Controversies and Public Health Implications of Community Water Fluoridation

Community water fluoridation (CWF) is one of the most significant public health programs targeting oral health. It has contributed to improving population oral health over the past 8 decades. As a public health program, CWF faces numerous evidentiary challenges. This review discusses 3 major controversies related to CWF's evidence of effectiveness, safety, and approaches to its implementation. Scientific evidence of CWF's effectiveness has been summarized. We discuss the need to expand the use of observational data to address the causal effects of fluoridation on dental caries by applying modern causal inference approaches. We present scientific evidence that CWF reduces socioeconomic inequalities in oral health, which has been inadequately acknowledged. The scientific evidence of the safety of established CWF programs worldwide, measured by indicators of child intellectual and behavioral development and executive functioning, is presented and discussed. The review provides consistent evidence to confirm CWF as an effective and safe public health program in preventing dental caries. The third controversy is related to the implementation approaches of CWF as a public health program. The connection between scientific evidence, health policy development, and the engagement of political and other actors in implementing policies to improve health is discussed. Different types of policy implementation are discussed. Maintenance and expansion of CWF as a public health program are needed to improve the population's oral health. A strong collaboration among scientists, public health practitioners, and policymakers will be necessary to address the controversies associated with CWF and continue the implementation of this public health measure.