© 2025 American Dental Association l 109
Fluoridation Facts
68. Is water fluoridation a cost-effective and cost-saving method
of preventing tooth decay?
Answer
Yes. When compared with the cost of other prevention programs, water fluoridation is the most
cost-effective means of preventing tooth decay for children and adults in the United States.
A number of studies conducted during the past 15 years have attempted to place a specific dollar
value on the benefit of fluoridation. These studies, conducted in different years (and therefore
using different dollar values), encompassing different communities and populations, and using
different methodologies, have two conclusions in common: (1) for systems that serve more than
1,000 people, the economic benefit of fluoridation exceeds the cost and (2) the benefit-cost
ratios increase as the size of the populations increase largely due to economies of scale.
Fact
The cost of community water fluoridation varies for each community depending on the following
factors.469
• Size of the community (population and water usage).
• Number of fluoride injection points where fluoride additives will be added to the water system.
• Amount and type of equipment used to add and monitor fluoride additives.
• Amount and type of fluoride additive needed to reach the target fluoride level of 0.7 mg/L
its price, cost of transportation, and storage.
• Expertise and preferences of personnel at the water plant.
The economic benefits of community water fluoridation arise from dental treatment averted that
would otherwise have been needed to treat caries that would have occurred in its absence. While
all studies have concluded that fluoridation is cost-effective and cost-saving, they vary in the time
horizon and discount rate, as well as whether they include time and travel costs to patients to receive
care. Because of the decay-reducing effects of fluoride, the need for restorative dental care (fillings)
is typically lower in fluoridated communities. Restorations rarely last the entire lifespan and are usually
replaced over time by larger and more complex restorations, including root canal fillings in some
cases.470 Therefore, an individual residing in a fluoridated community will typically pay for fewer
and less-complex dental restorative services during a lifetime.
Return on Investment Model
In 2016, a study471 led by researchers from the Colorado School of Public Health created a model
of fluoridation program costs, savings, net savings, and return on investment (ROI) for the 2013 US
population with access to optimally fluoridated water systems that served 1,000 or more people.
The researchers found that national annual savings associated with individuals avoiding tooth decay in
2013 as a result of fluoridation were estimated at $6.8 billion, or $32.19 per person, for the more than
211 million people who had access to fluoridated water through community water systems serving
Cost
Section 5
Fluoridation Facts
68. Is water fluoridation a cost-effective and cost-saving method
of preventing tooth decay?
Answer
Yes. When compared with the cost of other prevention programs, water fluoridation is the most
cost-effective means of preventing tooth decay for children and adults in the United States.
A number of studies conducted during the past 15 years have attempted to place a specific dollar
value on the benefit of fluoridation. These studies, conducted in different years (and therefore
using different dollar values), encompassing different communities and populations, and using
different methodologies, have two conclusions in common: (1) for systems that serve more than
1,000 people, the economic benefit of fluoridation exceeds the cost and (2) the benefit-cost
ratios increase as the size of the populations increase largely due to economies of scale.
Fact
The cost of community water fluoridation varies for each community depending on the following
factors.469
• Size of the community (population and water usage).
• Number of fluoride injection points where fluoride additives will be added to the water system.
• Amount and type of equipment used to add and monitor fluoride additives.
• Amount and type of fluoride additive needed to reach the target fluoride level of 0.7 mg/L
its price, cost of transportation, and storage.
• Expertise and preferences of personnel at the water plant.
The economic benefits of community water fluoridation arise from dental treatment averted that
would otherwise have been needed to treat caries that would have occurred in its absence. While
all studies have concluded that fluoridation is cost-effective and cost-saving, they vary in the time
horizon and discount rate, as well as whether they include time and travel costs to patients to receive
care. Because of the decay-reducing effects of fluoride, the need for restorative dental care (fillings)
is typically lower in fluoridated communities. Restorations rarely last the entire lifespan and are usually
replaced over time by larger and more complex restorations, including root canal fillings in some
cases.470 Therefore, an individual residing in a fluoridated community will typically pay for fewer
and less-complex dental restorative services during a lifetime.
Return on Investment Model
In 2016, a study471 led by researchers from the Colorado School of Public Health created a model
of fluoridation program costs, savings, net savings, and return on investment (ROI) for the 2013 US
population with access to optimally fluoridated water systems that served 1,000 or more people.
The researchers found that national annual savings associated with individuals avoiding tooth decay in
2013 as a result of fluoridation were estimated at $6.8 billion, or $32.19 per person, for the more than
211 million people who had access to fluoridated water through community water systems serving
Cost
Section 5
