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Community water fluoridation

Health Factors: Access to Care
Decision Makers: Local Government State Government Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 100% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Communities that fluoridate water adjust and monitor fluoride in public water supplies to reach optimal fluoride concentrations. As of 2015, the US Public Health Service (US PHS) recommends that community drinking water contain .7 ppm of fluoride, down from the  previous standard, a range of .7 to 1.2 ppm, set in 1962 (US PHS-Fluoride, Truman 2002). This change accounts for other sources of fluoride (e.g., toothpaste) and was intended to avoid the unwanted health effects of excessive fluoride (US PHS-Fluoride, EPA-Fluoride 2011).

Expected Beneficial Outcomes

Reduced cavities

Evidence of Effectiveness

There is strong evidence that community water fluoridation (CWF) cost-effectively prevents cavities (CG-Oral health, Truman 2002, Cochrane Iheozor-Ejiofor 2015, CDC-Fluoridation, US PHS-Fluoride) across socio-economic groups (CG-Oral health). Effects are strongest in low income communities (Burt 2002), and in communities with poor oral hygiene and limited access to oral health care (Pizzo 2007).

CWF reduces cavities in children’s baby teeth and permanent teeth (Cochrane Iheozor-Ejiofor 2015). High fluoride intake can increase the risk of mild tooth staining from dental fluorosis (CG-Oral health, Whelton 2004), especially for infants who drink formula instead of breast milk (Prystupa 2011, CDC-Fluoridation). Additional study is needed to determine other potential adverse effects of excessive fluoride exposure (CG-Oral health, Prystupa 2011, Peckham 2014).

As of 2013, fluoridation cost an average of 11 cents per person in large US communities and $4.92 per person in very small communities (less than 1000); cost savings range from $29.23 to $73.50 per person in averted dental treatment and productivity losses (Ran 2016, CG-Oral health). 

Implementation

United States

As of 2012, 74% of Americans live in communities that fluoridate their water (CDC-Fluoridation).

Wisconsin

As of 2012, 89% of Wisconsinites (approximately 4 million people) live in communities that fluoridate their water (CDC-CWF Statistics); 3.5 million have access to systems with advised fluoride levels (WDA-Fluoridation).

Implementation Resources

ADA-Fluoridation - American Dental Association (ADA). Mouth Healthy: Fluoridation information. Accessed on April 25, 2016
CDC-CWF Resources - Centers for Disease Control and Prevention (CDC). Community water fluoridation (CWF): Resources for public health partners and professionals. Accessed on April 25, 2016
CDC-Fluoridation - Centers for Disease Control and Prevention (CDC). Community water fluoridation. Accessed on November 30, 2015

Citations - Description

EPA-Fluoride 2011 - United States Environmental Protection Agency (EPA). EPA and HHS announce new scientific assessments and actions on fluoride/agencies working together to maintain benefits of preventing tooth decay while preventing excessive exposure. 2011. Accessed on February 5, 2016
Truman 2002* - Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. American Journal of Preventive Medicine. 2002;23(1 Suppl 1):21–54. Accessed on February 24, 2017
US PHS-Fluoride - US Department of Health and Human Services (US DHHS) Federal Panel on Community Water Fluoridation. US public health service (US PHS) recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Reports. 2015;130(4):318-331. Accessed on March 16, 2017

Citations - Evidence

Burt 2002* - Burt BA. Fluoridation and social equity. Journal of Public Health Dentistry. 2002;62(4):195–200. Accessed on December 1, 2015
CDC-Fluoridation - Centers for Disease Control and Prevention (CDC). Community water fluoridation. Accessed on November 30, 2015
CG-Oral health - The Guide to Community Preventive Services (The Community Guide). Oral health. Accessed on February 24, 2017
Cochrane Iheozor-Ejiofor 2015* - Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews. 2015;(6):CD010856. Accessed on April 25, 2016
Peckham 2014 - Peckham S, Awofeso N. Water fluoridation: A critical review of the physiological effects of ingested fluoride as a public health intervention. The Scientific World Journal. 2014;2014:293019 Accessed on April 25, 2016
Pizzo 2007* - Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: A critical review. Clinical Oral Investigations. 2007;11(3):189–93. Accessed on February 24, 2017
Prystupa 2011* - Prystupa J. Fluorine - A current literature review. An NRC and ATSDR based review of safety standards for exposure to fluorine and fluorides. Toxicology Mechanisms and Methods. 2011;21(2):103–70. Accessed on February 24, 2017
Ran 2016* - Ran T, Chattopadhyay SK, Community Preventive Services Task Force. Economic evaluation of community water fluoridation: A community guide systematic review. American Journal of Preventive Medicine. 2016. Accessed on April 25, 2016
Truman 2002* - Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. American Journal of Preventive Medicine. 2002;23(1 Suppl 1):21–54. Accessed on February 24, 2017
US PHS-Fluoride - US Department of Health and Human Services (US DHHS) Federal Panel on Community Water Fluoridation. US public health service (US PHS) recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Reports. 2015;130(4):318-331. Accessed on March 16, 2017
Whelton 2004* - Whelton HP, Ketley CE, McSweeney F, O’Mullane DM. A review of fluorosis in the European Union: Prevalence, risk factors and aesthetic issues. Community Dentistry and Oral Epidemiology. 2004;32(Suppl 1):9–18. Accessed on November 18, 2015

Citations - Implementation

CDC-CWF Statistics - Centers for Disease Control and Prevention (CDC). Community water fluoridation (CWF): 2012 water fluoridation statistics. Accessed on April 25, 2016
CDC-Fluoridation - Centers for Disease Control and Prevention (CDC). Community water fluoridation. Accessed on November 30, 2015
WDA-Fluoridation - Wisconsin Dental Association. Your oral health: Water fluoridation. Accessed on April 25, 2016

Page Last Updated

May 2, 2016

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