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Water Fluoridation
Water Fluoridation in United States
United States

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United States Value:


Percentage of population served by community water systems that have fluoridated water

Water Fluoridation in depth:

Water Fluoridation by State

Percentage of population served by community water systems that have fluoridated water

Water Fluoridation Trends

Percentage of population served by community water systems that have fluoridated water

Trend: Water Fluoridation in United States, 2023 Annual Report

Percentage of population served by community water systems that have fluoridated water

United States

 CDC, Water Fluoridation Reporting System

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About Water Fluoridation

US Value: 72.7%

Top State(s): Kentucky: 99.9%

Bottom State(s): Hawaii: 8.5%

Definition: Percentage of population served by community water systems that have fluoridated water

Data Source and Years: CDC, Water Fluoridation Reporting System, 2020

Suggested Citation: America's Health Rankings analysis of CDC, Water Fluoridation Reporting System, United Health Foundation,, accessed 2023.

Community water fluoridation, the addition of an optimal amount of fluoride to a public water supply, effectively prevents tooth decay in children and adults. Tooth decay, also called dental caries, is the result of bacteria dissolving a tooth’s enamel. Fluoride protects teeth from decay by rebuilding and strengthening the tooth’s surface. 

Dental caries is one of the biggest threats to oral health and one of the most common chronic diseases in the United States. Untreated dental caries can lead to pain, infection and tooth loss. One study found that children with dental caries had nearly 3 times the odds of missing school due to dental pain than children with good oral health.

Children from low-income families have a higher prevalence of tooth decay and experience more barriers to accessing dental care. Community water fluoridation is one of the primary methods of addressing this disparity — it can improve the oral health of large populations without adding time or cost burdens to individuals.

Community water fluoridation saves money for both individuals and communities. The return on investment varies by community size, but even small communities experience economic benefits. Estimates suggest that community water fluoridation saved an average of $32.19 per person in 2013.

Roughly 73% of the U.S. population with public water access in 2020 received water fortified with fluoride to the recommended concentration of 0.7 milligrams per liter. However, those using private wells — an estimated 23 million American households, according to the 2021 U.S. Census American Housing Survey — may not be getting the recommended amount of fluoride and may experience higher rates of tooth decay than individuals receiving fluoridated water through public water systems. 

A recent study found that children in low-income families just above the poverty level were less likely to live in a community where at least 75% of the population was served by a fluoridated water source, compared with children in both higher- and lower-income groups.

The Community Preventive Services Task Force recommends community water fluoridation as a safe and cost-effective intervention to widely deliver fluoride to all community members. Water fluoridation is effective at reducing the prevalence of tooth decay across socioeconomic groups. One community found that ceasing community water fluoridation led to a 51% increase in dental caries among young children ages 0-6. The Centers for Disease Control and Prevention named community water fluoridation one of the Ten Great Public Health Achievements of the 20th century.

Healthy People 2030 has an objective to increase the proportion of people whose water systems have the recommended amount of fluoride.

Benjamin, Regina M. “Oral Health: The Silent Epidemic.” Public Health Reports, Surgeon General’s Perspectives, 125, no. 2 (March 1, 2010): 158–59.

Centers for Disease Control and Prevention. “Ten Great Public Health Achievements -- United States, 1900-1999.” MMWR. Morbidity and Mortality Weekly Report 48, no. 12 (April 2, 1999): 241–43.

Jackson, Stephanie L., William F. Vann, Jonathan B. Kotch, Bhavna T. Pahel, and Jessica Y. Lee. “Impact of Poor Oral Health on Children’s School Attendance and Performance.” American Journal of Public Health 101, no. 10 (October 2011): 1900–1906.

Meyer, Jennifer, Vasileios Margaritis, and Aaron Mendelsohn. “Consequences of Community Water Fluoridation Cessation for Medicaid-Eligible Children and Adolescents in Juneau, Alaska.” BMC Oral Health 18, no. 1 (December 13, 2018): 215.

O’Connell, Joan, Jennifer Rockell, Judith Ouellet, Scott L. Tomar, and William Maas. “Costs and Savings Associated With Community Water Fluoridation in the United States.” Health Affairs 35, no. 12 (December 2016): 2224–32.

Sanders, Anne E., William B. Grider, William R. Maas, John A. Curiel, and Gary D. Slade. “Association Between Water Fluoridation and Income-Related Dental Caries of US Children and Adolescents.” JAMA Pediatrics 173, no. 3 (March 1, 2019): 288.

U.S. Department of Health and Human Services. “Oral Health in America: A Report of the Surgeon General.” Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

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