CLINICAL QUESTION

Do community water fluoridation programs prevent dental caries?

EVIDENCE-BASED ANSWER

Fluoridating water may result in a small reduction in tooth decay in children’s primary teeth, but its 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.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Dental caries, or cavities, are a significant public health issue, affecting approximately 60% to 90% of the global population. Community water fluoridation began in the United States in 1945 and is now practiced in approximately 25 countries.¹ It is widely regarded as a safe and effective means of reducing dental caries in children and adults. State and local governments determine whether to fluoridate water supplies. According to the Centers for Disease Control and Prevention (CDC) 2022 national water fluoridation statistics published in 2024 (prepared using water system data reported by states to the CDC Water Fluoridation Reporting System as of December 31, 2022), 62.8% of the US population had access to fluoridated water.² Fluoridated water availability varies widely among states, with less than one-third of people in Hawaii, New Jersey, Oregon, Montana, and Idaho having access.² Fluoridated water and fluoride toothpaste work synergistically to prevent cavities.