© 2025 American Dental Association l 31
Fluoridation Facts
Salt Fluoridation in the Americas
In North, South, and Central America, salt fluoridation is available in Belize, Bolivia, Colombia, Costa
Rica, the Dominican Republic, Ecuador, Mexico, Peru, Uruguay, and Venezuela. Like in Europe, the
extent of salt fluoridation varies among countries. Columbia, Costa Rica, Jamaica, Mexico, and
Uruguay provide fluoridated salt to nearly their entire populations, while there is less coverage in
other countries.148
The Pan American Health Organization (PAHO), a regional division of the WHO with responsibilities for
health matters in North, South, and Central America and the Caribbean, has been active in developing
strategies to implement decay-prevention programs in the regions of the Americas using water and salt
fluoridation.152 To achieve the greatest reduction in tooth decay while minimizing the risk of dental fluorosis,
it is advisable that a country implement only one of these two public health measures–either community
water fluoridation or salt fluoridation. The United States has implemented water fluoridation. The US
Food and Drug Administration (FDA) has not approved fluoridated salt for use in the United States.
Early studies evaluating the effectiveness of salt fluoridation conducted in Columbia, Hungary, and
Switzerland indicated that fluoride delivered via salt might produce a reduction in tooth decay similar
to that seen with optimally fluoridated water.153,154 When all salt destined for human consumption (both
domestic salt and bulk salt used by commercial bakeries, restaurants, institutions, and industrial food
production) is fluoridated, the decay-reducing effect could be comparable to that of water fluoridation
over an extended period of time.153,154 When only domestic salt is fluoridated, the decay-reducing
effect is diminished.150 Studies conducted in Costa Rica, Jamaica, and Mexico in the 1980s and 1990s
also showed significant reductions in tooth decay. However, it was noted that these studies did not
assess other variables that could have contributed to the reductions.153
The fact that salt fluoridation does not require a centralized piped water system is of particular value
in countries that do not have such water systems. Fluoridated salt is also a very cost-effective public
health measure. For example, in Jamaica, where all salt destined for human consumption is fluoridated,
the use of fluoridated salt was reported to reduce tooth decay by as much as 84%, at a cost of 6 cents
per person per year.152 In some cases, the cost to produce fluoridated salt is so low that, for consumers,
the cost of fluoridated salt is the same as for non-fluoridated salt.155
Implementing Salt Fluoridation
The implementation of salt fluoridation has unique challenges not incurred with water fluoridation.
Sources of salt, the willingness of local manufacturers to produce fluoridated salt, or the need to
import fluoridated salt would need to be studied. Because fluoridated salt should only be consumed
by the public in areas with a naturally low level of fluoride, it would be necessary to completely map
the naturally occurring levels of fluoride and devise a plan to keep fluoridated salt out of the areas with
moderate to high naturally occurring fluoride (to aid in reducing the risk of dental fluorosis). Additionally,
a plan would need to be developed to monitor the fluoride level in urine of those consuming fluoridated
salt, starting with a baseline before implementation and including follow-up testing on a regular basis.
While salt fluoridation typically is not implemented through a public vote, it would be necessary to
gain the cooperation of salt manufacturers and institutions of all kinds that would use salt in their food
preparation.154 Additionally, educational efforts would need to be directed at health professionals and
health authorities to avoid referendum approaches and identify enabling regulations.149
In a number of European countries, consumers have a choice of purchasing either fluoridated or
non-fluoridated salt for use in the home. While it has been argued that, unlike water fluoridation, this
option to purchase fluoridated or non-fluoridated salt allows for personal choice, studies indicate that
Fluoridation Facts
Salt Fluoridation in the Americas
In North, South, and Central America, salt fluoridation is available in Belize, Bolivia, Colombia, Costa
Rica, the Dominican Republic, Ecuador, Mexico, Peru, Uruguay, and Venezuela. Like in Europe, the
extent of salt fluoridation varies among countries. Columbia, Costa Rica, Jamaica, Mexico, and
Uruguay provide fluoridated salt to nearly their entire populations, while there is less coverage in
other countries.148
The Pan American Health Organization (PAHO), a regional division of the WHO with responsibilities for
health matters in North, South, and Central America and the Caribbean, has been active in developing
strategies to implement decay-prevention programs in the regions of the Americas using water and salt
fluoridation.152 To achieve the greatest reduction in tooth decay while minimizing the risk of dental fluorosis,
it is advisable that a country implement only one of these two public health measures–either community
water fluoridation or salt fluoridation. The United States has implemented water fluoridation. The US
Food and Drug Administration (FDA) has not approved fluoridated salt for use in the United States.
Early studies evaluating the effectiveness of salt fluoridation conducted in Columbia, Hungary, and
Switzerland indicated that fluoride delivered via salt might produce a reduction in tooth decay similar
to that seen with optimally fluoridated water.153,154 When all salt destined for human consumption (both
domestic salt and bulk salt used by commercial bakeries, restaurants, institutions, and industrial food
production) is fluoridated, the decay-reducing effect could be comparable to that of water fluoridation
over an extended period of time.153,154 When only domestic salt is fluoridated, the decay-reducing
effect is diminished.150 Studies conducted in Costa Rica, Jamaica, and Mexico in the 1980s and 1990s
also showed significant reductions in tooth decay. However, it was noted that these studies did not
assess other variables that could have contributed to the reductions.153
The fact that salt fluoridation does not require a centralized piped water system is of particular value
in countries that do not have such water systems. Fluoridated salt is also a very cost-effective public
health measure. For example, in Jamaica, where all salt destined for human consumption is fluoridated,
the use of fluoridated salt was reported to reduce tooth decay by as much as 84%, at a cost of 6 cents
per person per year.152 In some cases, the cost to produce fluoridated salt is so low that, for consumers,
the cost of fluoridated salt is the same as for non-fluoridated salt.155
Implementing Salt Fluoridation
The implementation of salt fluoridation has unique challenges not incurred with water fluoridation.
Sources of salt, the willingness of local manufacturers to produce fluoridated salt, or the need to
import fluoridated salt would need to be studied. Because fluoridated salt should only be consumed
by the public in areas with a naturally low level of fluoride, it would be necessary to completely map
the naturally occurring levels of fluoride and devise a plan to keep fluoridated salt out of the areas with
moderate to high naturally occurring fluoride (to aid in reducing the risk of dental fluorosis). Additionally,
a plan would need to be developed to monitor the fluoride level in urine of those consuming fluoridated
salt, starting with a baseline before implementation and including follow-up testing on a regular basis.
While salt fluoridation typically is not implemented through a public vote, it would be necessary to
gain the cooperation of salt manufacturers and institutions of all kinds that would use salt in their food
preparation.154 Additionally, educational efforts would need to be directed at health professionals and
health authorities to avoid referendum approaches and identify enabling regulations.149
In a number of European countries, consumers have a choice of purchasing either fluoridated or
non-fluoridated salt for use in the home. While it has been argued that, unlike water fluoridation, this
option to purchase fluoridated or non-fluoridated salt allows for personal choice, studies indicate that
