DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30341-3724
April 2, 2015
STATEMENT ON THE EVIDENCE SUPPORTING THE SAFETY AND EFFECTIVENESS OF COMMUNITY
WATER FLUORIDATION
On behalf of the Centers for Disease Control and Prevention (CDC), I am pleased to provide a
statement on the evidence regarding the safety and benefits of community water fluoridation. For
the record, this statement is not testimony for or against any specific legislative proposal.
Good oral health is an important part of good overall health and an essential part of our everyday
lives. Diet, sleep, psychological status, social interaction, school, and work are all affected by
impaired oral health. Over the past several decades, there have been major improvements in the
nation’s oral health that have benefitted most Americans.1
However, profound disparities in oral health status remain for some population subgroups, such
as the poor, the elderly, and many members of racial and ethnic minority groups.1 Tooth decay is
one of the most common chronic diseases among American children with 1 of 4 children living
below the federal poverty level experiencing untreated tooth decay.2 Untreated decay can cause
pain, school absences, difficulty concentrating, and poor appearance—all contributing to
decreased quality of life and ability to succeed.3
Tooth decay and its complications are preventable, and several preventive and early treatment
options are safe, effective, and economical. The CDC leads national efforts to improve oral health
by using proven strategies such as community water fluoridation and school-based dental sealant
programs that prevent oral diseases.
An Effective Intervention
Community water fluoridation is “the controlled addition of a fluoride compound to a public water
supply to achieve a concentration optimal for dental caries prevention.”1 The process of adding
fluoride to public water systems in the United States began in 1945 in Grand Rapids, Michigan.
Soon after, dramatic declines in dental caries were noted among school children in Grand Rapids
compared with school children from surrounding areas. Since then, community water fluoridation
has been adopted by communities across the country, providing the cornerstone of caries
prevention in the United States.1 In 2012, more than 210 million people, or 74.6% of the U.S.
population served by public water supplies, drank water with optimal fluoride levels to prevent
tooth decay.4
Water fluoridation is beneficial for reducing and controlling tooth decay and promoting oral health
across the lifespan. Evidence shows that water fluoridation prevents tooth decay by providing
frequent and consistent contact with low levels of fluoride, ultimately reducing tooth decay by
25% in children and adults.5-8 Additional evidence shows that schoolchildren living in communities
where water is fluoridated have, on average, 2.25 fewer decayed teeth compared to similar
children not living in fluoridated communities.9
The safety and benefits of fluoride are well documented and have been reviewed
comprehensively by several scientific and public health organizations. The U.S. Public Health
Service; the United Kingdom’s National Institute for Health Research, Centre for Reviews and
Dissemination, at the University of York; and the National Health and Medical Research Council,
Australia have all conducted scientific reviews by expert panels and concluded that community
water fluoridation is a safe and effective way to promote good oral health and prevent decay.10-12
The U.S. Community Preventive Services Task Force, on the basis of systematic reviews of
scientific literature, issued a strong recommendation in 2001 and again in 2013, for community
water fluoridation for the prevention and control of tooth decay.9,13
A Cost-saving Intervention
Although other fluoride-containing products such as toothpaste, mouth rinses, and dietary
supplements are available and contribute to the prevention and control of dental caries,
community water fluoridation has been identified as the most cost-effective method of delivering
fluoride to all members of the community regardless of age, educational attainment, or income
level.14,15 Analyses have also shown that water fluoridation provides additional benefits across the
lifespan beyond what is gained from using other fluoride-containing products.8,11,16
By preventing tooth decay, community water fluoridation has been shown to save money, both
for families and the health care system.7,17 The return on investment (ROI) for community water
fluoridation varies with size of the community, increasing as community size increases, but, as
noted by the U.S. Community Preventive Services Task Force, community water fluoridation is
cost-saving even for small communities.17,18 The estimated annual ROI for community water
fluoridation, excluding productivity losses, ranged from $5.03 in small communities of 5,000
people or less, to $31.88 in large communities of 20,000 or more people.7 The estimated ROI for
community water fluoridation including productivity losses was $6.71 in small communities and
$42.57 in large communities.19
A study of a community water fluoridation program in Colorado used an economic model to
