100 American Dental Association Figure 9. State Fluoridation Status * Data Source: Centers for Disease Control and Prevention/Division of Oral Health. “National Fluoridation Statistics” 2014. Available at https://www.cdc.gov/fluoridation/statistics/2014stats.htm 75 - 100% 50 - 74% 25 - 49% 0 - 24% personal litigation.86 While no court of last resort has ever ruled against fluoridation, community leaders can be swayed by the threat of litigation due to the cost and time involved in defending even a groundless suit, not to mention threats of political fallout. The American Dental Association (ADA) knows of no cases in which community leaders have been found liable for their pro-fluoridation efforts. In no instance has fluoridation been discontinued because it was proven harmful in any way.85-87 Defeats of referenda or the discontinuance of fluoridation have occurred most often when a small, vocal and well organized group has used a barrage of fear-inspiring allegations designed to confuse the electorate. Adoption of fluoridation is ultimately a decision of state or local decision makers, whether determined by elected officials, health officers or the voting public. Fluoridation can be enacted through state legislation, administrative regulation, ordiance or a public referendum. While fluoridation is not legislated at the federal level, it is legislated at the state and local level. As with any public health measure, a community has the right and obligation to protect the health and welfare of its citizens, even if it means overriding individual objections to implement fluoridation. Those opposed to fluoridation sometimes comment that “the government is forcing fluoridation” on the community. But who is “the government?” The fact is that since fluoridation is implemented by state or local votes (by city councils or public vote), the people are “the government.” Voters elect officials at the Percentage of population on community water systems receiving fluoridated water.*