Organizations Worldwide That Support Fluoridation

Fact – Community Water Fluoridation (CWF) is recognized a safe and effective public health measure by the World Health Organization and major and respected science and health organizations worldwide, including in the U.S., Canada, Britain, Europe, Australia, New Zealand and other countries.  Health agencies of all 50 states in the U.S. a number of health insurance companies and the States/Provinces in Australia, Canada and New Zealand also support CWF. 
There are no reputable science or health organizations that support the anti-F opinions. 

Bottom Line: Trust The Experts!

Two interesting articles about public response to fluoridation in the 1950s - Anti-fluoridation arguments have changed little in over over 65 years.
  Should We Put Fluorides In Our Water - MACLEANS, 1953.pdf
  Fight Over Fluoridation - Saturday Evening Post, 1956.pdf  (images)

Additional resources to help understand anti-science arguments

The World Health Organization and over 120 other specific examples of worldwide CWF support:

1. Academy for Sports Dentistry reference: “The CDC Division of Oral Health launched a new web feature with information on a variety of oral health topics and featured infographics. These open-access resources provide sharable information on a variety of oral health topics including cavities, dental sealants, gum disease, tooth loss, and community water fluoridation; as well as tobacco use, pregnancy, and returns on investment.”

2. Academy of Dentistry International (ADI):  “Fluoride helps the teeth to become stronger and less likely to decay. Here are some of the ways you can get the benefits of fluoride. Due to fluoridation, 1 out of 5 kids have no decay. ... Many communities have added the correct amount of fluoride needed for good dental health to the community water supply. In areas where this is not done, fluoride may be added to the water supply by some institutions.”

3. Academy of General Dentistry (AGD) “Supports Water Fluoridation. ... The controlled addition of a fluoride compound to public water supplies is considered to be the most cost-effective way to prevent cavities and fight tooth decay.”

4. Academy of Nutrition and Dietetics supports “optimal systemic and topical fluoride as an important public health measure to promote oral health and overall health throughout life.  Fluoride is an important element in the mineralization of bone and teeth.”

5. Alliance for a Cavity-Free Future states (ACFF), “Community water fluoridation (CWF) is the adjustment of the natural fluoride concentration of a community water supply to the recommended level for optimal oral health. Fluoridation is a public health measure against tooth decay that benefits people irrespective of age, gender, income, ethnicity, employment or access to treatment. CWF has long been a controversial topic with a lot of misinformation and ‘junk science’ shared through the media, on the internet and now also through social media. Caution should therefore be exercised in evaluating material in this area. … In over 70 years of CWF there have been no proven adverse health effects.”

6. Alzheimer’s Association supports “What are the public’s perspectives on lifestyle behaviors, choices ,and attitudes concerning cognitive health and the burden of cognitive decline? What do we view as the benefits and barriers of modifying personal lifestyle to reduce the risks associated with cognitive decline? … Organized public health efforts over the past 100 years have yielded remarkable achievements. Ten considered to be among the greatest are in the areas of: (Fluoridation of drinking water, #9). These achievements were possible because of combined, coordinated efforts to apply three core public health functions: assessment, policy development, and assurance.”

7. American Academy of Family Physicians (AAFP) “The American Academy of Family Physicians supports fluoridation of public water supplies. Fluoridation is a safe, economical, and effective method to prevent dental caries.”

8. American Academy of Pediatric Dentistry (AAPD) “Endorses and encourages the adjustment of fluoride content of public drinking water supplies to optimal levels where feasible.”  Policy Statement

9. American Academy of Pediatrics (AAP) “continues to recommend children drink fluoridated tap water despite a new study linking fluoride intake among pregnant women with a small dip in their children’s IQ.”  The Campaign for Dental Health (CDH), a program of the AAP, “was created to ensure that people of all ages have access to the most effective, affordable and equitable way to protect teeth from decay — community water fluoridation. The CDH is a broad network of oral health advocates, health professionals, child and family organizations, and scientists who are working together to preserve our nation’s gains in oral health. More than 150 local, state, and national organizations are partners in the CDH.”

10. American Association for the Advancement of Science objectives “are to further the work of scientists, to facilitate cooperation among them, to improve the effectiveness of science in the promotion of human welfare, and to increase public understanding and appreciation and the importance and promise of the methods of science in human progress, … request the Council of the Association, through the Board of Directors, through the Administrative Secretary, to go on record as endorsing fluoridation of community water supplies as a method for advancing dental public health…" (archived copy available)

11. American Association for Community Dental Programs “is a partner in the Campaign for Dental Health, joining 30 other organization allies to support the campaign to promote water fluoridation.”  Endorsement Policy: "The public health and evidence-based soundness of the endorsee initiative or program (e.g., community water fluoridation)."

