As noted in Oral Health in America: A Report of the Surgeon General, community water
fluoridation continues to be the most cost-effective, equitable and safe means to provide
protection from tooth decay in a community. Scientific studies have found that people living
in communities with fluoridated water have fewer cavities than those living where the water
is not fluoridated. For more than 50 years, small amounts of fluoride have been added to
drinking water supplies in the United States where naturally-occurring fluoride levels are
too low to protect teeth from decay. Over 8,000 communities are currently adjusting the
fluoride in their community’s water to a level that can protect the oral health of their
Over 170 million people, or 67 percent of the United States population served by public water
supplies, drink water with optimal fluoride levels for preventing decay. Of the 50 largest
cities in the country, 43 are fluoridated. Although water fluoridation reaches some
residents in every state, unfortunately, only 24 states are providing these benefits to 75
percent or more of their residents.
A significant advantage of water fluoridation is that all residents of a community can enjoy
its protective benefit—at home, work, school, or play—simply by drinking fluoridated water
or beverages and foods prepared with it. A person’s income level or ability to receive
routine dental care is not a barrier to receiving fluoridation’s health benefits. Water
fluoridation is a powerful strategy in our efforts to eliminate differences in health among
people and is consistent with my emphasis on the importance of prevention.
The U.S. Centers for Disease Control and Prevention has recognized the fluoridation of
drinking water as one of ten great public health achievements of the twentieth century.
Water fluoridation has helped improve the quality of life in the United States by reducing
pain and suffering related to tooth decay, time lost from school and work, and money spent
to restore, remove, or replace decayed teeth. An economic analysis has determined that in
most communities, every $1 invested in fluoridation saves $38 or more in treatment costs.
Fluoridation is the single most effective public health measure to prevent tooth decay and
improve oral health over a lifetime, for both children and adults.
While we can be pleased with what has already been accomplished, it is clear that there is
much yet to be done. Policymakers, community leaders, private industry, health
professionals, the media, and the public should affirm that oral health is essential to
general health and well being and take action to make ourselves, our families, and our
communities healthier. I join previous Surgeons General in acknowledging the continuing
public health role for community water fluoridation in enhancing the oral health of all
Richard H. Carmona, M.D., M.P.H., F.A.C.S.
United States Surgeon General