94 l © 2025 American Dental Association
Section 4: Public Policy
59. Does water fluoridation reduce disparities and improve health equity
in dental health?
Answer
Yes. Water fluoridation helps to reduce the disparities in oral health at the community level.
Populations with low socioeconomic status who live in fluoridated communities have less
tooth decay than their peers in non-fluoridated communities.
Fact
Health equity is defined by the CDC as “the state in which everyone has a fair and just opportunity
to attain their highest level of health.”401 It is achieved by addressing historical and ongoing injustices
overcoming economic, social, and other obstacles to health and healthcare and eliminating preventable
health disparities.401
Health equity arises from access to the social determinants of health, specifically from wealth,
power, and prestige.402 Achieving health equity requires valuing everyone equally with focused and
ongoing societal efforts to address avoidable inequalities and historical and contemporary injustices
while eliminating health and healthcare disparities.403 Health and health equity are determined
by the conditions in which people are born, grow, live, work, play, and age as well as biological
determinants.404 Structural determinants, such as political, legal, and economic factors, shape the
distribution of power and resources that affect health outcomes.404 Discriminatory practices are
often embedded in institutional and systems processes, leading to groups being underrepresented
in decision-making or being underserved.404
Health disparities are defined by the CDC as “preventable differences in the burden of disease, injury,
violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged
populations.”401 These disparities are linked with social, economic, and/or environmental disadvantage and
adversely affect groups of people who have systematically experienced more obstacles to health based
on factors such as race or ethnicity, gender, education, income, disability, geographic location, or sexual
orientation.405 Health disparities result from multiple factors, including poverty, environmental threats,
inadequate access to health care, individual and behavioral factors, and educational inequalities.406
In the first ever Surgeon General’s Report on Oral Health issued in May 2000, US Surgeon General
David Satcher noted that community water fluoridation is safe and effective in preventing dental caries
in both children and adults.47 Fluoridation benefits all residents served by community water supplies
regardless of their social or economic status.47 In 2001, Dr. Satcher issued a statement on fluoridation
in which he noted:
…community water fluoridation continues to be the most cost-effective, practical and safe means
for reducing and controlling the occurrence of dental decay in a community…water fluoridation
is a powerful strategy in efforts to eliminate health disparities among populations.394
The association between social class and disparities in dental health has been established through
extensive studies and reviews.48,127,128 The 2021 NIH) report called Oral Health in America: Advances
and Challenges407 and the CDC have emphasized the impact of social determinants of health on
oral health disparities, particularly among racial/ethnic and socioeconomic groups.
The Oral Health Foundation408 highlighted the higher prevalence of tooth decay among people of lower
socioeconomic status than among those with higher socioeconomic status due to a lack of prevention
and treatment services and a diet high in sugar, further underscoring the impact of socioeconomic
Section 4: Public Policy
59. Does water fluoridation reduce disparities and improve health equity
in dental health?
Answer
Yes. Water fluoridation helps to reduce the disparities in oral health at the community level.
Populations with low socioeconomic status who live in fluoridated communities have less
tooth decay than their peers in non-fluoridated communities.
Fact
Health equity is defined by the CDC as “the state in which everyone has a fair and just opportunity
to attain their highest level of health.”401 It is achieved by addressing historical and ongoing injustices
overcoming economic, social, and other obstacles to health and healthcare and eliminating preventable
health disparities.401
Health equity arises from access to the social determinants of health, specifically from wealth,
power, and prestige.402 Achieving health equity requires valuing everyone equally with focused and
ongoing societal efforts to address avoidable inequalities and historical and contemporary injustices
while eliminating health and healthcare disparities.403 Health and health equity are determined
by the conditions in which people are born, grow, live, work, play, and age as well as biological
determinants.404 Structural determinants, such as political, legal, and economic factors, shape the
distribution of power and resources that affect health outcomes.404 Discriminatory practices are
often embedded in institutional and systems processes, leading to groups being underrepresented
in decision-making or being underserved.404
Health disparities are defined by the CDC as “preventable differences in the burden of disease, injury,
violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged
populations.”401 These disparities are linked with social, economic, and/or environmental disadvantage and
adversely affect groups of people who have systematically experienced more obstacles to health based
on factors such as race or ethnicity, gender, education, income, disability, geographic location, or sexual
orientation.405 Health disparities result from multiple factors, including poverty, environmental threats,
inadequate access to health care, individual and behavioral factors, and educational inequalities.406
In the first ever Surgeon General’s Report on Oral Health issued in May 2000, US Surgeon General
David Satcher noted that community water fluoridation is safe and effective in preventing dental caries
in both children and adults.47 Fluoridation benefits all residents served by community water supplies
regardless of their social or economic status.47 In 2001, Dr. Satcher issued a statement on fluoridation
in which he noted:
…community water fluoridation continues to be the most cost-effective, practical and safe means
for reducing and controlling the occurrence of dental decay in a community…water fluoridation
is a powerful strategy in efforts to eliminate health disparities among populations.394
The association between social class and disparities in dental health has been established through
extensive studies and reviews.48,127,128 The 2021 NIH) report called Oral Health in America: Advances
and Challenges407 and the CDC have emphasized the impact of social determinants of health on
oral health disparities, particularly among racial/ethnic and socioeconomic groups.
The Oral Health Foundation408 highlighted the higher prevalence of tooth decay among people of lower
socioeconomic status than among those with higher socioeconomic status due to a lack of prevention
and treatment services and a diet high in sugar, further underscoring the impact of socioeconomic