12. American Association for Dental, Oral, and Craniofacial Research (AADOCR - was AADR) “supports community water fluoridation as a safe and effective, evidence-based intervention for the prevention of dental caries. … in the the current context of fluoride availability, the balance of evidence currently shows that community water fluoridation is safe, effective and cost-saving and in some communities, reduces oral health disparities. Therefore, AADR supports community water fluoridation and recommends the fluoridation of community water sources to a level of 0.7 milligrams of fluoride per liter of water.”

13. American Association of Oral and Maxillofacial Surgeons: A resolution (with 20 other organizations) to commemorating the 70th anniversary of community water fluoridation and “acknowledging community water fluoridation as one of the most practical, cost-effective, equitable, and safe measures communities can take to prevent tooth decay and improve oral health.”   "Sipping water is actually one of the best things you can do for your teeth, especially if it’s fluoridated."

14. American Association of Public Health Dentistry “reiterates its strong endorsement and support for the fluoridation of all community water systems as a safe and effective public health measure for the prevention of tooth decay.” 

15. American Association of Women Dentists “supports the use of fluoride products and recognizes the importance of fluoride in cavity prevention in both children and adults. Approved methods of receiving fluoride include but are not limited to community water fluoridation, topical fluoride application and fluoride supplements as recommended by a licensed dentist to prevent tooth decay.”

16. American Council on Science and Health reports: “Well, the media just handed these conspiracy theorists a gift on a giant silver platter: Multiple outlets are reporting that pregnant women who consume too much fluoride produce children with lower IQs. The reports are based on an extremely controversial study [2019 Green, et al.]  just published in JAMA Pediatrics. Are the study's conclusions true? It's doubtful.”  Time and the Anti-Fluoride Cause

17. American Dental Assistants Association: Policies and Resolutions Manual  - Fluoridation, p. 26 “Whereas, Studies have repeatedly and convincingly documented fluoridation of the public water supply as the most efficient and economical means of preventing dental caries; and … Resolved, That all Local Organizations and State Associations of the American Dental Assistants Association urge the use of fluoride supplements as preventive measures in areas lacking community water fluoridation.” (Word Document)

18. American Dental Association (ADA) “unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay. This support has been the Association's position since policy was first adopted in 1950.”  ADA Fluoridation Facts (eBook) – comprehensive answers to questions about fluoridation's effectiveness, safety, practice and cost-effectiveness – includes refutations of anti-fluoridation arguments.  All About Fluoride, Resources

19. American Dental Education Association (ADEA) states, “On average, people that live in fluoridated water communities have 25% fewer trips to the dentist than people in communities with non-fluoridated water.  Frequent exposure to the optimal fluoride concentration in water is an effective strategy to reduce the risk of tooth decay at the population level because it does not require any individual behavioral change.” 

20. American Dental Hygienists’ Association (Fluoride Facts) states: “Community water fluoridation is an effective, safe, and inexpensive way to prevent tooth decay. Fluoridation benefits Americans of all ages and socioeconomic status. Children and adults who are at low risk of dental decay can stay cavity-free through frequent exposure to small amounts of fluoride. This is best gained by drinking fluoridated water and using a fluoride toothpaste twice daily.  Frequent exposure to the optimal fluoride concentration in water is an effective strategy to reduce the risk of tooth decay at the population level because it does not require any individual behavioral change.”
    Statement on Water Fluoridation
    Adult Fluoride Use: One of the recommendations for Fluoride Products to Reduce Tooth Decay: Community water Fluoridation, 0.7 ppm, recommended for everyone.

21. American Dietetic Association “reaffirms that fluoride is an important element for all mineralized tissues in the body. Appropriate fluoride exposure and usage is beneficial to bone and tooth integrity and, as such, has an important, positive impact on oral health as well as general health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries (tooth decay) and its associated disability.”

22. American Fluoridation Society aims, “1) To promote improvement of dental health by securing the optimum fluoride content of community water systems in areas where it is sub-optimal. 2) To promote and co-ordinate medical, dental, educational, and administrative efforts to achieve this remotely by means of electronic media and personal contacts. 3) To distribute information about dental health and the benefits/risks of optimally fluoridated water to the fluoridation decision-makers in the communities. 4) To provide direct support to communities across the United States that may need expert testimony from the American Fluoridation Society member(s). 5) To provide the necessary information to debunk the opposition to fluoridation’s pseudo-science.”  Resource Library – selection from over 6,600 publish research papers.

