© 2025 American Dental Association l 105
Fluoridation Facts
65. Why does the public sometimes vote against community water
fluoridation when it is put to a public vote?
Answer
Fluoridation votes are sometimes unsuccessful due to voter apathy or low voter turnout due to
the vote being held as a special election or in an “off” year, confusing ballot language (a “no” vote
sometimes translates to support for fluoridation), blurring of scientific issues, the use of scare
tactics by those opposed to fluoridation, long campaigns that lead to “fluoridation fatigue,” lack of
leadership by elected officials, and a lack of political campaign skills among health professionals.
Fact
The fact is that fluoridation votes in the United States are more often successful than not. In 2016, it
was common to see those opposed to fluoridation citing more than “500 success stories” in regard to
communities rejecting water fluoridation.458 What is not made clear is that the number of communities
in these statements is a global number. Many of those communities are outside the United States.458
Since 2000, nearly 52 million people have been added to the population on US public water systems
that enjoys the benefit of optimally fluoridated water.57,459 In 2000, 65% of the public on public
water systems received fluoridated water.459 In 2022, the percentage had increased to 72.3% of the
population.57 However, despite the continuing growth of fluoridation in this country over the past
several decades, millions of people do not yet receive the protective benefits of fluoride in their
drinking water. CDC data from 2022 indicated that more than 25% of the population served by public
water systems did not have access to fluoridated water.57 In 2024, 45 of the 50 largest cities were
fluoridated.460 Of the 45 cities, 43 were fluoridated by adjustment and two had naturally occurring
fluoride at the recommended levels. The remaining five largest non-fluoridated cities (in order of
population largest to smallest) were: Portland, Oregon Tucson, Arizona Fresno, California Colorado
Springs, Colorado and Bakersfield, California.460
In 2020, recognizing the ongoing need to improve health and well-being, the HHS revised national
health objectives to be achieved by the year 2030.55 Included under oral health was an objective to
significantly expand the fluoridation of public water supplies. Specifically, Objective OH-11 of Healthy
People 2030 states that at least 77.1% of the US population served by community water systems
should be receiving the benefits of optimally fluoridated water by 2030.56 As of 2022, 22 states and
the District of Columbia met or exceeded the 2030 objective.57 Although water fluoridation reaches
some residents in every state, the coverage is uneven. Data from 2022 indicated that 27 states
provided fluoridation benefits to 75% or more of their residents on community water systems
while 10 states were at or below 50%.57
Fluoridation campaigns can vary greatly from community to community. To paraphrase an old saying,
“If you’ve seen one fluoridation campaign, you’ve seen one fluoridation campaign.” A number of
factors commonly come into play when fluoridation is put to a public vote and does not succeed.
Among those factors are a lack of funding, public and professional apathy, the failure of many
legislators and community leaders to take a stand because of perceived controversy, low voter
turnout, and the difficulty faced by an electorate in evaluating scientific information in the midst
of emotional charges by opponents. Voters are often unaware of the fluoride content of their water.
Unfortunately, citizens sometimes mistakenly believe their water contains the recommended level of
fluoride when, in fact, it does not. On the other hand, people sometimes say they have great teeth and
don’t need fluoridation when, in fact, the major reason they have such good teeth is because they’ve
Fluoridation Facts
65. Why does the public sometimes vote against community water
fluoridation when it is put to a public vote?
Answer
Fluoridation votes are sometimes unsuccessful due to voter apathy or low voter turnout due to
the vote being held as a special election or in an “off” year, confusing ballot language (a “no” vote
sometimes translates to support for fluoridation), blurring of scientific issues, the use of scare
tactics by those opposed to fluoridation, long campaigns that lead to “fluoridation fatigue,” lack of
leadership by elected officials, and a lack of political campaign skills among health professionals.
Fact
The fact is that fluoridation votes in the United States are more often successful than not. In 2016, it
was common to see those opposed to fluoridation citing more than “500 success stories” in regard to
communities rejecting water fluoridation.458 What is not made clear is that the number of communities
in these statements is a global number. Many of those communities are outside the United States.458
Since 2000, nearly 52 million people have been added to the population on US public water systems
that enjoys the benefit of optimally fluoridated water.57,459 In 2000, 65% of the public on public
water systems received fluoridated water.459 In 2022, the percentage had increased to 72.3% of the
population.57 However, despite the continuing growth of fluoridation in this country over the past
several decades, millions of people do not yet receive the protective benefits of fluoride in their
drinking water. CDC data from 2022 indicated that more than 25% of the population served by public
water systems did not have access to fluoridated water.57 In 2024, 45 of the 50 largest cities were
fluoridated.460 Of the 45 cities, 43 were fluoridated by adjustment and two had naturally occurring
fluoride at the recommended levels. The remaining five largest non-fluoridated cities (in order of
population largest to smallest) were: Portland, Oregon Tucson, Arizona Fresno, California Colorado
Springs, Colorado and Bakersfield, California.460
In 2020, recognizing the ongoing need to improve health and well-being, the HHS revised national
health objectives to be achieved by the year 2030.55 Included under oral health was an objective to
significantly expand the fluoridation of public water supplies. Specifically, Objective OH-11 of Healthy
People 2030 states that at least 77.1% of the US population served by community water systems
should be receiving the benefits of optimally fluoridated water by 2030.56 As of 2022, 22 states and
the District of Columbia met or exceeded the 2030 objective.57 Although water fluoridation reaches
some residents in every state, the coverage is uneven. Data from 2022 indicated that 27 states
provided fluoridation benefits to 75% or more of their residents on community water systems
while 10 states were at or below 50%.57
Fluoridation campaigns can vary greatly from community to community. To paraphrase an old saying,
“If you’ve seen one fluoridation campaign, you’ve seen one fluoridation campaign.” A number of
factors commonly come into play when fluoridation is put to a public vote and does not succeed.
Among those factors are a lack of funding, public and professional apathy, the failure of many
legislators and community leaders to take a stand because of perceived controversy, low voter
turnout, and the difficulty faced by an electorate in evaluating scientific information in the midst
of emotional charges by opponents. Voters are often unaware of the fluoride content of their water.
Unfortunately, citizens sometimes mistakenly believe their water contains the recommended level of
fluoride when, in fact, it does not. On the other hand, people sometimes say they have great teeth and
don’t need fluoridation when, in fact, the major reason they have such good teeth is because they’ve
