Position Statements of the AAC
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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.
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The American Academy of Cariology (AAC) strongly supports the use of fluoride toothpaste as a cornerstone method for caries control in all ages.
Fluoride toothpaste is an effective, evidence-based method for caries control. Dental caries is caused by frequent exposure of dental biofilm to dietary sugars. Therefore, the most effective use of fluoride is through methods that also promote biofilm removal—such as brushing with fluoride toothpaste, which not only disrupts the biofilm but also enhances fluoride availability within the oral cavity. Fluoride increase in the dental biofilm which was not perfectly removed by brushing, or in saliva surrounding teeth which were cleaned, helps caries control by reducing mineral loss and enhancing mineral gain. Robust clinical trials and systematic reviews validate that twice-daily brushing with fluoride toothpaste reduces the incidence of dental caries in children, adolescents, adults, and elderly populations.
Fluoride toothpaste is safe. Fluoride toothpaste is considered safe across all age groups when used properly. Although the ingestion of fluoride from swallowing toothpaste during early childhood can cause dental fluorosis, the levels are restricted to the very mild and mild levels, even in populations also exposed to fluoridated water. Guidance for parents to supervise young children’s brushing, use a smear or pea-sized amount of toothpaste based on age of the child, and encourage spitting out the toothpaste further minimizes the risk of fluorosis.
Fluoride toothpaste is accessible and cost-effective. Fluoride toothpaste is widely available over-the-counter and is affordable. Widespread adoption of fluoride toothpaste has contributed to marked declines in caries prevalence over the last five decades, even in countries without community water fluoridation.
Fluoride toothpaste complements community water fluoridation. While water fluoridation delivers population-level dental caries protection, fluoride toothpaste offers direct, targeted benefits to the surfaces most at risk for caries. Importantly, the effect of fluoride toothpaste and water fluoridation is additive, meaning that populations benefit more when exposed to both.
Fluoride toothpaste is recommended for all. Dental caries is a widespread disease linked to our exposure to dietary sugars. The best way for all of us to keep caries under control is by the use of a fluoride toothpaste twice daily, in the morning and before going to bed.
Our Commitment. The AAC is dedicated to advancing evidence-based oral health practices through education and research. We advocate for continued public education on the benefits and safe use of fluoride toothpaste and support equitable access to fluoride-containing oral hygiene products worldwide to further reduce dental caries and improve quality of life.
November 21, 2025
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The American Academy of Cariology (AAC) strongly supports the use of fluoride toothpaste to help stop cavities in people of all ages.
Using toothpaste with fluoride is one of the best ways to prevent cavities. Brushing your teeth with fluoride toothpaste helps remove germs and helps protect your teeth. Scientists have found that brushing twice a day with this kind of toothpaste helps keep teeth healthy for kids, teens, adults, and older people.
Fluoride toothpaste is safe if you use it the right way. Parents should help young kids use a small amount (like a tiny smear or a pea-sized drop), teach them to spit it out, and make sure they don’t swallow it.
Fluoride toothpaste is easy to find over-the-counter and usually not expensive. Using it has helped lower the number of cavities in many countries over the years. If you live in a place where the water has fluoride, you get the benefit from both, fluoride toothpaste and water; together they make teeth even more resistant to cavities.
Everyone should use fluoride toothpaste because cavities are common across all ages and are caused by sugary foods, which are very frequent in our diet. Brushing with fluoride toothpaste twice a day—morning and night—is the best way to keep your teeth healthy.
The AAC wants everyone to know that using fluoride toothpaste is safe and effective to help stop cavities.
Our Commitment: The AAC works to improve dental health by encouraging smart, science-based ways to prevent cavities. We support teaching people how using fluoride toothpaste helps their teeth and how to use it safely. We also believe everyone, no matter where they live, should be able to get toothpaste with fluoride to help prevent cavities and have healthier lives.
November 21, 2025