23. American Heart Association: “Fluoridation - No evidence exists that adjusting the fluoride content of public water supplies to a level of about one part per million has any harmful effect on the cardiovascular system.” Quote is no longer available - archive. Response to query about fluoridation, "We currently do not have any direct statements listed on our website related to the fluoridation of public drinking water. However, we always recommend following the CDC’s statements and guidelines for the most scientifically accurate information related to public health practices. Please visit the CDC’s Community Water Fluoridation page to learn more."

24. American Medical Association “(1) urges state health departments to consider the value of requiring statewide fluoridation (preferably a comprehensive program of fluoridation of all public water supplies, where these are fluoride deficient), and to initiate such action as deemed appropriate; and (2) supports the 2011 proposed fluoridation standards as promulgated by the US Department of Health and Human Services and the Environmental Protection Agency.”

25. American Nurses Association “recognizes the public health benefits of fluoridation of public drinking water systems and supports its use when the following conditions are met: a) The concentration of fluoride in the public drinking water is in accordance with the most current Public Health Service Recommendations for safe and optimal prevention of dental caries. b) State and local governments have carefully considered whether to fluoridate the public drinking water based on the existing water supply’s naturally occurring fluoride concentration. c) The most current, evidence-based, sound research supports the benefits of public water fluoridation and does not indicate harmful risks.”

26. American Osteopathic Association “supports the fluoridation of fluoride-deficient public water supply.”
    

27. American Public Health Association “is a longtime, proud supporter of community water fluoridation as a safe, effective and cost-saving means of preventing tooth decay.”  Position Paper

28. American Society for Clinical Nutrition and American Society for Nutritional Sciences: “Therefore, the Joint Public Information Committee of the American Institute of Nutrition and the American Society for Clinical Nutrition agrees that fluoridation of community water supplies to an optimal level whenever the natural level is less than optimal is a safe, economical and effective measure to improve dental health by improving nutrition.”

29. American Student Dental Association “encourages the fluoridation of community water supplies at optimal levels as determined by the U.S. Department of Health and Human Services. ASDA supports the use of fluoridated products as recommended by the Centers for Disease Control and Prevention.”  Talking Points 

30. American Water Works Association (AWWA) “supports the recommendations of the World Health Organization (WHO), American Medical Association (AMA), Canadian Medical Association (CMA), Centers for Disease Control (CDC), American Dental Association (ADA), Canadian Dental Association (CDA), and other professional organizations in the medical community, for the fluoridation of public water supplies as a public health benefit.” 
    ** This support continues despite a 2008 threat of potential legal action from anti-fluoridation attorney, Robert E. Reeves:  “If AWWA wishes to lower its potential liability related to fluoridation of water, please contact our office. We would suggest that one avenue AWWA may wish to pursue in the next month is to contact the National Kidney Foundation and its Chief Medical Officer Joseph Vassalotti. You could discuss with NKF a simultaneous public announcement by NKF and AWWA to voice a change in your organizations’ positions related to the safety of fluoridated water that you now no longer support the safety of fluoridated water.” (no longer on fluoridealert site, but can be found here or here)

31. Association of Maternal and Child Health Programs – Collaboration to Improve Early Childhood Oral Health: “MCH agencies recognize the importance of oral health, and have supported programs to improve oral health for mothers and children. Examples of initiatives that target oral health in early childhood include population services such as community water fluoridation and dental sealants…”

32. Association of State and Territorial Dental Directors (ASTDD) states, “The primary action of community water fluoridation is topical. Fluoride is ingested, and returns to the oral cavity through saliva secretion, via the salivary glands. The main implication of this mechanism of action is that the teeth are continuously bathed by fluoride-enriched saliva.36 Pre-eruptive systemic fluoride exposure remains important; however, current consensus recognizes that optimal oral health occurs when fluoride exposure continues after tooth eruption."   (Resources, Best Practice Approaches)
    "Policy Statement: The Association of State and Territorial Dental Directors (ASTDD) fully supports and endorses community water fluoridation in all public water systems at the optimal level recommended by the US Public Health Service.”

33. Association of State and Territorial Health Officials supports “access to community water fluoridation and build public awareness of how it benefits everyone in the community, regardless of age and socioeconomic status, and protects against tooth decay in populations with limited access to preventive services. Publicize the fact that people who live in communities with community water fluoridation experience 25 percent fewer cavities over a lifetime than people without access to fluoridation, contributing to better health and lowering healthcare costs.”

