vi l © 2025 American Dental Association
Table of Contents
61. Has the legality of water fluoridation been upheld by the courts?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
62. Why does opposition to community water fluoridation continue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
63. What are the tactics fluoridation opponents use to provoke opposition to water fluoridation?. . . . . 101
64. Where can valid, evidence-based information about water fluoridation be found
on the Internet?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
65. Why does the public sometimes vote against community water fluoridation when it is
put to a public vote?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
66. Is community water fluoridation accepted by other countries?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
67. Is community water fluoridation banned in Europe? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Section 5: Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
68. Is water fluoridation a cost-effective and cost-saving method of preventing
tooth decay?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
69. Why fluoridate an entire water system when the vast majority of the water is not
used for drinking?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
All About Fluoridation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
How to Take Action on Water Fluoridation ....................................................130
Communities Benefit from Water Fluoridation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Fluoride Fast Facts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Fluoride Facts for Water Operators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Figures
Figure 1: A Guide to Identifying and Using Trustworthy Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Figure 2: Dean’s Graph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 3: USEPA Standards and USPHS Recommendations for Fluoride in Drinking Water .............41
Figure 4: Examples of Toothpaste Amounts for Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Figure 5: Mean IQ Scores (Fluoridated versus Non-fluoridated). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Tables
Table 1: Dietary Fluoride Supplement Schedule for Children at High Risk of Caries Risk . . . . . . . . . . . . . . 27
Table 2: Reference Intakes for Fluoride. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Table 3: Dean’s Fluorosis Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Table of Contents
61. Has the legality of water fluoridation been upheld by the courts?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
62. Why does opposition to community water fluoridation continue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
63. What are the tactics fluoridation opponents use to provoke opposition to water fluoridation?. . . . . 101
64. Where can valid, evidence-based information about water fluoridation be found
on the Internet?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
65. Why does the public sometimes vote against community water fluoridation when it is
put to a public vote?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
66. Is community water fluoridation accepted by other countries?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
67. Is community water fluoridation banned in Europe? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Section 5: Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
68. Is water fluoridation a cost-effective and cost-saving method of preventing
tooth decay?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
69. Why fluoridate an entire water system when the vast majority of the water is not
used for drinking?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
All About Fluoridation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
How to Take Action on Water Fluoridation ....................................................130
Communities Benefit from Water Fluoridation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Fluoride Fast Facts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Fluoride Facts for Water Operators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Figures
Figure 1: A Guide to Identifying and Using Trustworthy Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Figure 2: Dean’s Graph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 3: USEPA Standards and USPHS Recommendations for Fluoride in Drinking Water .............41
Figure 4: Examples of Toothpaste Amounts for Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Figure 5: Mean IQ Scores (Fluoridated versus Non-fluoridated). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Tables
Table 1: Dietary Fluoride Supplement Schedule for Children at High Risk of Caries Risk . . . . . . . . . . . . . . 27
Table 2: Reference Intakes for Fluoride. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Table 3: Dean’s Fluorosis Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
