Community Water Fluoridation a Cost-Benefit-Risk Consideration

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.