34. Australian Dental Association states: “With long-demonstrated negligible adverse reactions, fluoridated water has proven to be the most equitable way of providing protection against decay to the Australian community.”

35. Australian Government Department of Health confirms, “Dental health in Australia has improved over the last 25 to 30 years. Changes such as adding fluoride to drinking water have helped to reduce tooth decay in children and adults.”  Additional Information

36. Australian Government National Health and Medical Research Council (NHMRC) Information Paper on Water fluoridation concludes, "The evidence shows that water fluoridation at current Australian levels reduces the occurrence and severity of tooth decay.  Water fluoridation at current Australian levels is associated with dental fluorosis.  In Australia, however, most dental fluorosis is very mild or mild, does not affect the function of teeth and is not of aesthetic concern to those who have it. There is evidence that water fluoridation at current Australian levels is not associated with cognitive dysfunction, lowered IQ, cancer, hip fracture and Down syndrome.  There is no reliable evidence of an association between water fluoridation at current Australian levels and other human health outcomes."   The 2017 Public Statement: "recommends community water fluoridation as a safe, effective and ethical way to help reduce tooth decay, and a range within which NHMRC supports states and territories fluoridating their drinking water supplies."

37. Australian Academy of Paediatric Dentistry states (AAPD), “Clearly, support of effective preventive strategies aimed at minimising the burden of dental disease should be at the forefront of any effective dental care or policy. These include promoting water fluoridation and multi-modal fluoride therapies, oral care education, dietary counselling, consideration of a sugar tax and other possible Government support interventions, as well as influencing inappropriate advertising – these remain significant issues and important avenues for guidance.”

38. Australian Medical Association (AMA) states, “Water fluoridation is something that has the full backing of the Australian Dental Association and the Australian Medical Association. It’s cheap, it’s proven to be beneficial, and data repeatedly proves that it is effective in reducing cavities in children.” 

39. Australian Research Centre for Population Oral Health released Guidelines for use of fluorides in Australia that stated, the 2019 “NHMRC Review searched the post-2006 literature for evidence of possible harmful effects of water fluoridation on human health. The NHMRC Review concluded that water fluoridation at current Australian levels is not associated with cognitive dysfunction, lowered IQ, cancer, hip fracture and Down syndrome. There was no reliable evidence of an association between water fluoridation at current Australian levels and other human health outcomes.” (p 32)
    "While sugar consumption and dental plaque remain as key aetiological factors for dental caries, the use of fluorides has been the cornerstone of caries prevention. Research has led to the development of two central preventive programmes involving water fluoridation and use of fluoridated toothpaste.6,7 Water fluoridation (WF) is recognized as one of the most effective public health interventions." (p. 30)

40. British Association for the Study of Community Dentistry (BASCD) Position Statement (Word doc): “We support the maximisation of the use of fluoride vehicles to reduce the prevalence and severity of tooth decay. … Dental caries can be largely prevented by maintaining a constant low level of fluoride in the oral cavity. Optimal fluoride can be obtained from different sources such as fluoridated drinking water, salt, milk and toothpaste. … Long-term exposure to an optimal level of fluoride results in substantially lower incidence and prevalence of tooth decay across all ages.”

41. British Dental Association (BDA) states, “The British Dental Association (BDA) has welcomed the new joint statement from all four UK Chief Medical Officers (CMOs) highlighting the benefits of water fluoridation in reducing tooth decay. The BDA fully supports community water fluoridation as a safe and effective public health intervention, as part of a package of measures to improve dental health, where technically feasible and appropriate for local needs."

42. British Fluoridation Society (BFS) “was founded in 1969 to work for improved dental health in the UK through the introduction of water fluoridation schemes.”

43. British Medical Association policy book 2019-2020, “notes that only 10% of the UK population are supplied with artificially fluoridated water following fragmented local introduction schemes since 1968 and:  i) acknowledges that this regional disparity has had detrimental effects on the dentition of areas where fluoridation is not routine; ii) calls for a universal approach to water fluoridation;  (Lapsed 2019) iii) calls on Public Health England to renew its policy on water fluoridation, not just its guidance.”
    "the BMA remains committed to the fluoridation of mains water supplies on the grounds of effectiveness, safety and equity and urges the Government to require that water companies fluoridate water supplies wherever this is formally requested by health authorities following proper consultation as required by the 1985 Water (Fluoridation) Act."