compare the program costs associated with community water fluoridation with treatment savings
achieved through reduced tooth decay. The analysis, which included 172 public water systems,
each serving populations of 1,000 individuals or more, found that 1 year of exposure to
fluoridated water yielded an average savings of $60 per person when the lifetime costs of
maintaining a restoration were included.20 Analyses of Medicaid claims data in 3 other states
(Louisiana, New York, and Texas), have also found that children living in fluoridated communities
have lower caries related treatment costs than do similar children living in non-fluoridated
communities; the difference in annual per child treatment costs ranged from $28 to $67.21-23
A Safe Intervention
Expert panels consisting of scientists from the United States and other countries, with expertise in
various health and scientific disciplines, have considered the available evidence in peer-reviewed
literature and have not found convincing scientific evidence linking community water fluoridation
with any potential adverse health effect or systemic disorder such as an increased risk for cancer,
Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low
intelligence, renal disorders, Alzheimer disease, or allergic reactions.9,11
Documented risks of community water fluoridation are limited to dental fluorosis, a change in
dental enamel that is cosmetic in its most common form. Changes range from barely visible lacy
white markings in milder cases to pitting of the teeth in the rare, severe form. In the United
States, most dental fluorosis seen today is of the mildest form, affecting neither aesthetics nor
dental function.24 Fluorosis can occur when young children—typically less than 8 years of age,
whose permanent teeth are still forming under the gums—take in fluoride from any source.9,11
Conclusion
In the seminal report, Oral Health in America: A Report of the Surgeon General, Surgeon General
David Satcher observed a “‘silent epidemic’ of dental and oral diseases […] with those suffering
the most found among the poor of all ages.”1 The report affirms that community water
fluoridation is “an inexpensive means of improving oral health that benefits all residents of a
community, young and old, rich and poor alike.” Because of its contribution to the dramatic
decline in tooth decay over the past 70 years, CDC named community water fluoridation 1 of 10
great public health achievements of the 20th century.14
Katherine Weno, DDS, JD
Director, Division of Oral Health
National Center for Chronic Disease Prevention
and Health Promotion
Centers for Disease Control and Prevention
References
1. 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.
2. Dye BA, Li X, Thornton-Evans G. Oral Health Disparities as Determined by Selected Healthy
People 2020 Oral Health Objectives for the United States, 2009–2010. NCHS data brief no.
104. Hyattsville, MD: National Center for Health Statistics; 2012.
http://www.cdc.gov/nchs/data/databriefs/db104.htm. Accessed February 17, 2015.
3. Guarnizo-Herreno CC, Wehby GL. Children's dental health, school performance, and
psychosocial well-being. J Pediatr. 2012;161:1153-9.
4. Centers for Disease Control and Prevention. 2012 Water Fluoridation Statistics website.
http://www.cdc.gov/fluoridation/statistics/2012stats.htm. Accessed February 17, 2015.
5. Koulourides T. Summary of session II: fluoride and the caries process. J Dent Res. 1990;69(Spec
Iss):558.
6. Featherstone JD. Prevention and reversal of dental caries: role of low level fluoride.
Community Dent Oral Epidemiol. 1999;27:30-40.
7. Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on interventions to prevent
dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev
Med. 2002(1S):21-54.
8. Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in
adults. J Dent Res. 2007;86:410-415.
9. Community Preventive Services Task Force. Guide to Community Preventive Services:
Preventing Dental Caries: Community Water Fluoridation website.
http://www.thecommunityguide.org/oral/fluoridation.html. Accessed February 17, 2015.
10. Public Health Service. Review of fluoride: benefits and risks. Report of the Ad Hoc
Subcommittee on Fluoride of the Committee to Coordinate Environmental Health and Related
Programs. Washington, DC: US Department of Health and Human Services; 1991.
http://www.health.gov/environment/ReviewofFluoride/default.htm. Accessed February 17,
2015.
11. McDonagh MS, Whiting PF, Bradley M, et al.. A Systematic Review of Public Water
Fluoridation. University of York, York: NHS Centre for Reviews and Dissemination; 2000.
http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport18.pdf. Accessed February 17, 2015.
12. Australian Research Centre for Population Oral Health. The use of fluorides in Australia:
Guidelines. Aust Dent J. 2006;51:195-199.
13. Community Preventive Services Task Force. Guide to Community Preventive Services:
Preventing Dental Caries: Community Water Fluoridation website (2000 archived review).
http://www.thecommunityguide.org/oral/fluoridation_archive.html. Accessed February 17,
2015.
14. 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.
