© 2025 American Dental Association l 33
Fluoridation Facts
A study of community milk programs in Bulgaria examined children at age 3 and again at age 8.162
The study found that tooth decay experience was substantially lower in the cohort of children who
had received fluoridated milk in school for five years (5.61 dmfs and 0.48 DMFS versus 9.41 dmfs
and 1.24 DMFS, respectively).162
In these two examples, “dmfs” is the mean number of decayed, missing, or filled tooth surfaces on
primary (or baby) teeth while “DMFS” is the mean number of decayed, missing, or filled tooth
surfaces on permanent teeth.
It was estimated that as of 2013, more than one million children worldwide were receiving fluoridated
milk.159 The majority of studies conducted have indicated that fluoridated milk is effective in preventing
tooth decay under certain conditions. It is most effective if the consumption of fluoridated milk starts
before 4 years of age and continues until the permanent teeth are present in the mouth. Most successful
programs are conducted through schools where the natural fluoride levels in water are low and children
are able to consume fluoridated milk for a minimum of 200 days a year.159 While these conditions may
prevent fluoridated milk from being recommended as a public health measure for an entire community,
fluoridated milk might be the most appropriate and effective means of fluoride exposure for children
in some circumstances.
15. Can the consistent use of bottled water result in individuals
missing the benefits of optimally fluoridated water?
Answer
Yes. The large majority of bottled waters on the market do not contain optimal levels (0.7 mg/L)
of fluoride.
Fact
There is not a large body of research regarding the risk for tooth decay associated with the consumption
of bottled water. However, a lack of exposure to fluoride in drinking water could increase an individual’s
risk for tooth decay. The vast majority of bottled waters do not contain significant amounts of fluoride.163
Individuals who drink bottled water as their primary source of water could be missing the decay-
preventive effects of optimally fluoridated water available from their community water supplies. These
consumers should seek advice from their dentists about their risk for tooth decay and specific fluoride
needs. A study is under way to evaluate the preventive effects of fluoridated bottled water on dental
caries compared to non-fluoridated bottled water in 4-year-old children.164
While drinking water from the tap is regulated by the EPA, bottled water is regulated by the FDA.165
The FDA has established maximum allowable levels for physical, chemical, microbiological, and
radiological contaminants in bottled water.166
Individuals who drink bottled water as their primary source of water could be
missing the decay-preventive effects of optimally fluoridated water available
from their community water supplies.
Fluoridation Facts
A study of community milk programs in Bulgaria examined children at age 3 and again at age 8.162
The study found that tooth decay experience was substantially lower in the cohort of children who
had received fluoridated milk in school for five years (5.61 dmfs and 0.48 DMFS versus 9.41 dmfs
and 1.24 DMFS, respectively).162
In these two examples, “dmfs” is the mean number of decayed, missing, or filled tooth surfaces on
primary (or baby) teeth while “DMFS” is the mean number of decayed, missing, or filled tooth
surfaces on permanent teeth.
It was estimated that as of 2013, more than one million children worldwide were receiving fluoridated
milk.159 The majority of studies conducted have indicated that fluoridated milk is effective in preventing
tooth decay under certain conditions. It is most effective if the consumption of fluoridated milk starts
before 4 years of age and continues until the permanent teeth are present in the mouth. Most successful
programs are conducted through schools where the natural fluoride levels in water are low and children
are able to consume fluoridated milk for a minimum of 200 days a year.159 While these conditions may
prevent fluoridated milk from being recommended as a public health measure for an entire community,
fluoridated milk might be the most appropriate and effective means of fluoride exposure for children
in some circumstances.
15. Can the consistent use of bottled water result in individuals
missing the benefits of optimally fluoridated water?
Answer
Yes. The large majority of bottled waters on the market do not contain optimal levels (0.7 mg/L)
of fluoride.
Fact
There is not a large body of research regarding the risk for tooth decay associated with the consumption
of bottled water. However, a lack of exposure to fluoride in drinking water could increase an individual’s
risk for tooth decay. The vast majority of bottled waters do not contain significant amounts of fluoride.163
Individuals who drink bottled water as their primary source of water could be missing the decay-
preventive effects of optimally fluoridated water available from their community water supplies. These
consumers should seek advice from their dentists about their risk for tooth decay and specific fluoride
needs. A study is under way to evaluate the preventive effects of fluoridated bottled water on dental
caries compared to non-fluoridated bottled water in 4-year-old children.164
While drinking water from the tap is regulated by the EPA, bottled water is regulated by the FDA.165
The FDA has established maximum allowable levels for physical, chemical, microbiological, and
radiological contaminants in bottled water.166
Individuals who drink bottled water as their primary source of water could be
missing the decay-preventive effects of optimally fluoridated water available
from their community water supplies.