44. British Oral Health Foundation:  “The addition of fluoride to water has been researched for over 75 years, and water fluoridation has been proven to reduce decay by 35%1. Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to tooth decay. ... Currently, some six million people in the UK receive a fluoridated water supply. Those in areas with fluoridated water have be shown to have lower rates of decay than those without. ... We believe that water fluoridation is the single most effective public health measure there is for reducing oral health inequalities and tooth decay rates, especially amongst children.”

45. Canadian Dental Association “supports fluoridation of municipal drinking water (at minimum levels required for efficacy as recommended by the Federal-Provincial Subcommittee on Drinking Water) as a safe, effective and economical means of preventing dental caries in all age groups.”

46. Canadian Dental Hygienists Association Board of Directors “Endorses the use of fluoride as an important oral health promotion and disease prevention approach; Recommends that water fluoridation be maintained and extended to additional communities where feasible.”  (FAQs CWF 2017)

47. Canadian Medical Association policy, Resolution GC77-27: “That the Canadian Medical Association encourage programs to promote fluoridation of communal water supplies."
    Policy: "Canadian Medical Association (CMA).  In: CMA 1977 Québec QC, Proceedings of the 146th Annual Meeting including transactions of General Council, June 20-22, 1977. Québec QC: The Association; 1977.”  Validated by email, 6/22/2022.

48. Canadian Paediatric Society position statement 2019,  The Use of Fluoride in Infants and Children, “The primary mechanism of the action of fluoride in preventing tooth decay is topical.  Water fluoridation is an effective delivery method for topical fluoride.”

49. Canadian Public Health Association, "Fluoridation is another method of preventing tooth decay. The fluoride ion reinforces the enamel after the tooth has surfaced, making it more resistant to decay. In fact, each dollar invested in fluoridation can save approximately $38 in dental treatment. ... The benefits of fluoridation were further demonstrated in a recent case study that examined dental caries rates from 2004/2005 to 2013/2014 in Edmonton and Calgary. Water fluoridation started in Edmonton in 1967 and continues today, whereas Calgary started the practice in 1991 and ended in 2011. ...Overall, the study showed that in Calgary there was an increase in dental caries in children’s primary teeth.  In permanent or adult teeth, specifically on smooth surfaces, there was also a trend towards greater tooth decay."
    CPHA Fluoridation support since 1952, Position Paper #2A Water Fluoridation  (documents used with permission)

50. Center for Public Health Law Research states: “In the judgment of a Community Guide expert panel, there is significant evidence to support water fluoridation as an effective public health intervention aimed at reducing tooth decay.”

51. Centers for Disease Control and Prevention states, “Drinking fluoridated water keeps teeth strong and reduces cavities (also called tooth decay) by about 25% in children and adults. By preventing cavities, community water fluoridation has been shown to save money both for families and for the US health care system.    Because of its contribution to the large decline in cavities in the United States since the 1960s, CDC named community water fluoridation one of 10 great public health achievements of the 20th century.”
    Fluoride Legislative User Information Database (FLUID) “is a comprehensive database containing legal decisions by U.S. courts and current information on federal, state and local policies regarding community water fluoridation.”

52. Children’s Dental Health Project states, “For 70 years, CWF has been an effective and safe way to reduce the rate of tooth decay. Even though fluoride toothpaste is widely used by Americans, studies in recent years continue to show that drinking water or other beverages with fluoride maximizes protection from cavities.”

53. Childsmile (NHS Health Scotland) “is reducing inequalities in oral health and ensuring access to dental services for every child across the country."  The Programme Manual states, “Fluoride is a naturally occurring mineral. When fluoride is present in the saliva, the fluoride ions become concentrated in the plaque. Even at very low levels, fluoride in the plaque and saliva is able to alter the balance between demineralisation and remineralisation, favouring the remineralisation process. As the remineralisation happens in the presence of fluoride, the new mineral crystals are stronger and less susceptible to acid attack. … Fluoride can either be given to children systemically (in the form of drops or tablets; added to milk or water in Public Health Programmes) or be used topically in the form of gels, varnishes or mouthwashes.” (p. 19)

54. Council of European Dentists 2015 Manual of Dental Practice states, “Fluoride is a substance which gives protection to teeth against tooth decay, if ingested in optimal quantities, or applied to the surface of the teeth by means of toothpaste or other methods. Fluoride may be found naturally at optimal or suboptimal levels in water supplies or in some countries (Hungary, Ireland, Spain and the UK by the addition of fluoride to the water supplies).” (P. 31)

55. Council of State Governments: “resolution seeks to encourage states to support and adopt community water fluoridation initiatives which have been shown to be effective in reducing dental caries and saving costs associated with tooth decay.”

