Is Fluoridation Effective?

Fluoridated water adds even more to the protection our teeth get from toothpaste and other fluoride products. And it is the most cost-effective and equitable way to prevent dental disease for everyone. Here is a sample of studies confirming the benefits of fluoridating public water systems.

Fluoridation reduces tooth decay in children.

  • A study (fluoridation; important; effects; effective2018) of over 13,000 U.S. children determined that for every 100 children with access to fluoridated water, there are 130 fewer decayed surfaces of primary teeth and 30 fewer decayed surfaces of permanent teeth. In other words, fluoridation reduces the risk of decay in both primary and permanent teeth.
  • In 2013, the U.S. Community Preventive Services Task Force panel of experts examined 28 studies and concluded that there is “strong evidence” that fluoridated water reduces tooth decay among children.
  • Canadian researchers (2021) compared children’s tooth decay rates in Calgary, which stopped fluoridation in 2011, and Edmonton, which continued fluoridation. Decay rates in Calgary increased significantly, well above the rates among Edmonton children, after fluoridation was stopped. Research like this led the Calgary city council to vote to restart fluoridation.
  • Researchers in Australia (2018) found that preschool-age children who didn’t have fluoridated water had an 86% higher rate of potentially preventable hospitalizations for serious dental conditions.


Fluoridation protects adults’ teeth, too.

  • Researchers in England fluoridation; important; effects; effective(2021) found that older adults benefited significantly from growing up with fluoridated water. The researchers wrote, “Being exposed to fluoridated water was associated with having more natural teeth in later life.”
  • An Australian study (2017) of adults aged 20-35 found that those who had lifetime access to fluoridated water had lower tooth decay rates than those who didn’t.
  • A study in Brazil (2016) found that the people who lived most of their lives in a non-fluoridated community had nearly three times as many decayed, filled or missing teeth than those who lived in fluoridated communities for at least three-quarters of their lives.
  • A study in the American Journal of Public Health (2010) found that people who consumed fluoridated water as children were less likely to have lost their teeth due to decay 40 or 50 years later, when they were middle-aged adults.


Fluoridation helps address disparities for families with low incomes.

  • In its 2021fluoridation; important; effects; effective Oral Health in America report, the National Institutes of Health (NIH) mentioned fluoridation a dozen times, citing the fact that it “benefits economically vulnerable groups.”
  • In 2014, researchers in England studied the hospital admission rates for tooth extractions at dozens of hospitals, including many in economically disadvantaged areas — some of them were fluoridated and some were not. Nineteen of the 20 areas with the highest hospital admission rates were in areas without fluoridation.
  • The co-authors of a 2010 study looking at the long-term impact of water fluoridation in the U.S. said their findings suggest that the benefits of fluoridation “may be larger than previously believed” and that fluoridation has “a lasting improvement in racial/ethnic and economic disparities in oral health.”


Fluoridation saves money by reducing the need for dental treatment.

  • An Alaska study (2021) examined changes in the cost of treating tooth decay in low-income children in two cities: Anchorage and Juneau. Before Juneau stopped fluoridating in 2007, the average cost to treat tooth decay was similar to Anchorage. After, costs in Juneau jumped by 47%, while treatment costs in fluoridated Anchorage increased only 5%.
  • A U.S. study (2016) found that each person in a fluoridated community saves an average of $32.19 a year (in 2013 dollars) in dental care that would otherwise be needed to treat decay. If non-fluoridated water systems (serving at least 1,000 people) were to fluoridate, the authors estimated that as much as $2.5 billion might be saved every year.
  • A New York study (2010) revealed that low-income children in counties with less fluoridation needed more dental treatment than those in counties where fluoridated water was common. The annual Medicaid treatment costs were almost $24 higher per recipient (in 2006 dollars) in counties with less fluoridated water.
  • A Colorado study (2005) showed that fluoridated water saved nearly $149 million each year (in 2003 dollars) by avoiding unnecessary treatment costs.
  • A Texas study (2000) found that fluoridation saved the state Medicaid program an average of $24 per child, per year (in 1997 dollars).
  • A Louisiana study (1999) compared areas that were fluoridated with those that were not. The study found that low-income children in communities without fluoridated water were three times more likely to need expensive dental treatment in a hospital operating room than those in communities with fluoridated water.