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Community Water Fluoridation a Cost-Benefit-Risk Consideration.

Bill Osmunson1, Griffin Cole2,3,4

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Community water fluoridation (CWF) may not be cost-effective when considering the costs of treating dental fluorosis and potential IQ loss. This study suggests exploring alternative dental caries prevention methods.

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Area of Science:

  • Public Health
  • Environmental Health
  • Dental Public Health

Background:

  • Community water fluoridation (CWF) has been used for over 70 years to prevent dental caries but remains controversial.
  • Economic evaluations of CWF typically focus on averted caries and operational costs, often omitting the costs associated with potential health risks.
  • Dental fluorosis and developmental neurotoxicity are potential risks linked to CWF that require economic consideration.

Purpose of the Study:

  • To conduct a comprehensive economic evaluation of CWF by incorporating the costs of treating adverse health effects.
  • To determine the overall cost-effectiveness of CWF when both benefits and risks are monetarily assessed.
  • To provide evidence-based recommendations regarding the continued use of CWF.

Main Methods:

  • Utilized published operational costs and estimated benefits of caries averted from CWF.
  • Estimated treatment costs for dental fluorosis based on clinical experience and patient perception.
  • Quantified economic impact of lower IQ attributed to developmental neurotoxicity from CWF exposure.

Main Results:

  • The study estimated a net loss of $556 per person per year (PPPY) from CWF when accounting for health harms.
  • Costs included $8 PPPY for operational costs and averted caries, $126 PPPY for dental fluorosis, and $438 PPPY for presumed IQ-related earnings loss.
  • Previous economic evaluations that excluded harm costs indicated CWF was cost-effective, but this analysis shows it is not.

Conclusions:

  • When the costs of treating dental fluorosis and potential IQ deficits are included, community water fluoridation is not cost-effective.
  • The findings indicate that fluoridation may result in a net economic loss, challenging its public health benefit.
  • Promotion of alternative dental caries prevention strategies and cessation of CWF are recommended based on this economic analysis.