56. Community Preventive Services Task Force (CPSTF) “recommends community water fluoridation to reduce tooth decay (i.e., dental caries or cavities).”

57. DentaQuest: “Teeth are covered with a sticky film called plaque. Plaque uses the food we eat to make acids that cause cavities. But fluoride fights acids in the mouth and makes teeth stronger. Even before your baby’s teeth come in, fluoridated water will make their teeth stronger. After teeth come in, keep guarding against cavities with fluoridated water and fluoride toothpaste, plus fluoride treatments at the dentist. Avoid bottled water because it usually doesn’t include fluoride.”

58. Dentistry "is the leading print and online title for everybody working in and involved with the UK dental profession." Published articles support community water fluoridation.

59. Department of Health & Social Care, UK –– Advancing our health: prevention in the 2020s. "Water fluoridation schemes such as this have been used for over 70 years internationally, and in England for over 55 years."  In its 2022 report, PHE concluded, that "The findings of the 2022 health monitoring report are consistent with the view that water fluoridation at levels prescribed within the UK regulatory limit (<1.5mg/l) is an effective, safe, and equitable public health intervention to reduce the prevalence, severity, and consequences of dental caries. It supports previous findings that these benefits are greatest in the most deprived areas, thereby contributing to reducing dental health inequalities."

60. Environmental Protection Agency (EPA), Q&A on Fluoride recognizes “Fluoride can also be added to public drinking water supplies as a public health measure for reducing cavities among the treated population." and "The HHS recommended optimal level of 0.7 milligrams per liter is set to promote public health benefits of fluoride for preventing tooth decay while minimizing the chance for dental fluorosis."

61. European Academy of Paediatric Dentistry (EAPD) “reaffirms its support [2019] for the use of community water fluoridation as a safe, effective, relevant and costsaving public health measure for the prevention and control of dental caries. The Academy recognises that CWF alone is not a panacea but should be seen as an important element in a multi-faceted approach to caries prevention  and control, which includes oral health promotion and access to affordable care.” (p. 514)

62. European Food Safety Authority (EFSA): “Although fluoride is not essential for tooth development, its role in the prevention of dental caries has been known for many years.  Epidemiological studies have shown an inverse correlation between the presence of fluoride in drinking water and the prevalence of dental caries in children.”

63. European Scientific Committee on Health and Environmental Risks (SCHER) – summary of 2010-2011 report, Critical Review of Any New Evidence on the Hazard Profile, Health Effects, and Human Exposure to Fluoride and the Fluoridating Agents of Drinking Water: “Fluoride, either naturally present or intentionally added to water, food and consumer products, e.g. toothpaste, is generally considered beneficial to prevent dental caries.” (p. 39)  There were no health risks listed for exposure to optimally fluoridated water.

64. Fédération Dentaire Internationale - see the FDI World Dental Federation Promoting Oral Health through Water Fluoridation Policy

65. Fluoride Exposed: “"Effie and Kylie] are Fluoride Exposed's fearless leaders. One Ph.D. ecologist and one MPH public health educator, taking the lead on a new approach to transparency in fluoride and water science. … Our goal here is not to ask you to support fluoridation like we do. Our goal is for everyone to learn more about science, regardless of your values-based beliefs about fluoridation.” (DentalTown and DentistryIQ articles)
    Fluoride Science is dedicated to balanced reviews of fluoride studies and communicating the qualities and summaries of the scientific evidence for professional communities that may engage in patient care and/or public health services.

66. Food and Drug Administration: Bottled water containing greater than 0.6 and up to 1.0 mg/L total fluoride will be eligible to make the claim, “Drinking fluoridated water may reduce the risk of [dental caries or tooth decay].”

67. Food Safety Authority of Ireland (FSAI) stated, “Overall, the FSAI’s Total Diet Study 2014-2016: Assessment of Dietary Exposure to Fluoride in Adults & Children in Ireland concludes that, based on scientific evidence, there is no safety concern for children and adults living in Ireland from exposure to fluoride through intake of foods and beverages.”

68. Green Facts: “An ‘optimum’ level of fluoride in drinking water, associated with the maximum level of dental caries protection and minimum level of dental fluorosis, has been determined. … Fluoridated drinking water is one of the most cost-effective means of delivering fluoride to large numbers of individuals. It requires a suitable community-wide drinking water delivery system along with a reasonable level of technological development.”

69. Health Canada: “Community Water Fluoridation has been proven to be a safe, effective and equitable way to prevent and reduce tooth decay (including root decay) for people of all ages - from children to seniors.”  Position Statement

70. Health Research Board, Ireland, Health Effects of Water Fluoridation, An Evidence Review: “In summary the literature found no strong evidence that CWF is definitively associated with negative health effects.”

71. Health Resources and Services Administration: “Fluoride helps to prevent dental decay. Most effectiveness is shown with systemic exposure to very low concentrations during tooth development via community water fluoridation or supplements, in combination with higher topical concentrations, which should not be swallowed. Remember that fluoride, when properly used, is safe. Like all other medications and supplements, more is not better. Many scientific studies showed the benefits of fluoride on dental caries, as well as documented its safety.” (p. 31)

72. Health Resources in Action (HRiA) policy:  “Despite its proven safety and effectiveness, community water fluoridation (CWF) implementation remains a challenge and is often thwarted, while de-fluoridation efforts are also ramping up throughout the country. A small, vocal, well-organized minority that relies on junk science and appeals to fear-based messaging means that fluoridation can no longer win on its scientific merits alone.” 

73. Hispanic Dental Association: “Our Advocacy Efforts include, Championing Community Water Fluoridation.”

74. I Like My Teeth - See Campaign for Dental Health under American Academy of Pediatrics

75. Indian Dental Association (India):  “Fluoride helps prevent tooth decay by a) Conversion of hydroxyapatite to a fluoridated hydroxyapatite, b) Increased rate of post eruptive maturation, c) Inhibits the micro-organism. ... In the event that water fluoridation is not feasible, school water fluoridation can be an alternative.”

76. Indian Health Service (U.S.) states, CWF “has the potential to benefit all age groups and all socioeconomic strata, including the lowest, which has the highest caries prevalence and is least able to afford preventive and restorative services.  Community water fluoridation is also the most cost-effective of all community-based caries preventive methods. An effective community water fluoridation program should be the cornerstone of all public oral health programs.”

77. Institute for Evaluation of Labour Market and Education Policy (Sweden):  “Fluoridation of the drinking water is a public policy whose aim is to improve dental health. Although the evidence is clear that fluoride is good for dental health, concerns have been raised regarding potential negative effects on cognitive development. We study the ef effects of fluoride exposure through the drinking water throughout life on cognitive and non-cognitive ability, math test scores and labor market outcomes in a large-scale setting. ... Conclusion: We have investigated the effects of fluoride on outcomes related to the central nervous system and more long-term labor market outcomes. Taking all together, we find a zero effect of fluoride on cognitive ability, non-cognitive ability and points on the national test in math. For income and employment status we find evidence of a positive effect of fluoride, which is in line with the explanation that better dental health is a positive factor on the labor market.”

78. Institute for Science in Medicine states, “One of the top public health achievements has been community water fluoridation (CWF), which now provides a safe, effective and economical way to help prevent tooth decay. ... Community water fluoridation (CWF) is the adjustment of the naturally-occurring fluoride content in drinking water for optimal health benefit. ... Needed Policy: In order to optimize the dental health of citizens, all communal water systems need to implement CWF as recommended by recognized public health authorities.” 
    The Anti-Fluoridationist Threat To Public Health: "Tactics of the Anti-fluoridation Movement:
    Misrepresenting the Conclusions of Valid Research, Citing Strange, Far-Fetched Case Studies to Attack Fluoridation, Engaging in Misleading Spin about Europe and Fluoride, Misrepresenting the Positions of Governmental or Health Organizations, Painting an Inaccurate Picture of Dental Fluorosis, Leaving Out Critical Facts, Using a “Rhetorical Question” to Create Fear, Holding Extreme Views About Health and Medicine. ... The anti-fluoridationists’ fake scientific controversy has resulted in reduced dental health, needless pain, suffering, and lost productivity, with substantially increased financial burdens on individuals and our health care system."

79. International Association for Dental Research Science Policy - 2022 update: “IADR supports community water fluoridation as a safe and effective, evidence-based intervention for the prevention of dental caries. This public health measure has a high benefit/cost ratio and benefits deprived communities the most thus reducing health inequalities. While fluoride occurs naturally in water, levels vary depending on regions and sources of water. Fluoridation is the controlled addition of a precise amount of fluoride to community water systems to the level beneficial for dental health, without systemic health side-effects. The practice of adding fluoride to community water supplies began after Dr. H. Trendley Dean observed a dose response relationship between naturally occurring fluoride levels in water with dental fluorosis and caries in his famous 21-city study1. Community water fluoridation began in Grand Rapids, Michigan, USA in 1945 and reached 63.4% of the United States population in 20182. Globally, over 400 million people in 25 countries have access to community water fluoridation3. The 75-year history of community water fluoridation as a public health measure has been summarized in an IADR Centenary Review.”

