108 l © 2025 American Dental Association
Section 4: Public Policy
to unacceptable risks to the environment. Additionally, the report concluded there was insufficient
evidence or no evidence that fluoridation was linked to endemic skeletal fluorosis, osteosarcoma,
lower IQs in children, or thyroid or reproductive problems.43
There are parts of the world where water fluoridation is not common. In some of these instances
water fluoridation is not feasible due to the lack of a central water supply, the prioritization of other
life-threatening health needs, the lack of trained technical personnel, or insufficient funds for start-up
and maintenance costs. In some cases where water fluoridation has not been implemented, countries
have chosen instead to institute salt fluoridation programs.
67. Is community water fluoridation banned in Europe?
Answer
No. There is no country in Europe that bans community water fluoridation.
Fact
Under EU laws and regulations, the individual member states can decide whether to fluoridate water.
Members of the EU construct their own water quality regulations within the framework of the
Drinking Water Directive,467 adopted in 1998, which outlines the quality of water intended for human
consumption. They can also decide whether to add fluoride to milk or salt products. There is no EU-wide
obligation to add fluoride to any product consumed by humans, including water, nor is there an EU-wide
obligation not to add fluoride to any product, including water.463
The Drinking Water Directive provides maximum permissible concentrations for many substances, one
of which is fluoride. The directive does not require or prohibit fluoridation it merely requires that the
fluoride concentration in water not exceed the maximum permissible concentration of 1.5 mg/L.467
Water fluoridation is not practical in some European countries because of complex water systems with
numerous water sources. In many cases, there are also technical, legal, financial, or political reasons
that water fluoridation has not been implemented. As an alternative to water fluoridation, many
European countries have opted for the use of dietary fluoride supplements or salt fluoridation.
Basel, Switzerland, is one such example.468 Those opposed to water fluoridation claimed a large victory
when Basel voted to cease water fluoridation in 2003. The facts are that Basel was the lone city with
fluoridated water surrounded by communities that used fluoridated salt. In the mid-1990s, trade
barriers that had prevented fluoridated salt from being sold to those living in Basel fell, and soon it was
evident that residents were receiving fluoride from salt as well as from drinking water. The government
voted to cease water fluoridation in 2003 because of this availability and the use of fluoridated salt in
the community. Basel, Switzerland did not stop providing fluoride. Officials simply chose another type
of fluoridation—salt fluoridation.468
Those opposed to fluoridation sometimes comment that “most of Europe has rejected water fluoridation.”
But what is not mentioned is that there are a number of countries in Europe that have opted to use
fluoridated salt or milk fluoridation.467
Additional information on this topic can be found in the Benefits Section, Question 14.
Section 4: Public Policy
to unacceptable risks to the environment. Additionally, the report concluded there was insufficient
evidence or no evidence that fluoridation was linked to endemic skeletal fluorosis, osteosarcoma,
lower IQs in children, or thyroid or reproductive problems.43
There are parts of the world where water fluoridation is not common. In some of these instances
water fluoridation is not feasible due to the lack of a central water supply, the prioritization of other
life-threatening health needs, the lack of trained technical personnel, or insufficient funds for start-up
and maintenance costs. In some cases where water fluoridation has not been implemented, countries
have chosen instead to institute salt fluoridation programs.
67. Is community water fluoridation banned in Europe?
Answer
No. There is no country in Europe that bans community water fluoridation.
Fact
Under EU laws and regulations, the individual member states can decide whether to fluoridate water.
Members of the EU construct their own water quality regulations within the framework of the
Drinking Water Directive,467 adopted in 1998, which outlines the quality of water intended for human
consumption. They can also decide whether to add fluoride to milk or salt products. There is no EU-wide
obligation to add fluoride to any product consumed by humans, including water, nor is there an EU-wide
obligation not to add fluoride to any product, including water.463
The Drinking Water Directive provides maximum permissible concentrations for many substances, one
of which is fluoride. The directive does not require or prohibit fluoridation it merely requires that the
fluoride concentration in water not exceed the maximum permissible concentration of 1.5 mg/L.467
Water fluoridation is not practical in some European countries because of complex water systems with
numerous water sources. In many cases, there are also technical, legal, financial, or political reasons
that water fluoridation has not been implemented. As an alternative to water fluoridation, many
European countries have opted for the use of dietary fluoride supplements or salt fluoridation.
Basel, Switzerland, is one such example.468 Those opposed to water fluoridation claimed a large victory
when Basel voted to cease water fluoridation in 2003. The facts are that Basel was the lone city with
fluoridated water surrounded by communities that used fluoridated salt. In the mid-1990s, trade
barriers that had prevented fluoridated salt from being sold to those living in Basel fell, and soon it was
evident that residents were receiving fluoride from salt as well as from drinking water. The government
voted to cease water fluoridation in 2003 because of this availability and the use of fluoridated salt in
the community. Basel, Switzerland did not stop providing fluoride. Officials simply chose another type
of fluoridation—salt fluoridation.468
Those opposed to fluoridation sometimes comment that “most of Europe has rejected water fluoridation.”
But what is not mentioned is that there are a number of countries in Europe that have opted to use
fluoridated salt or milk fluoridation.467
Additional information on this topic can be found in the Benefits Section, Question 14.
