How common is fluoridation?

Over the past several decades, there has been a slow, yet steady expansion of community water fluoridation (CWF) in the United States, providing benefits to millions of additional children and adults. Anti-fluoride activists ignore this fact and suggest that the trend is for communities to reject this proven health practice. The Fluoride Action Network (FAN) website lists communities that have voted against fluoridation since 1990 and offers this explanation:

water fluoridation increases year over year

“Since health authorities in North America have refused to let go of the fluoridation paradigm, local communities are doing the work for them. Since 2010, over 70 communities have rejected the practice …”

Yet many of these are non-U.S. communities, and FAN does not list the numerous communities that have chosen to fluoridate their water. Do not be fooled by the misleading information or selective reporting you hear from anti-fluoride groups. Take a closer look at what the data show.

  • FACT: Between 1992 and 2010, the total number of residents having access to fluoridated water grew by 60 million people. And the pace of fluoridation’s expansion has increased over the past 10 years.
  • FACT: Many of the communities FAN cites in its list are non-U.S. communities. Opponents’ lists do not include the numerous communities that vote in favor of fluoridation.
  • FACT: The statistics that opponents use are skewed by the unusual experience of Nebraska. In 2008, its state legislature passed a law requiring fluoridation in every community of 1,000 persons or larger. Many Nebraska communities viewed this as an “unfunded mandate” just as the Great Recession began. Local budgetary concern was the main reason why many communities there took advantage of an “opt-out” provision in the law. It is likely that some (perhaps many) of these opt-out communities in Nebraska would have decided to fluoridate had the timing been better and had a longer implementation period been allowed.
Victories for Fluoridation

While public health officials are understandably concerned when any community discontinues fluoridation or decides not to start it, most of the communities that have taken this step in recent years are fairly small. Check out the resources for information about community water fluoridation trends:

  • ASTDD Fluoridation Challenge Surveillance Annual Reports (2014-2017)
    Association of State and Territorial Dental Directors (ASTDD)
    The ASTDD posted the findings of its ongoing surveillance of attempts by opponents of water fluoridation to end the practice in targeted communities. In 2017, although existing fluoridation policy was challenged in 48 communities, it was maintained in 39 (81%). This continues a trend that has been documented over the past four years.
  • Community Water Fluoridation: The Top 10 and Bottom 10 (2014)
    The Pew Charitable Trusts
    The percentage of residents served by public water systems in each state who are receiving fluoridated water.

For additional information about fluoridation victories around the country, contact us at