Policy Factsheet

Water Fluoridation

Reasons for Policy

  • Tooth decay is the most common chronic disease of childhood1 and disproportionately affects low income and minority children 1,2,3
  • More than 50% of children and 80% of adolescents have dental caries4
  • Water fluoridation is the most effective measure in preventing oral disease on a large scale 5
  • Less than 65% of the US population served by public water systems have access to water fluoridated at the optimal levels 6

Community Groups

  • Local Government
  • Local Oral Health Professionals
  • Local Public Health Department
  • Local Water Utility
  • Public Dental Health Advocates

Policy Components

  • Fluoridate public water supplies to an optimal level of 1mg/L
  • Educate public about proven safety and benefits of fluoridated water

Desired Outcomes

  • Improvements in oral health of children and adolescents
  • Reduced costs of pediatric dental care

Level of Evidence Available to Evaluate Effectiveness of Policy

For all policies we describe on this website, we have applied the Standards of Evidence as defined by Flay et al. (2005) in the Standards of Evidence document published by Prevention Science.

The effectiveness level of this policy is 1: Evidence-Based Policies Meeting Criteria for Effectiveness.

The levels of effectiveness as noted are:

  1. meets criteria for policy effectiveness (consistent, positive outcomes from at least two high-quality experimental or quasi-experimental trials using a comparison group or interrupted time series design);
  2. consistent evidence available linking policy with positive outcomes from high-quality observational studies only;
  3. insufficient evidence available for policy or policy components.

Achievable Results

On average, water fluoridation can achieve a 50-60% decrease in dental cavities.

Community Examples

Links to Policy Examples

Be sure to check with your state, county, and municipal governments regarding potential existing laws that may impede any new policy development.


  1. Nelson, WE, ed. Textbook of Pediatrics. 15th ed. Philadelphia, PA: WB Saunders; 1996, 628.  

  2. General Accounting Office. Oral health: Dental disease is a chronic problem among low-income populations. Report GAO/HEHS-00-72. Available at http://www.gao.gov.  

  3. US Inspector General. Children’s Dental Services under Medicaid: Access and Utilization. San Francisco, CA: US Department of Health and Human Services; 1996. Publication 09-93-00240.  

  4. Mouradian, WE, Wehr, E, & Crall, JJ (2000). Disparities in Children’s Oral Health and Access to Dental Care. JAMA 2000;284(20), 2625-2631.  

  5. Centers for Disease Control and Prevention: Public Health Service report on fluoride benefits and risks. JAMA 2001;266(8), 1061-1067.  

  6. US Public Health Service. Healthy People 2000 Progress Report on Oral Health. Washington, DC: US Dept of Health and Human Services; 1995.  

  7. Flay, BR, Biglan, A, Boruch, RF, Ganzalez Castro, F, Gottfredson, D, Kellam, S, Moscicki, EK, Schinke, S, Valentine, JC, & Ji, P (2005). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science, 6(3), 151-175.  

  8. Richmond, VL (1985). Thirty years of fluoridation: A review. American Journal of Clinical Nutrition; (41)129-138.