15. Burt BA, ed. Proceedings for the workshop: cost-effectiveness of caries prevention in dental
public health, Ann Arbor, Michigan, May 17--19, 1989. J Public Health Dent. 1989;49(special
issue):331-337.
16. Slade GD, Sanders AE, Do L, Roberts-Thompson K, Spencer AJ. Effects of fluoridated drinking
water on dental caries in Australian adults. J Dent Res. 2013;92:376-82.
17. Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. J
Public Health Dent. 2001;61:78-86.
18. Ran T, Chattopadhyay S. Economic evaluation of community water fluoridation: a Community
Guide systematic review (working paper).
19. Griffin S, Jones K, Tomar S. Unpublished data, January 2015.
20. O’Connell JM, Brunson D, Anselmo T, Sullivan PW. Costs and savings associated with
community water fluoridation programs in Colorado. Prev Chronic Dis. 2005.
http://www.cdc.gov/pcd/issues/2005/nov/05_0082.htm. Accessed February 17, 2015.
21. Water fluoridation and costs of medicaid treatment for dental decay—Louisiana, 1995–1996.
MMWR. 1999;48(34):753‐7.
22. Kumar JV, Olubunmi A, Melnik TA. Geographic Variation in Medicaid Claims for Dental
Procedures in New York State: Role of Fluoridation Under Contemporary Conditions. Public
Health Reports. 2010;125:647‐654.
23. Texas Department of State Health Services. Water fluoridation costs in Texas: Texas Health
Steps (EPSDT‐MEDICAID). Austin, TX: Texas Department of State Health Services; 2000.
www.dshs.state.tx.us/dental/pdf/flstudy.pdf. Accessed March 10, 2015.
24. Beltrán-Aguilar ED, Barker L, Dye BA. Prevalence and severity of dental fluorosis in the United
States, 1999-2004. NCHS Data Brief no. 53. Hyattsville, MD: National Center for Health
Statistics; 2010. http://www.cdc.gov/nchs/data/databriefs/db53.pdf. Accessed February 17,
2015.
Fluoridation Growth
Fluoridation Growth Data Table
Year
Receiving
Fluoridated
Water
(Natural)
Receiving
Fluoridated
Water
(Total)
Served by Community Water
Systems
Total U.S. Population
Percentage of U.S.
population receiving
fluoridated water*
Percentage of
population served by
community water
systems receiving
fluoridated water
2014
211,393,167
284,099,832
318,857,056
66.3
74.4
2012
210,655,401
282,534,910
313,914,040
67.1
74.6
2010
10,077,922
204,283,554
276,607,387
308,745,538
66.2
73.9
2008
8,805,304
195,545,109
269,911,707
304,059,724
64.3
72.4
2006
184,028,0381
265,794,2521
299,398,4842
61.5
69.21
2004
180,632,4811
262,690,0431
293,638,1582
61.5
68.81
2002
172,209,7351
255,434,2891
288,125,9732
59.0
67.31
2000
161,924,0801
249,671,2491
282,216,9522
57.4
65.81
1992
10,011,8613
144,217,4763
232,438,0003
256,894,0004
56.1
62.03
1990
250,132,0004
1989
135,256,7575
220,179,0005
247,342,0004
54.7
61.45
1988
132,422,0646
218,924,0006
245,021,0004
54.0
60.56
130,172,3347
211,730,8737
238,466,0004
54.6
61.57
115,948,9468
227,726,0004
50.9
105,338,3439
215,973,0004
48.8
205,052,0004
9,005,2627
1985
1980
10,711,0499
1975
1970
1969
8,378,82410
88,475,68410
202,677,0004
43.7
1967
10,009,00011
81,925,70011
198,712,0004
41.2
1965
9,775,10012
69,630,10012
152,192,00012
194,303,0004
35.8
45.8
1964
7,706,00013
56,069,10013
150,277,00013
191,889,0004
29.2
37.3
1963
189,242,0004
24.7
1962
186,538,0004
23.6
1961
183,691,0004
23.0
1960
180,671,0004
22.8
1959
177,830,0004
22.3
1958
174,882,0004
22.0
1957
171,984,0004
21.1
1956
168,903,0004
20.1
1955
165,931,0004
15.8
1954
163,026,0004
13.7
1953
160,184,0004
11.0
1952
157,553,0004
8.8
1951
154,878,0004
3.3
1950
152,271,0004
1949
149,188,0004
1948
146,631,0004
1947
144,126,0004
1946
141,389,0004
1945
139,928,0004
1940
132,122,0004
 Top of Page
Data Sources
1. Centers for Disease Control and Prevention. Populations Receiving Optimally Fluoridated Public Drinking Water — United States, 1992–2006. MMWR
2008;57(no.27):737–741. Accessed on October 29, 2008. [Available online from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5727a1.htm
(https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5727a1.htm)].
2. U.S. Census Bureau. Annual Population Estimates, Estimated Components of Population Change and Rates of the Components of Population change for the United
States and States: April 1, 2000 to July 1, 2006. Accessed on April 18, 2007. [Available online from: http://www.census.gov/popest/
(http://www.census.gov/popest/)
].
3. Fluoridation Census 1992. Division of Oral Health, National Center for Prevention Services, Centers for Disease Control and Prevention, Public Health Service, U.S.
Department of Health and Human Services. September 1993. Accessed on October 29, 2008. [Available online at:
https://www.cdc.gov/fluoridation/pdf/statistics/1992.pdf
[PDF–43M].
4. Table HS-1. Population 1900 to 2002. U.S. Census Bureau. URL: http://www2.census.gov/library/publications/2004/compendia/statab/123ed/hist/hs-01.pdf
[PDF–81K] (http://www2.census.gov/library/publications/2004/compendia/statab/123ed/hist/hs-01.pdf)
. Accessed July 14, 2005.
5. Fluoridation Census Summary, 1989. Dental Disease Prevention Activity, National Center for Prevention Services, Centers for Disease Control, Public Health
Service, U.S. Department of Health and Human Services. July 1991. Accessed on October 29, 2008. [Available online at:
https://www.cdc.gov/fluoridation/pdf/statistics/1989.pdf
[PDF–8M]].
6. Fluoridation Census Summary, 1988. Dental Disease Prevention Activity, Center for Prevention Services, Centers for Disease Control, Public Health Service, U.S.
Department of Health and Human Services. February 1990. Accessed on October 29, 2008. [Available online at:
https://www.cdc.gov/fluoridation/pdf/statistics/1988.pdf
[PDF–866K]].
7. Fluoridation Census, 1985. Dental Disease Prevention Activity, Center for Prevention Services, Centers for Disease Control, Public Health Service, U.S. Department
of Health and Human Services. U.S. Government Printing Office Publication #1988-535-439. Accessed on October 29, 2008. [Available online at:
https://www.cdc.gov/fluoridation/pdf/statistics/1985.pdf
[PDF–42M]].
8. Fluoridation Census, 1980. Dental Disease Prevention Activity, Center for Prevention Services, Centers for Disease Control, Public Health Service, U.S. Department
of Health and Human Services. U.S. Government Printing Office Publication #1984-751-641, Region No. 4.
9. Fluoridation Census, 1975. Dental Disease Prevention Activity, Bureau of State Services, Center for Disease Control, Public Health Service, U.S. Department of
Health, Education and Welfare. U.S. Government Printing Office Publication #1977-740-116/3782, Region No. 4. Accessed on October 29, 2008. [Available online
at: https://www.cdc.gov/fluoridation/pdf/statistics/1975.pdf
[PDF–7M]].
10. Fluoridation Census, 1969. Division of Dental Health, National Institutes of Health, U.S. Department of Health, Education, and Welfare. Natural Fluoride Content of
Community Water Supplies, Division of Dental Health, NOH, DHEW. U.S. Government Printing Office Publication #1970-0-380-791. Accessed on October 29, 2008.
[Available online at: https://www.cdc.gov/fluoridation/pdf/statistics/1969.pdf
[PDF–5M]].
11. Fluoridation Census, 1967. Division of Dental Health, National Institutes of Health, U.S. Department of Health, Education, and Welfare. U.S. Government Printing
Office Publication #1968-0-310-023. Accessed on October 29, 2008. [Available online at: https://www.cdc.gov/fluoridation/pdf/statistics/1967.pdf
[PDF–2.7M]].
12. Fluoridation Census, 1965. Division of Dental Public Health and Resources, Public Health Service, U.S. Department of Health, Education, and Welfare. Accessed on
October 29, 2008. [Available online at: https://www.cdc.gov/fluoridation/pdf/statistics/1965.pdf
[PDF–1.5M]]
13. Annual Fluoridation Census Report: National, State and Community Experience 1963. Division of Dental Public Health and Resources, Public Health Service, U.S.
