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Supporting Community Water Fluoridation

Despite the strong evidence supporting community water fluoridation, oral health professionals often hesitate to advocate for it with their patients.

Supporting Community Water Fluoridation

Despite the strong evidence supporting community water fluoridation, oral health professionals often hesitate to advocate for it with their patients. This may be due to a lack of understanding about the topic or fear of patients’ opposing viewpoints. The term community water fluoridation is used when an optimal amount of fluoride is adjusted in a public water supply for dental caries prevention. Current guidelines recommend community water systems use concentrations of fluoride at 0.7 milligrams/liter (mg/L) in drinking water to protect against caries and reduce the risk of dental fluorosis. This concentration is based on the latest evidence, and was updated from the 1962 recommendation of 0.7 mg/L to 1.2 mg/L.

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Risk of Dental Fluorosis

Dental fluorosis is when the appearance of the tooth enamel is changed due to regular exposure to high concentrations of fluoride from infancy to age 8. Most cases of dental fluorosis in the US are mild. Mild dental fluorosis is an appearance of slightly visible white spots on the enamel, and in no way affects the function of the teeth. Mild dental fluorosis can be prevented via parents monitoring their children’s use of dental products and ensuring they avoid routine swallowing of fluoride-containing toothpastes and mouthrinses.

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Benefits of Water Fluoridation

Fluoridated water protects the strength of the tooth structure, prevents tooth decay, and remineralizes teeth that are in the active stage of the demineralization process. Current evidence continues to support water fluoridation as a safe and effective method for reducing dental caries among children12 and adults. A recent systematic review investigated the effects of community water fluoridation in the prevention of dental caries. The study found that children living in fluoridated areas had 35% fewer caries lesions, restorations, and missing teeth due to decay on their primary teeth.

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Adults Benefit, Too

Additionally, permanent teeth among children living in areas with fluoridated water had 26% fewer dental cavities, restorations, and missing teeth. Another systematic review assessed the effects of community water fluoridation in the prevention of dental caries among adults living in fluoridated areas vs adults who were lifelong residents in nonfluoridated areas. The review found that adults of all ages who lived in fluoridated communities had fewer caries lesions at the coronal and root surfaces than those who lived in nonfluoridated areas.

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Anti-Fluoride Movement

Today, anti-fluoridationists—recognizing that public interest has become more focused on healthy lifestyles—have found the idea that water fluoridation causes health problems to be more enticing. The lack of supporting evidence has never stopped these activists from arguing that water fluoridation causes disease, including cancer. A report reviewing decades of research and more than 50 human epidemiologic studies concluded that optimal fluoridated water does not increase the risk of cancer in humans.

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Role of Oral Health Professionals

Oral health professionals are in an ideal position to inform patients about the benefits of community water fluoridation—not once, but at every recare appointment. Becoming confident in initiating a conversation about community water fluoridation is the first step. Clinicians should be informed about water fluoridation status in their community and state. Knowing which communities have public water systems vs well water is a good start to improving water fluoridation knowledge. Using zip codes, the United States Centers for Disease Control and Prevention provides water fluoridation information at the state and local level.

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