110 l © 2025 American Dental Association
Section 5: Cost
more than 1,000 people that year. With the estimated cost of the systems to fluoridate ($324 million),
the estimated net savings from fluoridation were $6.5 billion and the estimated ROI averaged 20 to
1 across water systems of all sizes (from 1,000 to more than 100,000 people, with an ROI range
of 15.5–26.2).
However, it was noted that the cost per person to fluoridate varies significantly among different-
sized communities based on a number of the factors outlined in the previous paragraph. Because of
those variables, the researchers urged communities to inform their policy decisions by identifying
their specific water system’s annual cost and comparing that cost to the annual estimated per person
savings ($32.19) in averted treatment costs. The researchers noted that in 2013, while 211 million
people had access to fluoridated water, more than 78 million people had access to a public water
system that served 1,000 or more people that was not fluoridated. The study findings suggested
that if those water systems had been fluoridated, an additional $2.5 billion could have been saved
as a result of reductions in tooth decay.471
Community Preventive Services Task Force (CPSTF) Systematic Review
The economic benefits of fluoridation were also reconfirmed in a systematic review472 conducted in
2013 by the CPSTF, which sought to update its prior review conducted in 200262 that also found that
fluoridation saved money. The 2013 review concluded that the then-recent evidence continued to show
that the economic benefit of fluoridation programs exceeds their cost, with benefit-cost ratios that
ranged from 1.12:1 to 135:1.62 Those ratios were positively associated with community population size.472
Scoping Review
A scoping review of the global literature published in 2020473 identified 24 relevant studies. All studies
concluded that water fluoridation was a cost-effective strategy to prevent tooth decay when it
was compared with non-fluoridated communities, independent of the perspective, time horizon, or
discount rate applied.
Cost of Dental Restorations
There are various types of dental restorations (fillings) commonly used for the initial treatment of
tooth decay (cavities), including amalgam (silver) and composite resins (tooth-colored). In the 2016 study
noted earlier,471 the most commonly used treatment was a two-surface composite resin restoration in
posterior (back) permanent teeth. Considering that in the United States the fee474 for a two-surface
composite resin restoration in a permanent tooth placed by a general dentist typically ranges from
$207–$278*, fluoridation clearly demonstrates significant cost savings. An individual can enjoy a
lifetime of fluoridated water for less than the cost of one dental filling.
An individual can enjoy a lifetime of fluoridated water for less than the cost of one
dental filling.
*The survey data should not be interpreted as constituting a fee schedule in any way and should not be used for that purpose.
Dentists must establish their own fees based on their individual practice and market considerations. The ADA discourages
dentists from engaging in any unlawful concerted activity regarding fees or otherwise.
Section 5: Cost
more than 1,000 people that year. With the estimated cost of the systems to fluoridate ($324 million),
the estimated net savings from fluoridation were $6.5 billion and the estimated ROI averaged 20 to
1 across water systems of all sizes (from 1,000 to more than 100,000 people, with an ROI range
of 15.5–26.2).
However, it was noted that the cost per person to fluoridate varies significantly among different-
sized communities based on a number of the factors outlined in the previous paragraph. Because of
those variables, the researchers urged communities to inform their policy decisions by identifying
their specific water system’s annual cost and comparing that cost to the annual estimated per person
savings ($32.19) in averted treatment costs. The researchers noted that in 2013, while 211 million
people had access to fluoridated water, more than 78 million people had access to a public water
system that served 1,000 or more people that was not fluoridated. The study findings suggested
that if those water systems had been fluoridated, an additional $2.5 billion could have been saved
as a result of reductions in tooth decay.471
Community Preventive Services Task Force (CPSTF) Systematic Review
The economic benefits of fluoridation were also reconfirmed in a systematic review472 conducted in
2013 by the CPSTF, which sought to update its prior review conducted in 200262 that also found that
fluoridation saved money. The 2013 review concluded that the then-recent evidence continued to show
that the economic benefit of fluoridation programs exceeds their cost, with benefit-cost ratios that
ranged from 1.12:1 to 135:1.62 Those ratios were positively associated with community population size.472
Scoping Review
A scoping review of the global literature published in 2020473 identified 24 relevant studies. All studies
concluded that water fluoridation was a cost-effective strategy to prevent tooth decay when it
was compared with non-fluoridated communities, independent of the perspective, time horizon, or
discount rate applied.
Cost of Dental Restorations
There are various types of dental restorations (fillings) commonly used for the initial treatment of
tooth decay (cavities), including amalgam (silver) and composite resins (tooth-colored). In the 2016 study
noted earlier,471 the most commonly used treatment was a two-surface composite resin restoration in
posterior (back) permanent teeth. Considering that in the United States the fee474 for a two-surface
composite resin restoration in a permanent tooth placed by a general dentist typically ranges from
$207–$278*, fluoridation clearly demonstrates significant cost savings. An individual can enjoy a
lifetime of fluoridated water for less than the cost of one dental filling.
An individual can enjoy a lifetime of fluoridated water for less than the cost of one
dental filling.
*The survey data should not be interpreted as constituting a fee schedule in any way and should not be used for that purpose.
Dentists must establish their own fees based on their individual practice and market considerations. The ADA discourages
dentists from engaging in any unlawful concerted activity regarding fees or otherwise.
