A new study in the Journal of the American Dental Association found that community water fluoridation significantly reduces cavities and the need for dental restorations in children and teenagers, making it a cost-effective public health strategy that dentists should actively promote to their patients and communities.
- Children exposed to community water fluoridation had 19% lower risk of requiring multiple dental restorations compared to those without fluoridation.
- The study analyzed 35,610 privately insured children in Massachusetts using dental insurance claims from 2016-2019 linked to municipal fluoridation data.
- Adolescents aged 13 and older showed the strongest protective effects, with a 26.9% reduced risk of needing multiple restorations.
- Discontinuing fluoridation could increase dental care costs for both public and private health systems due to higher restoration demands.
- Dentists should use this evidence to educate patients and communities about fluoridation's ongoing value despite recent political criticism.
Community water fluoridation appears to be a cost-effective strategy for curbing caries in children and teens therefore reducing the need for dental restorations, according to a study published September 15 in the Journal of the American Dental Association.
These results not only uphold the continuation of community water fluoridation’s preventive public health benefits, but dental professionals should use them to advise communities and patients about its ongoing value, the authors wrote.
“Discontinuing fluoridation could result in increased restorative oral health care demands, elevating public and private health expenditures,” wrote the authors, led by Dr. Sam Merabi, MPH, MS, of the Mailman School of Public Health at Columbia University in New York.
Though public water fluoridation has been championed as a safe strategy for reducing cavity rates, it has gained negative attention after U.S. Health and Human Services Secretary Robert F. Kennedy Jr. criticized fluoride and expressed support for reversing recommendations supporting the practice.
Since his comments, fluoride has been under fire. In 2025, Utah and Florida stopped adding fluoride to public water supplies.
To explore whether public water fluoridation reduces amalgam or composite resin restoration risk among children, a retrospective cohort study including 35,610 privately insured children up to age 16 in Massachusetts was conducted. For the study, dental insurance claims from 2016 to 2019 that were linked to municipal fluoridation and IRS data were analyzed.
Regression models were used to estimate adjusted mean differences and risk ratios in amalgam or composite resin restorations to examinations ratios, according to the study.
After adjusting for factors such as age, sex, and topical fluoride, it was determined that those exposed to community water fluoridation had a lower amalgam or composite resin restorations-to-examinations ratio (-0.034; 95% confidence interval [CI], -0.057 to -0.011; p = 0.004). Furthermore, a lower ratio was seen among those ages 13 and older at study entry (-0.092; 95% CI, -0.155 to -0.030; p = 0.004), the authors wrote.
Additionally, secondary threshold analyses revealed greater relative risk reductions with higher treatment thresholds, reaching an overall 19% reduced risk for more than eight amalgam or composite resin restorations (estimate, -0.211; 95% CI, -0.360 to -0.062; p = 0.005). On a similar note, a 26.9% reduced risk was seen for more than seven amalgam or composite resin restorations among patients 13 and older at study entry (estimate, -0.312; 95% CI, -0.511 to -0.115; p = .002), they wrote.
However, the study had some limitations, including that the actual water fluoridation effect is likely underestimated. Due to water consumption from travel, school, bottled water, or fluoride drop prescriptions, it may not show their actual exposure, the authors wrote.
“Children in fluoridated communities had fewer amalgam or composite resin restorations per routine examination and a lower risk of requiring multiple amalgam or composite resin restorations, with the strongest observed effects among adolescents,” Merabi and colleagues wrote.
