98 American Dental Association water. Centers for Disease Control and Prevention (CDC) data from 2014 indicated more than 25% of the population served by public water systems did not have access to fluoridated water.19 In 2017, 44 of the 50 largest cities were fluoridated.82 Of the 44 cities, 42 were fluoridated by adjustment and two had naturally occurring fluoride at the recommended levels (Figure 7). The remaining six largest nonfluoridated cities (in order of population largest to smallest) were: Portland, Oregon Albuquerque, New Mexico Tucson, Arizona Fresno, California Colorado Springs, Colorado and Wichita, Kansas. In October 2017, the Albuquerque Bernalillo County Water Utility Authority authorized budget monies to restore fluoridation to their customers. It is estimated that fluoridated water will be available in six to eight months. In 2010, recognizing the ongoing need to improve health and well-being, the U.S. Department of Health and Human Services revised national health objectives to be achieved by the year 2020.17 Included under oral health was an objective to significantly expand the fluoridation of public water supplies. Specifically, Objective 13 of Healthy People 2020 states that at least 79.6% of the U.S. population served by community water systems should be receiving the benefits of optimally fluoridated water by the year 2020.18 This replaced the Healthy People 2010 objective of 75%.83 As of 2014, twenty states met or exceeded the 2020 objective.19 (See Figure 8.) Although water fluoridation reaches some residents in every state the coverage is uneven. Data from 2014 indicated that 26 states provided fluoridation benefits to 75% or more of their residents on community water systems while eight states were at or below 50%.19 (See Figure 9.) Figure 7. Largest Fluoridated Cities * Data compiled by the American Dental Association and Centers for Disease Control and Prevention/Division of Oral Health. Information current as of October 2017. Two cities (Jacksonville, Florida and El Paso, Texas) are naturally fluoridated.*
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