Benefits l Fluoridation Facts 23 While cavities are often thought of as a problem for children, adults in the U.S. are keeping their teeth longer (partially due exposure to fluoridation) and this increased retention of teeth means more adults are at risk for cavities — especially decay of exposed root surfaces.57,58 Tooth root surfaces are covered with cementum (a softer surface than the enamel) and so are susceptible to decay. As Baby Boomers age, root decay experience is expected to increase in future years possibly to the point where older adults experience similar or higher levels of new cavities than do school children.57 Additional information on this topic can be found in this Section, Question 11. Additionally, once an individual has a cavity repaired with a filling (restoration), that filling can break down over time especially around the edges. These rough edges (or margins) can harbor bacteria that start the cavity process over again or leak which allows the bacteria to enter the tooth below the existing filling. These fillings often need to be replaced — sometimes multiple times over decades — each time growing larger to the point where the best restoration for the tooth is a crown that covers the entire tooth surface. Preventing cavities and remineralizing teeth at the earliest stages of decay is very important not only in saving tooth structure but also in reducing the cost for dental care. Community water fluoridation is an effective public health measure that is a cost-saving and cost-effective approach to preventing tooth decay. Additional information on this topic can be found in the Cost Section, Question 68. Oral health disparities exist in the United States and have been documented through extensive studies and reviews.59-61 Despite the fact that millions of people in the U.S. enjoy good dental health, disparities exist for many racial and ethnic groups, as well as by socioeconomic status, sex, age and geographic location.62 Water fluoridation helps to reduce the disparities in oral health at the community level as it benefits all residents served by community water supplies. In his 2001 Statement on Community Water Fluoridation,63 former Surgeon General Dr. David Satcher noted: …community water fluoridation continues to be the most cost-effective, practical and safe means for reducing and controlling the occurrence of dental decay in a community…water fluoridation is a powerful strategy in efforts to eliminate health disparities among populations.63 Additional information on this topic can be found in the Public Policy Section, Question 59. Today, the major focus for achieving and maintaining oral health is on prevention. Established by the U.S. Department of Health and Human Services, Healthy People 202064 provides a science-based, comprehensive set of ambitious, yet achievable, ten-year national objectives for improving the health of the public. Included under oral health is an objective to expand the fluoridation of public water supplies. Objective 13 states that at least 79.6% of the U.S. population served by community water systems should be receiving the benefits of optimally fluoridated water by the year 2020.65 Data from the CDC indicate that, in 2014, 74.4% of the U.S. population on public water systems, or a total of 211.4 million people, had access to fluoridated water.66 Conversely, approximately 25% or more than 72.7 million people on public water systems do not receive the decay preventing benefits of fluoridation. While cavities are often thought of as a problem for children, adults in the U.S. are keeping their teeth longer (partially due exposure to fluoridation) and this increased retention of teeth means more adults are at risk for cavities — especially decay of exposed root surfaces.