Department of Health, Education, and Welfare (DHEW).
Note: Fluoridation Censuses originally published only as paper documents, including several referenced above, are available online in PDF format at
http://www.cdc.gov/fluoridation/statistics/reference_stats.htm. Archived paper copies were available for most, but not all, Fluoridation Censuses. The available copies
were scanned and converted to PDFs.
* Estimates for percentage of U.S. population receiving fluoridated water were calculated differently for years before 1964, and since 1964. For years prior to 1964, the
percentage was calculated by dividing the population receiving fluoridated water from systems adding fluoride (adjusted) by the total U.S. population. Since 1964, the
percentage was calculated by dividing the population receiving fluoridated water from both adjusted and naturally fluoridated water systems by the total U.S.
population.
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Page last updated: November 7, 2016
Content source: Division of Oral Health (/oralhealth), National Center for Chronic Disease Prevention and Health Promotion (/chronicdisease)
STATE OF NEVADA
BRIAN SANDOVAL
Governor
CODY L. PHINNEY, MPH
Administrator, DPBH
RICHARD WHITLEY, MS
Director, DHHS
JOHN DIMURO, D.O., MBA
Chief Medical Officer
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC AND BEHAVIORAL HEALTH
4150 Technology Way, Suite 300
Carson City, Nevada 89706
Telephone: (775) 684-4200 · Fax: (775) 687-7570
MEMORANDUM
DATE:
March 3, 2017
TO:
Assemblywoman Joiner
THROUGH: Ms. Cody Phinney, Administrator, Division of Public and Behavioral Health
FROM:
Dr. Antonina Capurro, State Dental Health Officer, Oral Health Program
RE:
Water Fluoridation Information
“Oral health means much more than healthy teeth, and is integral to the general health and well-being
of all Americans. Oral health must be included in the provision of health care and design of community
programs.”(Oral Health in America: Summary of the Surgeon General’s Report May 2000).
Industry Support for Water Fluoridation
The American Dental Association, the World Health Organization, the American Medical Association,
and the Centers for Disease Control and Prevention (CDC) have endorsed community water
fluoridation as an effective means to prevent tooth decay. In 1945, Grand Rapids Michigan became the
first city to add fluoride to the community water supply. Over the past 70 years, communities across
the country have provided fluoridation to community drinking water.
The Centers for Disease Control and Prevention has recognized water fluoridation as one of the
greatest public health achievements of the twentieth century.
CDC guidelines require that water fluoridation should be optimally adjusted to reach a fluoridation
level of 0.7 ppm (parts per million) to prevent dental caries while reducing the effects of enamel
fluorosis. According the 2015 Cochrane Oral Health review of water fluoridation data (6), when
comparing communities with and without water fluoridation, water fluoridation was linked to a 35%
decrease in decayed, missing, and filled deciduous (baby) teeth and a 26% decrease in decayed,
missing, filled permanent (adult) teeth in children. Due to the documented benefits of water
fluoridation, the Healthy People 2020 national goal is to increase the proportion of the U.S. population
served by community water systems with optimally fluoridated water to 79.6%. Nevada’s current
status is 74% as Southern Nevada has provided optimally fluoridated community water since 2000.
What is Fluoride
Fluoride is a naturally occurring mineral found in plants, soil, foods, and water sources. Fluoride is the
reduced ionic form of fluorine, the thirteenth most abundant element in the earth’s crust. Fluoride
combines with positive ions to form a stable compound.
How Does Fluoride Affect Tooth Structures
Teeth consist of calcium and phosphate in a hydroxyapatite crystalline structure. When carbohydrates
and sugars are eaten, the bacteria in the mouth produce acids. These acids dissolve calcium and
phosphate from the teeth and form what we know as a cavity. Because of one’s diet, the teeth are in a
constant state of demineralization and remineralization. The calcium and phosphate that are removed
from the tooth structure become part of the oral plaque. If fluoride is available in the saliva, it will
form a new type of crystal structure that is stronger than the original enamel formation and is resistant
to bacterial acids.
Why is Fluoride in Toothpaste
Fluoride is most effective at preventing decay when it is maintained at low levels in the oral cavity.
