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Community water fluoridation delivers cavity-preventing fluoride to everyone with access to the tap. Water fluoridated at the level the U.S. Public Health Service (USPHS) recommends reduces cavities by approximately 25% in children and adults. The recommendations balance two goals:
| Goal | Level |
|---|---|
| Prevention — the USPHS target | 0.7 mg/L, and at least 0.6 mg/L, which still prevents cavities |
| Safety — EPA’s secondary standard, to prevent mild or moderate dental fluorosis (changes in the look of tooth enamel from too much fluoride before age 8) | no more than 2.0 mg/L |
| Safety — EPA’s maximum contaminant level, to prevent bone disease and mottled teeth | 4.0 mg/L |
CDC analyzed how closely water systems hit these marks during 2016–2021, using monthly reports to its Water Fluoridation Reporting System (WFRS).
The data
Of about 54,000 water systems in WFRS, 5,888 add fluoride, serving approximately 200 million people — 145 million directly and 55 million more through systems that buy their fluoridated water. 4,080 of them, serving 124,616,896 people, reported at least one month of data in the study period.
To weight each reading by how many people drank the water, CDC multiplied each system’s monthly average fluoride level by the population it served — giving 7,936,442,898 person-months of measurements.
What the measurements showed
| Fluoride level | Share of person-months |
|---|---|
| Below 0.6 mg/L — too low for full cavity prevention | 16.3% |
| 0.6 to 2.0 mg/L | 83.7% |
| Above 2.0 mg/L | 0.01% (796,283 person-months) |
| Above 4.0 mg/L | 0.002% |
The most common level was exactly the 0.7 mg/L target. The 4,080 systems stayed below the 2.0 mg/L safety standard 99.99% of the time.
Distribution of population-weighted monthly fluoride levels, 2016–2021. Image from CDC’s report.
Why low levels matter
Cavities are one of the most common preventable chronic diseases in U.S. children: approximately one in four children living below the federal poverty level has untreated cavities. Systems below 0.6 mg/L spend resources without giving their communities the protection. Routine maintenance and monitoring keep levels steady through equipment failures, supply disruptions and shutdowns.
The report makes the case for fluoridation’s value:
- It promotes health equity, because it lowers cavities and costs and is available at the tap.
- Healthy People 2030 aims to raise the share of U.S. residents served by optimally fluoridated water to 77.1%, from 73.0% in 2018.
- Fluoridation programs save a net $6.5 billion a year in avoided dental treatment and related costs.
- After Juneau, Alaska, stopped fluoridating, more cavity-related procedures were recorded among people under 18 — especially those born after it stopped.
Gaps in reporting
31% of fluoride-adjusting systems reported no fluoride levels at all during 2016–2021, and system counts and populations depend on states keeping federal databases current. Reporting could improve through data-sharing agreements between state drinking water and oral health programs, and state policies requiring systems to record and report fluoride monthly.
CDC encourages water systems to work with their state programs, report to WFRS and hold the 0.7 mg/L target consistently — especially those whose readings fell below 0.6 mg/L.
Sources
Based on Boehmer TJ, Lesaja S, Espinoza L, Ladva CN, "Community Water Fluoridation Levels To Promote Effectiveness and Safety in Oral Health — United States, 2016–2021," MMWR Vol. 72, No. 22, CDC; a work of the United States government in the public domain.
Licens: CC0 1.0 (allmän egendom) · Bearbetat efter www.cdc.gov
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