on the exposed root surfaces of teeth—a condition that especially affects older adults.

5. Is fluoridated water still needed?

• Yes. Fluoridation remains critically important. Tooth decay is widespread, affecting more than 90 percent of Americans by the time they reach their adult years.
• At a time when more than 100 million Americans lack dental insurance, fluoridation offers an easy, inexpensive preventive strategy that everyone benefits from simply by turning on their tap.
• Although Americans’ dental health has improved considerably in recent decades, tooth decay and other oral health issues remain a challenge. A 2010 study revealed that nearly one out of seven children aged 6 to 12 years had suffered a toothache over the previous six months.
• Even the U.S. armed forces recognize the need for fluoridated water. A senior official with the Department of Defense called tooth decay “a major problem for military personnel” and notes that fluoridation will “directly reduce their risk for dental decay and improve [military] readiness.” Most military bases have provided fluoridated water for decades.
• Fluoridated water is also the most inexpensive way to provide fluoride. The per-person annual cost of fluoride rinse programs is roughly double the cost of fluoridated water. The per-person annual cost of fluoride supplements is more than 70 times higher than fluoridated water. Fluoride varnishes or gels also cost more than providing fluoridated water.