The American Academy of Cariology (AAC) firmly asserts that community water fluoridation (CWF) is a safe, cost-effective, and equitable public health intervention to prevent dental caries in children and adults.

Water fluoridation is safe. At the optimal level of 0.7 milligrams of fluoride per liter of water (mg/L), water fluoridation reduces the prevalence of dental caries while posing minimal risks, such as mild dental fluorosis. The primary advantage of water fluoridation is its ability to provide consistent, low-level exposure to fluoride ions in the mouth, helping prevent tooth demineralization and promoting enamel remineralization. Extensive scientific research reaffirms the safety and effectiveness of properly implemented water fluoridation programs. Concerns about CWF’s impact on children’s neurodevelopment are primarily based on studies conducted in areas with natural fluoride levels as high as 8-12 mg/L, which is 11-17 times the optimal level of 0.7 mg/L recommended for public health purposes. These studies show associations rather than causation and are often limited by methodological flaws, including unreported confounding factors, lack of control for socioeconomic variables, and inconsistent exposure measurements. Importantly, there is no established biological mechanism to explain a causal link between fluoride at optimal levels and neurodevelopmental effects.

Water fluoridation is a cost-effective public health measure. Water fluoridation significantly reduces healthcare costs by preventing caries lesions that would otherwise require costly restorative treatment. While earlier studies estimated a 25-30% reduction in cavities, more recent systematic reviews suggest that this benefit may be less pronounced in communities with widespread access to other fluoride sources, such as toothpaste. Despite this, water fluoridation saves U.S. communities approximately $6.5 billion annually in dental treatment expenses, with an average return on investment of $20 for every $1 spent. Water fluoridation alleviates financial burdens on individuals and contributes to substantial cost savings across the broader healthcare system.

Water fluoridation promotes equity. It benefits all members of a community, regardless of socioeconomic status or access to dental care. Research shows significant reductions in caries prevalence, particularly among vulnerable populations, such as children from low-income families who may lack access to other preventive dental measures like fluoride toothpaste or regular dental visits. By reducing disparities in oral health outcomes, water fluoridation serves as a critical public health intervention, ensuring equitable access to cavity prevention and improving overall community health.

Fluoride toothpaste complements rather than replaces the benefits of CWF. While the widespread use of fluoride toothpaste has significantly contributed to reducing dental caries due to its topical effect, CWF remains essential, particularly for individuals with limited access to oral hygiene products and dental care. Together, these measures provide a robust and comprehensive defense against dental caries, ensuring protection for the entire population.

Our Commitment. The AAC is committed to advancing oral health through evidence-based prevention, education, and research in dental caries. It strongly advocates for the continuation and expansion of community water fluoridation measures to improve oral health outcomes and reduce disparities globally.

January 7, 2025

The AAC remains committed to monitoring emerging scientific evidence. As new evidence is generated, position statements will be updated to ensure alignment with the most current and rigorous research.