Water fluoridation

Water fluoridation is the controlled addition of fluoride to public water supplies to reduce tooth decay. Fluoridated water maintains fluoride levels effective for cavity prevention, achieved naturally or through supplementation.[2] In the mouth, fluoride slows tooth enamel demineralization and enhances remineralization in early-stage cavities.[3] Defluoridation is necessary when natural fluoride exceeds recommended limits.[4] The World Health Organization (WHO) recommends fluoride levels of 0.5–1.5 mg/L, depending on climate and other factors.[5] In the U.S., the recommended level has been 0.7 mg/L since 2015, lowered from 1.2 mg/L.[6][7] Bottled water often has unknown fluoride levels.[8]

Tooth decay affects 60–90% of schoolchildren worldwide.[9] Fluoridation reduces cavities in children, with Cochrane reviews estimating reductions of 35% in baby teeth and 26% in permanent teeth when no other fluoride sources are available, though efficacy in adults is less clear.[10] In Europe and other regions, declining decay rates are attributed to topical fluorides and alternatives like salt fluoridation and nano-hydroxyapatite.[3][11][12][13]

The United States was the first country to engage in water fluoridation, and 72% of its population drinks fluoridated water as of 2022.[14][15] Globally, 5.4% of people receive fluoridated water, though its use remains rare in Europe, except in Ireland and parts of Spain.[16] The WHO, FDI World Dental Federation, and Centers for Disease Control and Prevention endorse fluoridation as safe and effective at recommended levels.[17][18] Critics question its risks, efficacy, and ethical implications.[19][20][21]

  1. ^ Cite error: The named reference Lamberg was invoked but never defined (see the help page).
  2. ^ Cite error: The named reference FRWG was invoked but never defined (see the help page).
  3. ^ a b Cite error: The named reference Pizzo was invoked but never defined (see the help page).
  4. ^ Cite error: The named reference Taricska was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference WHO2011 was invoked but never defined (see the help page).
  6. ^ Cite error: The named reference HHSEPA2011 was invoked but never defined (see the help page).
  7. ^ "Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries". Federal Register. 1 May 2015. Archived from the original on 5 December 2024. Retrieved 8 January 2025.
  8. ^ Cite error: The named reference Hobson was invoked but never defined (see the help page).
  9. ^ Cite error: The named reference Petersen-2004 was invoked but never defined (see the help page).
  10. ^ Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. (June 2015). "Water fluoridation for the prevention of dental caries". The Cochrane Database of Systematic Reviews. 6 (6): CD010856. doi:10.1002/14651858.CD010856.pub2. PMC 6953324. PMID 26092033.
  11. ^ Cite error: The named reference NHMRC was invoked but never defined (see the help page).
  12. ^ "Question: European countries have rejected fluoridation, so why should we fluoridate water?". www.wda.org. Wisconsin Dental Association. 8 March 2013. Archived from the original on 1 August 2019. Retrieved 6 February 2018.
  13. ^ Limeback H, Enax J, Meyer F (2023). "Clinical Evidence of Biomimetic Hydroxyapatite in Oral Care Products for Reducing Dentin Hypersensitivity: An Updated Systematic Review and Meta-Analysis". Biomimetics. 8 (1): 23. doi:10.3390/biomimetics8010023. PMC 9844412. PMID 36648809.
  14. ^ Cite error: The named reference extent2012 was invoked but never defined (see the help page).
  15. ^ "2022 Water Fluoridation Statistics". www.cdc.gov. 19 November 2024. Retrieved 19 December 2024.
  16. ^ Vinceti SR, Veneri F, Filippini T (2024). "Water fluoridation between public health and public law: An assessment of regulations across countries and their preventive medicine implications". Annali di Igiene: Medicina Preventiva e di Comunità. 36 (3). Roma, Italy: Società Editrice Universo (SEU): 261–269. doi:10.7416/ai.2024.2594. PMID 38265641.
  17. ^ "Support for Water Fluoridation" (PDF). British Fluoridation Society. 2012. Archived from the original (PDF) on 6 March 2016. Retrieved 19 April 2016.
  18. ^ CDC (April 1999). "Ten great public health achievements – United States, 1900–1999". MMWR. Morbidity and Mortality Weekly Report. 48 (12): 241–243. PMID 10220250.
  19. ^ "Introduction to the SCHER opinion on Fluoridation". European Commission Scientific Committee on Health and Environmental Risks (SCHER). 2011. Retrieved 18 April 2016.
  20. ^ Tiemann M (5 April 2013). "Fluoride in Drinking Water: A Review of Fluoridation and Regulation Issues" (PDF). pp. 1–4. Retrieved 19 April 2016.
  21. ^ Cheng KK, Chalmers I, Sheldon TA (October 2007). "Adding fluoride to water supplies". BMJ. 335 (7622): 699–702. doi:10.1136/bmj.39318.562951.BE. PMC 2001050. PMID 17916854.
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