Dentists should consider encouraging policymakers to continue community water fluoridation (CWF), as evidence shows its effectiveness in preventing caries, according to a study recently published in the Journal of the American Dental Association.
Furthermore, water fluoridation may be linked to a nearly 25% reduction in caries and may help lower overall treatment costs, the authors wrote.
“It is imperative that dentists, policy makers, and others remember that caries poses a major challenge to the nation’s oral health and CWF remains the most effective, cost-effective, and cost saving means of preventing this disease across population groups,” wrote the authors, led by Dr. John J. Warren, MS, of the University of Iowa College of Dentistry (JADA, February 25, 2026).
In recent months, fluoride has been under fire. In 2025, Utah and Florida stopped adding fluoride to public water supplies.
Fluoride in drinking water is considered safe, and studies have not confirmed claims linking fluoride exposure to reduced cognitive abilities or lower birth weights in children. Reviewing the evidence of CWF's benefits can reach large populations, including those with limited access to dental care, without requiring individual behavior change. Evidence shows CWF is particularly beneficial for disadvantaged communities, provides significant oral healthcare cost savings, and is widely supported by U.S. adults.
The study reviewed the evidence on CWF's benefits in preventing caries, its cost-effectiveness, and the effects of stopping CWF. The authors examined observational studies published in dental literature between January 2014 and December 2025.
Additionally, they analyzed government-commissioned reports and independent panel reviews, including a 2024 review by the government of New Zealand, along with reports from Australia, Canada, and the U.S. Early studies were included to provide historical context on CWF's impact on caries prevention. The review focused on peer-reviewed studies conducted in the U.S. or in similarly developed countries.
As CWF expanded over the decades, caries' prevalence declined in fluoridated communities. Studies from Canada, Alaska, Australia, and the Republic of Korea showed that when CWF is discontinued, caries rates in children increased significantly. Research consistently associated water fluoridation with an approximate 25% reduction in caries, according to the study.
Economic evaluations, including cost-benefit and cost-effectiveness analyses, found that CWF leads to substantial savings compared with nonfluorinated communities. In 2025, researchers modeled the potential U.S. impact of banning CWF and estimated that, even in a best-case scenario, removing fluoride raises costs by $9.8 billion over five years. Overall, fluoridation costs a fraction compared to additional treatment expenses seen after its cessation and is linked to lower restorative needs.
However, because the included studies were observational and accounted for exposure to multiple fluoride sources and other preventive measures, it is challenging to isolate the specific impact of community water fluoridation alone, the authors added.
“Dentists should advise policy makers and their patients not to abandon water fluoridation for the prevention of caries,” the team concluded.
