© 2025 American Dental Association l 21
Fluoridation Facts
United States: Juneau and Anchorage, Alaska (Meyer et al., 2022)
A retrospective study published in 2022113 revisited the impact of Juneau after the cessation of
community water fluoridation in 2007 by comparing it to comparable data from Anchorage, where
fluoridation continued. Using Medicaid dental claims from 2003 to 2012, the study compared caries-
related procedures and costs for children aged 0–18 years. In Anchorage, caries-related procedures
and inflation-adjusted treatment costs showed no significant changes, while Juneau experienced a
substantial increase in both.113
Canada: Calgary and Edmonton (McLaren et al., 2022)
A 2022 study114 examined the effect of fluoridation cessation in the Canadian cities of Calgary, which
started fluoridation in 1991 and stopped it in 2011, and Edmonton, which has remained fluoridated since
1967. The cities had no significant difference in the prevalence of decay in primary teeth from 2004—
2005 through 2013–2014, but by 2018–2019 the prevalence of tooth decay was significantly higher
in Calgary, which stopped fluoridation, than in fluoridated Edmonton. The authors concluded that the
cessation of community water fluoridation had an adverse impact on children’s dental health in Calgary.114
This study aligns with the findings of a 2016 systematic review pointing to an increase in dental caries
following fluoridation cessation.115
Canada: Calgary and Edmonton (Yazdanbakhsh et al., 2024)
A 2024 study116 evaluated the effect of fluoridation cessation in Calgary on pediatric dental treatments
performed under general anesthesia. Health administrative databases provided records of children under
12 years of age who underwent caries-related procedures under general anesthesia at publicly funded
facilities in Alberta between 2010 and 2019. Children from Calgary, where fluoridation was discontinued,
were compared to those from Edmonton, where fluoridation remained in place. An increase in general
anesthesia procedures was reported in Calgary, particularly among children aged 0–5 years. This increase
was found to be more pronounced over time, with the non-fluoridated areas experiencing higher rates
of treatments compared to fluoridated areas.116
Israel (Nezihovski et al., 2024)
Community water fluoridation began in Israel in 1981, became a mandatory policy in 2002, and was
discontinued by the Ministry of Health in 2014. To assess the impact of this policy change, a 2024
study117 assessed the dental health treatment among children aged 3–5 years who were treated under
general anesthesia or sedation. Treatment records, including restorative procedures and stainless-
steel crowns, were examined and analyzed from 2014–2019. A statistically significant increase in
dental treatments post-fluoridation cessation was observed, with the number of procedures nearly
doubling across all age groups.117 These findings align with a previous study conducted in Israel using
2014–2019 data.112
Historical Studies and Factors Noting No Increase in Tooth Decay after Discontinuation
of Fluoridation
There have been several studies from outside the United States that have not reported an increase in
tooth decay following the discontinuation of fluoridation. In all these, the discontinuation of fluoridation
coincided with the implementation of other measures to prevent tooth decay.
Fluoridation Facts
United States: Juneau and Anchorage, Alaska (Meyer et al., 2022)
A retrospective study published in 2022113 revisited the impact of Juneau after the cessation of
community water fluoridation in 2007 by comparing it to comparable data from Anchorage, where
fluoridation continued. Using Medicaid dental claims from 2003 to 2012, the study compared caries-
related procedures and costs for children aged 0–18 years. In Anchorage, caries-related procedures
and inflation-adjusted treatment costs showed no significant changes, while Juneau experienced a
substantial increase in both.113
Canada: Calgary and Edmonton (McLaren et al., 2022)
A 2022 study114 examined the effect of fluoridation cessation in the Canadian cities of Calgary, which
started fluoridation in 1991 and stopped it in 2011, and Edmonton, which has remained fluoridated since
1967. The cities had no significant difference in the prevalence of decay in primary teeth from 2004—
2005 through 2013–2014, but by 2018–2019 the prevalence of tooth decay was significantly higher
in Calgary, which stopped fluoridation, than in fluoridated Edmonton. The authors concluded that the
cessation of community water fluoridation had an adverse impact on children’s dental health in Calgary.114
This study aligns with the findings of a 2016 systematic review pointing to an increase in dental caries
following fluoridation cessation.115
Canada: Calgary and Edmonton (Yazdanbakhsh et al., 2024)
A 2024 study116 evaluated the effect of fluoridation cessation in Calgary on pediatric dental treatments
performed under general anesthesia. Health administrative databases provided records of children under
12 years of age who underwent caries-related procedures under general anesthesia at publicly funded
facilities in Alberta between 2010 and 2019. Children from Calgary, where fluoridation was discontinued,
were compared to those from Edmonton, where fluoridation remained in place. An increase in general
anesthesia procedures was reported in Calgary, particularly among children aged 0–5 years. This increase
was found to be more pronounced over time, with the non-fluoridated areas experiencing higher rates
of treatments compared to fluoridated areas.116
Israel (Nezihovski et al., 2024)
Community water fluoridation began in Israel in 1981, became a mandatory policy in 2002, and was
discontinued by the Ministry of Health in 2014. To assess the impact of this policy change, a 2024
study117 assessed the dental health treatment among children aged 3–5 years who were treated under
general anesthesia or sedation. Treatment records, including restorative procedures and stainless-
steel crowns, were examined and analyzed from 2014–2019. A statistically significant increase in
dental treatments post-fluoridation cessation was observed, with the number of procedures nearly
doubling across all age groups.117 These findings align with a previous study conducted in Israel using
2014–2019 data.112
Historical Studies and Factors Noting No Increase in Tooth Decay after Discontinuation
of Fluoridation
There have been several studies from outside the United States that have not reported an increase in
tooth decay following the discontinuation of fluoridation. In all these, the discontinuation of fluoridation
coincided with the implementation of other measures to prevent tooth decay.
