Water Fluoridation in Washington

Washington

Community water fluoridation, the addition of an optimal amount of fluoride (a mineral) 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 are 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 for addressing this disparity — it can improve the oral health of large populations without imposing additional time or cost burdens on 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.

In 2022, roughly 72% of the U.S. population with public water access received water fortified with fluoride at 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 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 than were 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 tooth decay across socioeconomic groups. One community found that ceasing community water fluoridation led to a 51% increase in dental caries among children younger than seven. 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. https://doi.org/10.1177/003335491012500202.

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. https://doi.org/10.2105/AJPH.2010.200915.

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. https://doi.org/10.1186/s12903-018-0684-2.

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. https://doi.org/10.1377/hlthaff.2016.0881.

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. https://doi.org/10.1001/jamapediatrics.2018.5086.

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 Institutes of Health, National Institute of Dental and Craniofacial Research, 2000.https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf.