Key Findings - Water Fluoridation & Tooth Decay :

1) The addition of fluoride to water for the purpose of preventing tooth decay began in the 1940s with the belief that fluoride's primary benefit came from ingestion of fluoride during the tooth-forming years. It is now acknowledged by the dental research community, however, that fluoride's primary benefit comes from topical contact with teeth, and not from ingestion as previously assumed. It is also now acknowledged that fluoride is ineffective at preventing tooth decay in the pits & fissures of teeth - where the majority of decay occurs.

2) It is well recognized that tooth decay rates declined quite dramatically in all western countries in the latter half of the 20th century - irrespective of whether the country fluoridated its water or not. Today, tooth decay rates thoughout continental western Europe - where 98% of the population does not drink fluoridated water - are as low as the tooth decay rates in the United States, where a majority of the population drinks fluoridated water.

3) Within countries that fluoridate their water, recent large-scale surveys of dental health - utilizing modern scientific methods not employed in the early surveys from the 1930s-1950s - have found little difference in tooth decay , including "baby bottle tooth decay", between fluoridated and unfluoridated communities.

4) The largest dental survey ever conducted in the United States, by the National Institute of Dental Research in 1986-87, found no difference in Decayed, Missing & Filled Teeth, and a minimal difference in Decayed, Missing & Filled Surfaces among children who had lived their entire lives in a fluoridated or unfluoridated community.

5) Since 2000, four studies have reported that tooth decay does not increase, but continues to decrease, after water fluoridation is stopped.

6) Water fluoridation is often promoted as a means of preventing dental crises within low-income populations. It is becoming evident, however, that water fluoridation has been ineffective at preventing widespread tooth decay in poor urban areas of the United States - most of which have been fluoridated for 20 to 50 years.

Excerpts from the Scientific Literature - Recent Surveys of Water Fluoridation/Tooth Decay: (back to top)

"This study assessed the relationship between dental caries and fluorosis at varying fluoride levels in drinking water. Methods: Subjects were followed from birth with questionnaires every 3-4 months to gather information on fluoride intake. 420 study subjects received dental examinations at age 5 on primary teeth and at age 9 on early-erupting permanent teeth... Conclusions: Fluorosis prevalence increased significantly with higher water fluoride levels; however, caries prevalence did not decline significantly."
SOURCE: Hong L, Levy S, Warren J, Broffit B. (2006). Dental caries and fluorosis in relation to water fluoride levels. ADEA/AADR/CADR Conference, Orlando Florida, March 8-11, 2006.

"This study reports changes in non-cavitated tooth surface diagnoses after a 4-year period... No fluoride, socioeconomic status or beverage variables were significantly associated with lesion progression."
SOURCE: Warren JJ, Levy SM, Broffitt B, Kanellis MJ. (2006). Longitudinal study of non-cavitated carious lesion progression in the primary dentition. Journal of Public Health Dentistry 66(2):83-7.

“In the present study, fluoridated water did not seem to have a positive effect on dental health, as it might have been expected in a community with the respective caries prevalence.”
SOURCE: Meyer-Lueckel H, et al. (2006). Caries and fluorosis in 6- and 9-year-old children residing in three communities in Iran. Community Dentistry and Oral Epidemiology 34:63-70.

"Graphs of tooth decay trends for 12 year olds in 24 countries, prepared using the most recent World Health Organization data, show that the decline in dental decay in recent decades has been comparable in 16 nonfluoridated countries and 8 fluoridated countries which met the inclusion criteria of having (i) a mean annual per capita income in the year 2000 of US$10,000 or more, (ii) a population in the year 2000 of greater than 3 million, and (iii) suitable WHO caries data available. The WHO data do not support fluoridation as being a reason for the decline in dental decay in 12 year olds that has been occurring in recent decades."
SOURCE: Neurath C. (2005). Tooth decay trends for 12 year olds in nonfluoridated and fluoridated countries. Fluoride 38:324-325.

"A Bayesian survival analysis is presented to examine the effect of fluoride-intake on the time to caries development of the permanent first molars in children between 7 and 12 years of age using a longitudinal study conducted in Flanders... Our analysis shows no convincing effect of fluoride-intake on caries development."
SOURCE: Komarek A, et al. (2005). A Bayesian analysis of multivariate doubly-interval-censored dental data. Biostatistics 6:145-55.

"In lifetime residents of fluoridated areas 47% had evidence of erosion; in 21% erosion had progressed to the dentine or pulp. The corresponding figures in non-fluoridated areas were 43% and 21% respectively... Levels in fluoridated and non-fluoridated areas were similar. "
SOURCE: Harding MA, et al. (2003). Dental erosion in 5-year-old Irish school children and associated factors: a pilot study. Community Dental Health 20(3):165-70.

"There was no statistically significant difference between DMFT in municipalities of the same size, regardless of the presence or absence of fluoride in the water supply..."
SOURCE: Sales-Peres SH, Bastos JR. (2002). [An epidemiological profile of dental caries in 12-year-old children residing in cities with and without fluoridated water supply in the central western area of the State of Sao Paulo, Brazil]. Cadernos de Saude Publica 18: 1281-8.

"Water fluoridation status of the children's area of residence did not have a significant effect on Early Childhood Caries (ECC) at the 0.1 level of significance in the unadjusted logistic regression analysis, nor was it found to be a confounder of the effect of race/ethnicity on ECC prevalence in the multivariable model."
SOURCE: Shiboski CH, et al. (2003). The association of early childhood caries and race/ethnicity among California preschool children. Journal of Public Health Dentistry 63(1):38-46.

"[E]ven a longitudinal approach did not reveal a lower caries occurrence in the fluoridated than in the low-fluoride reference community."
SOURCE: Seppa L. et al. (2002). Caries occurrence in a fluoridated and a nonfluoridated town in Finland: a retrospective study using longitudinal data from public dental records. Caries Research 36: 308-314.

"The magnitude of [fluoridation's] effect is not large in absolute terms, is often not statistically significant and may not be of clinical significance."
SOURCE: Locker, D. (1999). Benefits and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial Sub-committee Report. Prepared for Ontario Ministry of Health and Long Term Care.

"[R]esults of recent large-scale studies in at least three countries show that, when similar communities are compared and the traditional DMFT index of dental caries is used, there is no detectable difference in caries prevalence. This has been demonstrated for schoolchildren in the major cities of New Zealand, Australia, the US and elsewhere."
SOURCE: Diesendorf, M. et al. (1997). New Evidence on Fluoridation. Australian and New Zealand Journal of Public Health. 21: 187-190.

"Higher fluoride proportions appeared to be associated with lower dfs + DFS, with an estimated difference between fluoridated and non-fluoridated groups of 0.65 decayed or filled surfaces per child, but this association was not statistically significant. The effects of fluoridation on the other outcomes were small and not statistically significant."
SOURCE: Domoto P, et al. (1996). The estimation of caries prevalence in small areas. Journal of Dental Research 75:1947-56.

"lifetime exposure to fluoridation is associated with average reductions of 2.0 dmfs and between 0.12 and 0.30 DMFS per child compared with non-exposed children." (Note: DMFS = Decayed, Missing & Filled Surfaces. There are 128 tooth surfaces in a child's mouth. This study found a difference of 0.12 to 0.30 decayed surfaces, out of 128, between children in fluoridated & unfluoridated communities.)
SOURCE: Spencer AJ, et al. (1996). Water fluoridation in Australia. Community Dental Health 13(Suppl 2):27-37.

"Data from Head Start surveys show the prevalence of baby bottle tooth decay is about three times the national average among poor urban children, even in communities with a fluoridated water supply."
SOURCE: Von Burg MM et al. (1995). Baby Bottle Tooth Decay: A Concern for All Mothers. Pediatric Nursing 21: 515-519.

"Children attending centers showed no significant differences (in baby bottle tooth decay) based on fluoride status for the total sample or other variables."
SOURCE: Barnes GP, et al. (1992). Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of head start children. Public Health Reports 107: 167-73.

"An analysis of national survey data collected by the National Institute of Dental Research (NIDR) concludes that children who live in areas of the U.S. where the water supplies are fluoridated have tooth decay rates nearly identical with those who live in nonfluoridated areas."
SOURCE: Hileman, B. (1989). New Studies Cast Doubt on Fluoridation Benefits. Chemical & Engineering News. May 8. (See article)

"We found that caries prevalences do vary between the geochemical regions of the state. In the total sample, however, there were no significant differences between those children drinking optimally fluoridated water and those drinking suboptimally fluoridated water."
SOURCE: Hildebolt CF, et al. (1989). Caries prevalences among geochemical regions of Missouri. American Journal of Physical Anthropology 78:79-92.