When teeth are attacked by the acid produced by oral bacteria, available fluoride in the saliva and
plaque strengthen demineralized areas by forming a new crystal structure that is resistant to acidic
attacks. Toothpaste has been made affordable to allow the average individual to receive the benefits of
fluoride. Most supermarket brands of toothpaste contain 0.15% fluoride or 1,500 ppm. While the
fluoride in toothpaste offers protection to the teeth when they are brushed, water fluoridation provides
similar beneficial fluoride exposure several times a day.
History of Water Fluoridation in Nevada
In Southern Nevada, fluoride has been added and maintained at optimal levels in the municipal water
supply of since 2000. The water fluoridation levels are lower than the Safe Drinking Water Act limit of
4.0mg/L. The Nevada Oral Health Program works with partners at the City of Henderson and the
Southern Nevada Water Systems to monitor fluoridation quality. Data such as daily water testing,
laboratory results, and average water fluoride concentrations are collected and reported to the Center
for Disease Control’s National Water Fluoridation Reporting System. The public is able to view
reported fluoride information related to their community water system from the CDC’s
MyWaterFluoride page. Due to the quality of data reported and successful maintenance of optimal
water fluoridation levels in over 90% of the adjusted water systems, states are issued the CDC Water
Fluoridation Quality Award. Nevada has received this award in 2015 and 2016 for Southern Nevada.
What is Water Fluoridation
The U.S. Environmental Protection Agency regulates drinking water and determines safe mineral and
contaminant limits to protect the health and safety of the population. According to the CDC, surface
water typically has low concentrations of fluoride between 0.2ppm or less while groundwater (wells)
has higher concentrations of fluoride between 0.1 ppm to 5.0ppm. (Note: ppm is equivalent to
milligrams per liter of water) Water fluoridation simply adjusts natural water fluoridation levels to
reach optimal concentration levels. The U.S. has approved sodium fluoride, sodium fluorosilicate,
and fluorosilicic acid for use in water fluoridation. These compounds must meet NSF/ANSI 60 and
American Water Works Association product quality standards before they can be purchased. A water
2
treatment facility will process, reduce, and dissacociate the elements of one of these compounds to
release the fluoride element. That cleaned element is added to water systems and carefully tested to
result in the optimal 0.7ppm concentration. While the EPA sets citeria that states must follow, the Safe
Drinking Water Act defines water fluoridation as a state program and allows individual states to
administer federal standards.
Oral Health Program Data
In 2007, Nevada’s Oral Health Program conducted an oral health survey of children in Head Start sites
across the state. They discovered that 64% of Washoe County children had early childhood decay with
49% of Clark County children demonstrating similar decay rates. Furthermore, 34% of Head Start
children within Washoe County had restorations or active decay in their front six teeth while 20% of
Clark County children experienced decay or previous restorations. While water fluoridation may be
only one of several factors that contribute to a contrast in decay rates between children living in
Washoe and Clark County, it is worth noting that the Clark County children had been exposed to water
fluoridation their entire life as water fluoridation began in 2000 and the children surveyed in this study
were between three and five years of age.
The Fiscal Impact
From a public health perspective, any preventative measure that can be implemented to reduce
Medicaid expenses for dental treatment while decreasing the burden of oral disease should be
explored. In FY 16, Medicaid expenses for dental treatment totaled over $83 million and the Medicaid
eligible population continues to increase. Nevada projected that there would be 687, 515 Medicaid
enrollees in January 2017 which is a 6.3% increase from the same period of time in 2016. Community
water fluoridation affects individuals from diverse circumstances, age categories, and various
socioeconomic backgrounds. According to Effectiveness of Fluoride in Preventing Caries in Adult,
(Griffin, 2007), water fluoridation reduces tooth decay in children and adults by 25%. In addition,
through an investigation of the effects of community water fluoridation, the CDC has found that for
every $1 invested in community water fluoridation $38 are saved in avoidable dental treatment
costs(1).
References
1. Centers for Disease Control and Prevention, Cost Savings of Community Water Fluoridation,
July 2013. Accessed Jan. 2017
2. Community Preventive Services Task Force, “Preventing Dental Caries: Community Water
Fluoridation,” Available at Preventing Dental Caries: Community Water Fluoridation
3. Department of Health and Human Services, Division of Public and Behavioral Health, Oral
Health Program. (2007). Head Start Oral Health Survey Nevada 2007 (Rep.). NV.
4. Duchon, Kip, “Water Fluoridation Principles and Practices” Centers for Disease Control and
Prevention training. Sacramento, Ca. 2017.
