16 l © 2025 American Dental Association
Section 1: Effectiveness and Benefits
Cochrane Review (Iheozor-Ejiofor et al., 2024)
A Cochrane Review95 is a systematic review that attempts to identify, appraise, and synthesize all the
empirical evidence that meets pre-specified eligibility criteria to answer a specific research question.
The 2024 Cochrane Review27 on the effectiveness of community water fluoridation found that adding
fluoride to water supplies may lead to slightly less tooth decay in children’s baby teeth. and more
children being free of tooth decay. This review added just one new study to its 2015 report because
its stringent inclusion criteria limited it to prospective cohort studies that were started before the
initiation of a new fluoridation program. That one recent U.K. study found a reduction in the incidence
rate of caries (tooth decay) in children that was consistent with other recent studies.27
Systematic Review and Meta-Analysis—Brazil (Belotti and Frazão, 2021)
This 2021 systematic review30 examined the impact of community water fluoridation on tooth decay
among children in Brazil, a country where fluoride toothpaste is widely used. The review focused on
studies conducted in Brazil and published after 1995, analyzing data from 16 studies that assessed
tooth decay in children under 13 years old. The comparison between children living in fluoridated and
non-fluoridated communities revealed that water fluoridation significantly reduced the prevalence
and severity of tooth decay in both primary and permanent teeth. Children in fluoridated communities
had approximately 46% lower odds of experiencing decay. Additionally, among children aged 5–8
years, those in fluoridated areas had, on average, 2.28 fewer decayed teeth compared to those in
non-fluoridated areas. These findings underscore the effectiveness of water fluoridation in preventing
tooth decay in children, even in settings where other fluoride sources are commonly available.30
National Health and Medical Research Council Review—Australia (2017)
In 2017, the Australian government’s National Health and Medical Research Council (NHMRC) released
the NHMRC Public Statement 2017–Water Fluoridation and Human Health in Australia,96 recommending
community water fluoridation as a safe, effective, and ethical way to help reduce tooth decay. Based on
a comprehensive review of the evidence, published in 2016, and the translation of that evidence into the
NHMRC Information Paper–Water Fluoridation: Dental and Other Human Health Outcomes,34 published
in 2017, the Public Statement noted that the NHMRC found that water fluoridation reduces tooth decay
by 26–44% in children and adolescents and by 27% in adults. Additionally, it noted that recent Australian
research found that access to fluoridated water from an early age is associated with less tooth decay
in adults. The Statement notes that NHMRC supports Australian states and territories fluoridating their
drinking water supplies within the range of 0.6 to 1.1 mg/L.96
The Guide to Community Preventive Services (2013)
Established by the HHS in 1996, the Community Preventive Services Task Force (CPSTF) develops and
disseminates guidance on which community-based health promotion and disease prevention intervention
approaches work and which do not work, based on available scientific evidence. The Task Force issues
findings based on systematic reviews of effectiveness and economic evidence. The Guide to Community
Preventive Services (“The Community Guide”) is a collection of evidence-based findings of the CPSTF and is
designed to assist decision makers in selecting interventions to improve health and prevent disease.97
In a 2013 update of the evidence, the CPSTF continued to recommend community water fluoridation
to reduce tooth decay, noting that cavities decreased when fluoridation was implemented and that
cavities increased when fluoridation was stopped, as compared to communities that continued
fluoridation.42
Section 1: Effectiveness and Benefits
Cochrane Review (Iheozor-Ejiofor et al., 2024)
A Cochrane Review95 is a systematic review that attempts to identify, appraise, and synthesize all the
empirical evidence that meets pre-specified eligibility criteria to answer a specific research question.
The 2024 Cochrane Review27 on the effectiveness of community water fluoridation found that adding
fluoride to water supplies may lead to slightly less tooth decay in children’s baby teeth. and more
children being free of tooth decay. This review added just one new study to its 2015 report because
its stringent inclusion criteria limited it to prospective cohort studies that were started before the
initiation of a new fluoridation program. That one recent U.K. study found a reduction in the incidence
rate of caries (tooth decay) in children that was consistent with other recent studies.27
Systematic Review and Meta-Analysis—Brazil (Belotti and Frazão, 2021)
This 2021 systematic review30 examined the impact of community water fluoridation on tooth decay
among children in Brazil, a country where fluoride toothpaste is widely used. The review focused on
studies conducted in Brazil and published after 1995, analyzing data from 16 studies that assessed
tooth decay in children under 13 years old. The comparison between children living in fluoridated and
non-fluoridated communities revealed that water fluoridation significantly reduced the prevalence
and severity of tooth decay in both primary and permanent teeth. Children in fluoridated communities
had approximately 46% lower odds of experiencing decay. Additionally, among children aged 5–8
years, those in fluoridated areas had, on average, 2.28 fewer decayed teeth compared to those in
non-fluoridated areas. These findings underscore the effectiveness of water fluoridation in preventing
tooth decay in children, even in settings where other fluoride sources are commonly available.30
National Health and Medical Research Council Review—Australia (2017)
In 2017, the Australian government’s National Health and Medical Research Council (NHMRC) released
the NHMRC Public Statement 2017–Water Fluoridation and Human Health in Australia,96 recommending
community water fluoridation as a safe, effective, and ethical way to help reduce tooth decay. Based on
a comprehensive review of the evidence, published in 2016, and the translation of that evidence into the
NHMRC Information Paper–Water Fluoridation: Dental and Other Human Health Outcomes,34 published
in 2017, the Public Statement noted that the NHMRC found that water fluoridation reduces tooth decay
by 26–44% in children and adolescents and by 27% in adults. Additionally, it noted that recent Australian
research found that access to fluoridated water from an early age is associated with less tooth decay
in adults. The Statement notes that NHMRC supports Australian states and territories fluoridating their
drinking water supplies within the range of 0.6 to 1.1 mg/L.96
The Guide to Community Preventive Services (2013)
Established by the HHS in 1996, the Community Preventive Services Task Force (CPSTF) develops and
disseminates guidance on which community-based health promotion and disease prevention intervention
approaches work and which do not work, based on available scientific evidence. The Task Force issues
findings based on systematic reviews of effectiveness and economic evidence. The Guide to Community
Preventive Services (“The Community Guide”) is a collection of evidence-based findings of the CPSTF and is
designed to assist decision makers in selecting interventions to improve health and prevent disease.97
In a 2013 update of the evidence, the CPSTF continued to recommend community water fluoridation
to reduce tooth decay, noting that cavities decreased when fluoridation was implemented and that
cavities increased when fluoridation was stopped, as compared to communities that continued
fluoridation.42
