The status of community water fluoridation in the United States

Community water fluoridation has served the American public extremely well as the cornerstone of dental caries prevention activities for 45 years. The dental and general health benefits associated with the ingestion of water-borne fluorides have been well known by researchers for an even longer period. Continued research has repeatedly confirmed the safety, effectiveness, and efficiency of community water fluoridation in preventing dental caries for Americans regardless of age, race, ethnicity, religion, educational status, or socioeconomic level. Despite the obvious benefits associated with this proven public health measure, slow progress has been made toward achieving the 1990 national fluoridation objectives as listed in "Promoting Health/Preventing Disease: Objectives for the Nation." This paper documents the lagging pace of community fluoridation by reviewing and analyzing data reported in "Fluoridation Census, 1985," a document published in late 1988 by the Public Health Service's Centers for Disease Control. Failure to attain the 1990 objectives is attributable to a combination of circumstances, including their low priority within many local, State, and Federal health agencies, inadequate funding at all levels of government, lack of a coordinated and focused national fluoridation effort, failure of most States to require fluoridation, lack of Federal legislation mandating fluoridation, general apathy of most health professional organizations toward fluoridation, misconceptions by the public about effectiveness and safety and, finally, unrelenting opposition by a highly vocal minority of the lay public. In addition, fluoridation successes have not been consistent among States, with wide variation in accomplishments documented in the reported data.While fluoridation still is one of the most cost effective public health measures available to local,State, and Federal public health agencies, it remains significantly underused nearly a half century after its discovery. Without a major increase in emphasis at the highest policy levels within local, State, and Federal health agencies, fluoridation objectives currently proposed for inclusion in the year 2000 national health objectives are not likely to be achieved. More private sector involvement and better coordination of efforts among all levels of government will be necessary to make significant improvements in progress toward universal fluoridation of all public water supplies in the United States.