Dental Tribune India

Dentists need to promote community water fluoridation (CWF) – latest report

By Dr. Isha Rao, Dental Tribune South Asia
November 06, 2021

A recent communication paper titled ‘Community Water Fluoridation and the Integrity of Equitable Public Health Infrastructure” reviews the 76-year history of CWF in the United States (US) and states the need for its advocacy by dental professionals in the current scenario.

Centre for Disease Control and Prevention (CDC) defines Community Water Fluoridation (CWF) as ‘the process of adjusting the amount of fluoride in drinking water to a level recommended for preventing tooth decay.’ 

CWF, as a dental program, is in a unique position to prevent caries across all socio-economic groups. Although not everyone has access to dental care, everyone in the United States can use public drinking tap water.

Dental caries, the most prevalent chronic disease globally, is known to disproportionately affect communities of lower socio-economic strata. Mexican Americans have the highest frequency of dental caries (73%) in the US, followed by non-Hispanic black children (54%). Caries prevalence is lowest in non-Hispanic white children (44%).

Many factors are currently leading to a decrease in the expansion of CWF:

  1. There is a growing misconception that caries is no longer a public health concern and that fluoridation is unnecessary.
  2. CWF involves political processes that make this measure challenging to implement.
  3. Opponents of CWF make incorrect claims about its adverse effects to shape public opinion. 

Scientists have found no convincing evidence on the harmful effects of CWF. There have been claims that the prevalence of kidney disease and diabetes in Black Americans puts them at risk of fluoridation’s adverse effects. Scientific evidence has shown that these claims are false. These patients can drink optimally fluoridated water without any ill effects. 

Using CWF, we can reduce the cavity rate at the population level by 25%.

Agnotologists (those that study culturally-induced ignorance) describe the current situation as being governed by active rejection or manipulation of scientific data.

To address concerns of mistrust, dentists should provide a clear explanation of scientific data. They should provide accurate information in a ‘health-literate manner to the public, who may doubt the program’s efficacy.

Dental associations are an essential resource for health workers to get information on CWF advocacy. Evidence-based resources like the ones stated below are available:

  1. 2018 Edition of Fluoridation Facts by the American Dental Association (ADA)
  2. CDC has a repository of fluoridation information and innovations in technology.
  3. Public Health 3.0- A model for public health infrastructure by the US Department of Health and Human Services.

The US Public Health Service (USPHS) recommends 0.7 mg/l of fluoride as the optimal water fluoride concentration. This concentration offers the most significant oral health benefit, without risk to other organs.

The cost of one person’s lifetime of water fluoridation is less than the cost of one dental filling in the US.

In July 2020, former chief dental officers of the USPHS wrote a letter supporting CWF to prevent dental caries and improve oral and general health.

CWF is, after all, the most cost-effective population-based tool to reduce tooth decay. It emphasizes the prevention of caries over costlier dental treatment.

Hence dental professionals need to promote community water fluoridation. According to the paper, dentists promoting CWF are critical in sustaining and expanding this program. We must use the best evidence on water fluoridation and share the science behind this vital practice.


  1. Community water fluoridation and the integrity of equitable public health infrastructure.
  2. Water Fluoridation Basics | Community Water Fluoridation


Dr. Isha Rao (BDS) graduated from MGM Dental College, Navi Mumbai in 2020. She currently works as an Assistant Editor (Public Health) at Dental Tribune South Asia and covers various areas in Public Health. She is interested in pursuing research in the domain of public health policy and financing.

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