An update on community water fluoridation, part 1: Mechanism of action, effectiveness, and cost savings

Water fluoridation has been an effective means of caries prevention for more than 80 years. The authors reviewed evidence on the benefits of community water fluoridation (CWF) in preventing caries, its cost-effectiveness, and the impact of discontinuing CWF.

The authors focused on observational studies identified in the dental literature from January 1, 2014, through December 31, 2025. The review was facilitated by means of an assessment of several national reports and independent panels' reports on the benefits of CWF in preventing caries.

Researchers found water fluoridation to be associated with substantially less caries, with most finding that water fluoridation reduced caries by approximately 25%. In addition, fluoridation has been found to be a cost-saving measure, as its cost is consistently a small fraction of the increased treatment costs expected in the absence of fluoridation. Moreover, researchers found that cessation of water fluoridation consistently results in higher caries levels and greater restorative needs.

There is overwhelming evidence that, along with other fluoride agents, water fluoridation is effective in preventing caries. Dentists should advise policy makers and their patients not to abandon water fluoridation for the prevention of caries.