5. Griffin SO, Regnier E, Griffin PM, Huntley VN. Effectiveness of fluoride in preventing caries
in adults. J Dent Res. 2007; 86(5):410–414.
6. Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam
R, Tugwell P, Welch V, Glenny AM. Water fluoridation for the prevention of dental
caries. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010856. DOI:
10.1002/14651858.CD010856.pub2.
3
7. Schmidt, Dena. (2017). Medicaid 101 [PDF document]. Retrieved from:
http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/About/Medicaid_101-Senate_02-1317.pdf
8. World Health Organization. Fluorides and Oral Health. WHO Technical Report Series No. 846.
Geneva: World Health Organization, 1994.
9. U.S. Department of Health and Human Services, Office of Disease Prevention and Health
Promotion. Healthy People 2020. Washington, DC: U.S. Department of Health and Human
Services, Office of Disease Prevention and Health Promotion, 2010.
https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health
10. US Department of Health and Human Services, Public Health Service, Office of the Surgeon
General. Oral health in America: A report of the Surgeon General. Rockville, MD: National
Institutes of Health, National Institute of Dental and Craniofacial Research; 2000.
4
Fluoridation Facts Compendium
National and International Organizations That Recognize the Public Health Benefits of
Community Water Fluoridation for Preventing Dental Decay
Academy of Dentistry International Academy of General Dentistry Academy of Nutrition and Dietetics Academy for Sports Dentistry Alzheimer's Association America's Health Insurance Plans American Academy of Family Physicians American Academy of Nurse Practitioners American Academy of Oral and Maxillofacial Pathology American Academy of Orthopaedic Surgeons American Academy of Pediatrics American Academy of Pediatric Dentistry American Academy of Periodontology American Academy of Physician Assistants American Association for Community Dental Programs American Association for Dental Research American Association for Health Education American Association for the Advancement of Science American Association of Endodontists American Association of Oral and Maxillofacial Surgeons American Association of Orthodontists American Association of Public Health Dentistry American Association of Women Dentists American Cancer Society American College of Dentists American College of Physicians American College of Preventive Medicine American College of Prosthodontists American Council on Science and Health American Dental Assistants Association American Dental Association American Dental Education Association American Dental Hygienists' Association American Federation of Labor and Congress of Industrial Organizations American Fluoridation Society American Hospital Association American Legislative Exchange Council American Medical Association American Nurses Association American Osteopathic Association American Pharmacists Association American Public Health Association American School Health Association American Society for Clinical Nutrition American Society for Nutritional Sciences American Student Dental Association American Water Works Association Association for Academic Health Centers Association of American Medical Colleges Association of Clinicians for the Underserved Association of Maternal and Child Health Programs Association of State and Territorial Dental Directors Association of State and Territorial Health Officials Association of State and Territorial Public Health Nutrition Directors British Fluoridation Society
Canadian Dental Association Canadian Dental Hygienists Association Canadian Medical Association Canadian Nurses Association Canadian Paediatric Society Canadian Public Health Association Child Welfare League of America Children's Dental Health Project Chocolate Manufacturers Association Consumer Federation of America Council of State and Territorial Epidemiologists Delta Dental Plans Association FDI World Dental Federation Federation of American Hospitals Health Resources and Services Administration (HRSA) Hispanic Dental Association Indian Dental Association (U.S.A.) Institute of Medicine International Association for Dental Research International Association for Orthodontics International College of Dentists March of Dimes Birth Defects Foundation National Association of Community Health Centers National Association of County and City Health Officials National Association of Dental Assistants National Association of Local Boards of Health National Association of Social Workers National Confectioners Association National Dental Assistants Association National Dental Association National Dental Hygienists' Association National Foundation of Dentistry for the Handicapped National Head Start Association
National Health Law Program National Healthy Mothers, Healthy Babies Coalition Oral Health America Robert Wood Johnson Foundation Society for Public Health Education Society of American Indian Dentists Special Care Dentistry Academy of Dentistry for Persons with Disabilities American Association of Hospital Dentists American Society for Geriatric Dentistry The Children's Health Fund The Dental Health Foundation (of California) U.S. Department of Defense U.S. Department of Veterans Affairs U.S. Public Health Service Centers for Disease Control and Prevention (CDC) National Institute of Dental and Craniofacial Research (NIDCR) World Federation of Orthodontists World Health Organization
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