6 l © 2025 American Dental Association
Introduction
Water Fluoridation as a Public Health Measure
Throughout decades of research and more than 80 years of practical experience, the fluoridation of
public water supplies has dramatically improved public oral health. In 1994, the US Department of Health
and Human Services (HHS) issued a report that reviewed public health achievements.46 Along with other
successful public health measures, such as the virtual eradication of polio and reductions in childhood blood
lead levels, fluoridation was lauded as one of the most economical preventive interventions in the nation.46
In 2000, US Surgeon General Dr. David Satcher issued the first Surgeon General report on oral health, Oral
Health in America: A Report of the Surgeon General.47 In the report, Dr. Satcher stated that community water
fluoridation continues to be the most cost-effective, practical, and safe means for reducing and controlling the
occurrence of tooth decay in a community. Additionally, Dr. Satcher noted that water fluoridation is a powerful
strategy in efforts to eliminate health disparities across populations. Studies have shown that water fluoridation
is the most significant strategy employed to reduce disparities in tooth decay.48–51
Additional information about this topic can be found in the Public Policy Section, Question 59.
Because of the important role fluoridation has played in the reduction of tooth decay,
the CDC proclaimed community water fluoridation as one of 10 great public health
achievements of the 20th century.1,2
In the 2003 National Call to Action to Promote Oral Health,52 Surgeon General Dr. Richard Carmona called on
policymakers, community leaders, private industry, health professionals, the media, and the public to affirm
that oral health is essential to general health and well-being. Additionally, Dr. Carmona urged these groups to
apply strategies to enhance the adoption and maintenance of proven community-based interventions such
as community water fluoridation.
Writing in Public Health Reports in 2010, Surgeon General Dr. Rebecca Benjamin noted that, “Community
water fluoridation continues to be a vital, cost-effective method of preventing dental caries.”53
In a 2015 Surgeon General’s Perspective54 issued to coincide with the release of the updated USPHS
recommendation on fluoride levels in drinking water to prevent tooth decay, Surgeon General Dr. Vivek H.
Murthy stated, “As Surgeon General, I encourage all Americans to make choices that enable them to prevent
illness and promote well-being. Community water fluoridation is one of the most practical, cost-effective,
equitable, and safe measures communities can take to prevent tooth decay and improve oral health.”54
HHS announced in 2015 that, after more than four years of additional research and review following the
initial notice of intent, the USPHS had made a final recommendation on the fluoride level in drinking water39
that updated and replaced the 1962 Drinking Water Standards related to community water fluoridation.
In this guidance, the single optimal concentration of fluoride in drinking water of 0.7 mg/L (milligrams per
liter) for all the United States was defined as “the concentration that provides the best balance of protection
from dental caries while limiting the risk of dental fluorosis.”39
Additional information about this topic can be found in the Safety Section, Question 19.
Introduction
Water Fluoridation as a Public Health Measure
Throughout decades of research and more than 80 years of practical experience, the fluoridation of
public water supplies has dramatically improved public oral health. In 1994, the US Department of Health
and Human Services (HHS) issued a report that reviewed public health achievements.46 Along with other
successful public health measures, such as the virtual eradication of polio and reductions in childhood blood
lead levels, fluoridation was lauded as one of the most economical preventive interventions in the nation.46
In 2000, US Surgeon General Dr. David Satcher issued the first Surgeon General report on oral health, Oral
Health in America: A Report of the Surgeon General.47 In the report, Dr. Satcher stated that community water
fluoridation continues to be the most cost-effective, practical, and safe means for reducing and controlling the
occurrence of tooth decay in a community. Additionally, Dr. Satcher noted that water fluoridation is a powerful
strategy in efforts to eliminate health disparities across populations. Studies have shown that water fluoridation
is the most significant strategy employed to reduce disparities in tooth decay.48–51
Additional information about this topic can be found in the Public Policy Section, Question 59.
Because of the important role fluoridation has played in the reduction of tooth decay,
the CDC proclaimed community water fluoridation as one of 10 great public health
achievements of the 20th century.1,2
In the 2003 National Call to Action to Promote Oral Health,52 Surgeon General Dr. Richard Carmona called on
policymakers, community leaders, private industry, health professionals, the media, and the public to affirm
that oral health is essential to general health and well-being. Additionally, Dr. Carmona urged these groups to
apply strategies to enhance the adoption and maintenance of proven community-based interventions such
as community water fluoridation.
Writing in Public Health Reports in 2010, Surgeon General Dr. Rebecca Benjamin noted that, “Community
water fluoridation continues to be a vital, cost-effective method of preventing dental caries.”53
In a 2015 Surgeon General’s Perspective54 issued to coincide with the release of the updated USPHS
recommendation on fluoride levels in drinking water to prevent tooth decay, Surgeon General Dr. Vivek H.
Murthy stated, “As Surgeon General, I encourage all Americans to make choices that enable them to prevent
illness and promote well-being. Community water fluoridation is one of the most practical, cost-effective,
equitable, and safe measures communities can take to prevent tooth decay and improve oral health.”54
HHS announced in 2015 that, after more than four years of additional research and review following the
initial notice of intent, the USPHS had made a final recommendation on the fluoride level in drinking water39
that updated and replaced the 1962 Drinking Water Standards related to community water fluoridation.
In this guidance, the single optimal concentration of fluoride in drinking water of 0.7 mg/L (milligrams per
liter) for all the United States was defined as “the concentration that provides the best balance of protection
from dental caries while limiting the risk of dental fluorosis.”39
Additional information about this topic can be found in the Safety Section, Question 19.