"[S]urvey results in British Columbia with only 11 per cent of the population using fluoridated water, show lower average DMFT rates than provinces with 40-70 percent of the population drinking fluoridated water. How does one explain this?... [S]chool districts recently reporting the highest caries free rates were totally unfluoridated."
SOURCE: Gray, AS. (1987). Fluoridation: Time for a New Base Line? Journal of the Canadian Dental Association. 10: 763-765.

"Recent studies and reports agree that the differences in dental decay prevalence between fluoridated and non-fluoridated areas in New Zealand are small. For 12- and 13-year old children nationally the percentages who were caries-free in each kind of area differed by only 1 or 2 per cent, and were often higher in the non-fluoridated part of a health district."
SOURCE: Colquhoun, J. (1987). Child Dental Health Differences in New Zealand. Community Health Studies 6: 85-90.

"In this study in oral epidemiology, officially collected statistics are presented which show that, 15 yr after fluoridation commenced in Auckland, New Zealand, there was still a significant correlation between dental health of children and their social class. They also show that treatment levels have continued to decline in both fluoridated and unfluoridated areas, and are related to social class factors rather than to the presence or absence of water fluoridation... When the socioeconomic variable is allowed for, dental health appears to be better in the unfluoridated areas."
SOURCE: Colquhoun J. (1985). Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology 13:37-41. SEE STUDY

Excerpts from the Scientific Literature - Fluoridation & "Baby Bottle Tooth Decay"(back to top)

"Water fluoridation status of the children's area of residence did not have a significant effect on Early Childhood Caries (ECC) at the 0.1 level of significance in the unadjusted logistic regression analysis, nor was it found to be a confounder of the effect of race/ethnicity on ECC prevalence in the multivariable model."
SOURCE: Shiboski CH, et al. (2003). The association of early childhood caries and race/ethnicity among California preschool children. Journal of Public Health Dentistry 63(1):38-46.

"Data from Head Start surveys show the prevalence of baby bottle tooth decay is about three times the national average among poor urban children, even in communities with a fluoridated water supply."
SOURCE: Von Burg MM et al. (1995). Baby Bottle Tooth Decay: A Concern for All Mothers. Pediatric Nursing 21: 515-519.

"Children attending centers showed no significant differences (in baby bottle tooth decay) based on fluoride status for the total sample or other variables."
SOURCE: Barnes GP, et al. (1992). Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of head start children. Public Health Reports 107: 167-73.

"Regardless of water fluoridation, the prevalence of BBTD (baby bottle tooth decay) remained high at all of the sites surveyed. More research needs to be done on the relationship of fluoridated water and BBTD.
SOURCE: Kelly M, Bruerd B. (1987). The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations. Journal of Public Health Dentistry 47:94-97.

Excerpts from the Scientific Literature - Fluoridation Cessation Studies: (back to top)

"The prevalence of caries decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community."
SOURCE: Maupome G, Clark DC, Levy SM, Berkowitz J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.

"The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child."
SOURCE: Seppa L, Karkkainen S, Hausen H. (2000). Caries Trends 1992-1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468.

"In contrast to the anticipated increase in dental caries following the cessation of water fluoridation in the cities Chemnitz and Plauen, a significant fall in caries prevalence was observed."
SOURCE: Kunzel W, Fischer T, Lorenz R, Bruhmann S. (2000). Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: 382-9.

"In 1997, following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence, DMFT and DMFS values remained at a low level for the 6- to 9-year-olds and appeared to decrease for the 10/11-year-olds. In the 12/13-year-olds, there was a significant decrease, while the percentage of caries-free children of this age group had increased..."
SOURCE: Kunzel W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34: 20-5.

