Water Fluoridation

by CDC

August 2005 - Tooth decay, also known as dental caries, is a health problem that has plagued humankind for centuries. Until as recently as 60 years ago, the damage caused by caries was an inevitable fact of life for most people. The disease often meant many visits to the dentist to have damage and painful teeth repaired or removed. Today, primarily as a result of fluoride, damage caused by decay can be reduced and, in many instances, prevented.

Fluoride's benefits for teeth were discovered in the 1930s. Dental scientists observed remarkably low decay rates among people whose water supplies contained significant amounts of natural fluoride. Several studies conducted during the 1940s and 1950s confirmed that when a small amount of fluoride is added to the community water supply, decay rates among residents of that community decrease. Although these studies focused primarily on the benefits of water fluoridation for children, more recent studies demonstrate that decay rates in adults are also reduced as a result of fluoride in the drinking water.

Water fluoridation (fluoride in water) prevents tooth decay two ways: primarily through direct contact with teeth throughout life, and when consumed by children during the tooth forming years. The most inexpensive way to deliver the benefits of fluoride to all residents of a community is through water fluoridation. All water naturally contains some fluoride. When a community fluoridates its water, it adjusts the level of fluoride in the water to the optimal level for preventing tooth decay. Currently, more than 170 million people in the United States using public water supplies drink water containing enough fluoride to protect teeth.

One of the health objectives contained in Healthy People 2010, the plan that sets health goals for the nation for the year 2010, calls for at least 75 percent of the population served by community water systems to receive optimal levels of fluoride. The current level is 67 percent. To reach this goal, approximately 14.3 million more people must gain access to fluoridated water through public water systems.

Other sources of fluoride are also available. Fluoride can be applied directly to teeth through toothpaste, mouth rinses, and professionally applied fluoride treatments available in the dental office. Children who have been evaluated by their dentists as being at high risk for tooth decay and whose home water supplies contain low amounts of fluoride can take dietary fluoride supplements. This daily supplement, which can be prescribed by a dentist or a physician, should be taken only by children if the home water supply has been verified to contain a low concentration of fluoride. These methods of delivering fluoride are more expensive than water fluoridation and require a conscious decision to use them. However, the widespread availability of fluorides, via water fluoridation, toothpaste, and other sources, has resulted in the steady decline of dental caries throughout the United States.

The Benefits of Fluoride

Community water fluoridation is an effective, safe, and inexpensive way to prevent tooth decay. This method of fluoride delivery benefits Americans of all ages and socioeconomic status. Brushing twice a day with a fluoride toothpaste is an easy way to prevent tooth decay.

Fluoridation, which was started in Grand Rapids, Michigan in 1945, has been used successfully in the United States for more than 50 years. It benefits both children and adults. Fluoride works by stopping or even reversing the decay process. It keeps tooth enamel strong and solid.

Community water fluoridation is considered one of 10 great public health achievements of the 20th century. Of the 50 largest cities in the United States, 42 have community water fluoridation (and 2 cities are have natural fluoride levels that are optimal). Fluoridation reaches 67 percent of the population on public water supplies - more than 170 million people.

The annual cost of fluoridation is approximately $0.50 in communities of ≥ 20,000 to approximately $3.00 per person in communities ≤ 5,000 (in 1995 dollars) for all but the smallest water systems. Even so, 100 million Americans do not have access to fluoridated water.

Communities with fluoridated drinking water in the United States, Australia, Britain, Canada, Ireland, and New Zealand show striking reductions in tooth decay - those with fluoridated drinking systems have 15-40 percent less tooth decay.

Nearly all tooth decay can be prevented when fluoridation is combined with dental sealants and other fluoride products, such as toothpaste.

Fluoride dietary supplements can provide fluoride to those who do not have adequate levels in their drinking water. They are available as tablets, drops, or lozenges.

Over-the-counter fluoride dental products such as toothpastes and mouth rinses are effective in preventing decay.

Products with high concentrations of fluoride that are applied in the dental office or prescribed for home use offer additional protection for those at increased risk of tooth decay.

Because older Americans are now keeping their teeth longer, fluoride will continue to be important for preventing tooth decay in this age group. Older Americans are especially susceptible to tooth decay because of exposed root surfaces and mouth dryness that may result from many medications.

About the Author

www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.