For 80 years, fluoridating the water in communities has been “the Holy Grail” of preventive dentistry. Community water fluoridation has been practiced in the U.S. since 1945, and as of December 31, 2022, the CDC reported that 62.8% of the U.S. population had access to fluoridated water. Some states, though, (Hawaii, Idaho, Oregon, New Jersey, Montana) have large numbers of citizens who have no access to fluoridation.
The U.S. Public Health Service, The Center for Disease Control and Prevention, the American Dental Association, and the American Academy of Pediatrics all still “endorse” water fluoridation and fluoride supplements for those without access. The United States Preventive Services Task Force, the USPSTF, has not changed its guidelines/position for children to receive fluoride supplementation starting at age 6 months if their water lacks fluoride.
The current question addressed by this blog is “Does community water fluoridation prevent dental caries,” ie. cavities. Numerous studies have addressed that question and their conclusions are not what I expected. It was my mistaken impression that fluoride in public drinking water, prevented dental caries in adults and children alike, and that fluoridation prevented cavities and thus prevented missing or broken teeth. And the number of fillings needed would be less.
The article t referenced below concluded that community water fluoridation “may result in a small reduction in tooth decay in children’s primary teeth, but it’s impact on permanent teeth remains unclear. Community water fluoridation may slightly decrease the proportion of children with decayed, missing, or filled primary and permanent teeth.” This result does not match up with the impression I’ve had since childhood that the water I drink and the fluoridated toothpaste I use will prevent me from ever having a cavity or breaking a tooth.
Children and their developing and maturing primary teeth are the target for fluoridation, yet they’re reporting only a “small reduction in tooth decay.” For adults, studies report low-certainty evidence that the “modest” decrease in decayed, missing, or filled teeth is “not statistically significant” for both primary and permanent teeth.
So, for children, community water fluoridation does slightly increase the “proportion of caries-free children regarding their primary dentition.” Permanent dentition is not as significantly impacted, BUT it seems if a person were exposed to fluoridated water throughout their entire life, the benefits would carry over from primary to permanent teeth. Fluoride toothpaste is another factor to consider, but its effect does not provide enough “evidence to evaluate the impact of removing community water fluoridation.” Even with fluoride toothpaste, community water fluoridation is necessary.
Dr. G’s Opinion: The article I refer to here is not a ringing endorsement of community water fluoridation. I’m surprised at their conclusions. As I said earlier, my impressions have always been the opposite and fluoridation has had a huge impact on dental caries. I haven’t had a cavity since I was a pre-teen. Everywhere I have lived has had fluoridated water, and I’ve always used fluoride toothpaste. Something has helped me. I’m going to give fluoride the credit.
Reference: Jiang D, Qui J. Water Fluoridation for Dental Caries Prevention. Am Fam Phys 2025 August;112(2):129-130.