Recent News Reports - Water Fluoridation & Poverty: (back to top)

Cincinnati - Fluoridated since 1979:

"City and regional medical officials say tooth decay is the city's No. 1 unmet health-care need. 'We cannot meet the demand,' says Dr. Larry Hill, Cincinnati Health Department dental director. 'It's absolutely heartbreaking and a travesty. We have kids in this community with severe untreated dental infections. We have kids with self-esteem problems, and we have kids in severe pain and we have no place to send them in Cincinnati. People would be shocked to learn how bad the problem has become.'”
SOURCE: Solvig E. (2002). Cincinnati's dental crisis. The Cincinnati Enquirer October 6. (See article)

Concord, NH - Fluoridated since 1978:

"It's overwhelming," said Deb Bergschneider, dental clinic coordinator at the Concord center. "Because we serve the uninsured, we see the lower level of the community and the need is just astronomical. ... By the time they get to us, their mouths are bombed out. They are all emergency situations. It's a severe, severe, problem. It's sad."
SOURCE: Gerth U. (2005). Nothing to smile about. Fosters Daily Democrat, May 22. (See article)

Boston - Fluoridated since 1978:

"With a study estimating that the number of untreated cavities among Boston students greatly exceeds the national average, public health officials are about to launch an offensive against what they say is a growing dental crisis in the city... According to statistics cited in the city's latest annual health report, ''The Health of Boston 1999'': Eighteen percent of children 4 years old and younger who were seen in the pediatric program at Tufts University School of Dental Medicine in 1995 had baby-bottle tooth decay, a painful condition that arises when a baby is given a bottle of juice or milk at bedtime. Treatment can cost up to $4,000 per child.  About 90 percent of 107 Boston high school students were found to need dental treatment, according to a 1996 unpublished study. That report also estimated that the city's students had four times more untreated cavities than the national average..."
SOURCE: Kong D. (1999). City to launch battle against dental 'crisis'. Boston Globe November 27. (See article)

Connecticut - Statewide mandatory fluoridation since 1960s:

"Dental decay remains the most common chronic disease among Connecticut’s children. Poor oral health causes Connecticut children to lose hundreds of thousands of school days each year. One in four Connecticut children is on Medicaid, but two of three Connecticut children receive no dental care. And DSS continues to exploit the seriously stretched public health providers and the few remaining private providers. There is an oral health crisis in Connecticut."
SOURCE: Slate R. (2005). State must fund plan to provide oral health care for the poor. New Haven Register May 5. (See article)

South Bronx - Fluoridated since 1965:

"Bleeding gums, impacted teeth and rotting teeth are routine matters for the children I have interviewed in the South Bronx. Children get used to feeling constant pain. They go to sleep with it. They go to school with it. Sometimes their teachers are alarmed and try to get them to a clinic. But it's all so slow and heavily encumbered with red tape and waiting lists and missing, lost or canceled welfare cards, that dental care is often long delayed. Children live for months with pain that grown-ups would find unendurable. The gradual attrition of accepted pain erodes their energy and aspiration. I have seen children in New York with teeth that look like brownish, broken sticks. I have also seen teen-agers who were missing half their teeth. But, to me, most shocking is to see a child with an abscess that has been inflamed for weeks and that he has simply lived with and accepts as part of the routine of life. Many teachers in the urban schools have seen this. It is almost commonplace."
SOURCE: Kozol J. (1991). Savage Inequalities. Harper Perennial.

Pittsburgh, PA - Fluoridated since 1953:

"Nearly half of children in Pittsburgh between 6 and 8 have had cavities, according to a 2002 state Department of Health report. More than 70 percent of 15-year-olds in the city have had cavities, the highest percentage in the state. Close to 30 percent of the city's children have untreated cavities. That's more than double the state average of 14 percent."
SOURCE: Law V. (2005). Sink your teeth into health care. Pittsburgh Tribune-Review February 13.

Washington DC - Fluoridated since 1952:

Washington DC has "one of the highest decay rates in children in the country." The "typical new patient, age 6, has five or six teeth with cavities -- a 'staggering" number'" at the Children's National Medical Center.
SOURCE: Morse S. (2002). Bottled Water: Just add Fluoride. Washington Post March 5. (See article)

General:

“There was little evidence to show that water fluoridation has reduced social inequalities in dental health."
SOURCE: Centre for Reviews and Dissemination. (2003). What the 'York Review' on the fluoridation of drinking water really found. University of York. (See review)

"In this study in oral epidemiology, officially collected statistics are presented which show that, 15 yr after fluoridation commenced in Auckland, New Zealand, there was still a significant correlation between dental health of children and their social class. They also show that treatment levels have continued to decline in both fluoridated and unfluoridated areas, and are related to social class factors rather than to the presence or absence of water fluoridation... When the socioeconomic variable is allowed for, dental health appears to be better in the unfluoridated areas."
SOURCE: Colquhoun J. (1985). Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology 13:37-41.

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