80. Ireland, Dental Health Foundation states, “The dramatic improvement seen in the oral health of Ireland since the introduction of water fluoridation in the mid-1960s – particularly among children and young adults with lifetime exposure to water fluoridation (labelled “Full Fl” in charts) – has been mainly attributed to the caries-preventive effect of fluorides in water and in toothpaste.”

81. Irish Dental Association Position Paper: “The Irish Dental Association (IDA) strongly endorses water fluoridation as the most practical, cost effective and safe, public health measure to control the occurrence of tooth decay in Ireland. Community water fluoridation is endorsed by the World Health Organisation (WHO) as the first choice method of providing fluoride to communities. The US Centers for Disease Control and Prevention (CDC), and the EU Scientific Committee on Health and Environment Risks (SCHER) have also endorsed water fluoridation. The US Surgeon General described water fluoridation as one of the top ten greatest public health measures of the twentieth century. ... The Irish Dental Association recognises that water fluoridation is a contentious issue and is regularly debated in the media. The Irish Dental Association recommends that policymakers be guided by high quality, peer-reviewed evidence.”

82. Irish Expert Body on Fluorides and Health states, "Fluoride plays a key role in the prevention of tooth decay."  The organization operates under the aegis of the Department of Health, and advises that, “the balance of scientific evidence worldwide confirms that water fluoridation, at the optimal level, does not cause any ill effects and continues to be safe and effective in protecting the oral health of all age groups. The effects of fluoridation on health and related matters are kept under constant review.”  Answers from Irish Expert Body on Fluorides and Health

83. Israeli Ministry of Health: "The fluoridation of drinking water is considered an achievement of the public health system, through its beneficial influence on dental health. It can spare people pain, suffering and hospitalizations, and constitutes a part of the basic human right for health."
    "The decision by Yael German of the Yesh Atid party /to end fluoridation/, amazed experts at Israel’s schools of dentistry and public health because it contravened a year of recommendations and attempts by professionals and the ministry to change German’s mind."
    The effect of community water fluoridation cessation on children's dental health: a national experience: "After CWF cessation in Israel [2014], rates of dental treatments significantly increased."



84. KidsHealth: "Fluoride is a mineral found in water sources and soil. Fluoride is added to the water in the United States and other countries. It is also found in some toothpastes, mouth rinses, and vitamin supplements.  Fluoride strengthens teeth enamel. The enamel is the hard outer covering of the teeth. By keeping the enamel strong, fluoride helps prevent cavities.  Cavities are caused by tooth decay. Tooth decay is caused by some types of bacteria (germs) in the mouth. These bacteria make acid that can break down tooth enamel. Fluoride prevents the acid from breaking down the enamel. It also helps teeth damaged by acid to repair themselves. Fluoride cannot repair cavities, but it can reverse some tooth decay and prevent new cavities."

85. Linus Pauling Institute: “The use of fluoridated dental products and adequate intakes of fluoride reduce the occurrence of caries throughout life by promoting tooth mineralization and re-mineralization. … The major sources of systemic and topical fluoride are drinking water, foods and beverages made with fluoridated water, infant formulas, and fluoride-containing oral care products. Fluoridated salt and milk are currently available outside the US in Europe, Latin America, and Southeast Asia.”  Linus Pauling's statement supporting fluoridation.

86. Malaysian Dental Association (MDA): Questions and answers, Q. 12 Fluoride in Water - "Extensive experimental, clinical and epidemiological research undertaken for more than 60 years have attested to the safety and effectiveness of water fluoridation. No other public health measure has had the scientific endorsement and broad base of research which supports its use as dose fluoridation. The legality of fluoridation has been tested and upheld in the highest courts since the early 1950s."

87. Mayo Clinic states, “By the age of 6 months, children should have fluoride in their water, and children of brushing age should use soft brushes and fluoridated toothpaste.”

88. National Academies of Sciences Engineering Medicine (NASEM): "In 2019, the National Toxicology Program (NTP) released the draft monograph Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects (NTP 2019a). The draft monograph summarized the findings of the systematic review and concluded that 'fluoride is presumed to be a cognitive neurodevelopmental hazard to humans.'  NTP asked the NASEM to review the draft monograph. National Academies of Sciences, Engineering, and Medicine.  The committee provided many suggestions for improvement and concluded that NTP had not adequately supported its conclusions." 
    NTP released its revised draft monograph on 9/16/2020.  The NASEM reviewed the revised draft and concluded, “the committee is still concerned about the presentation of the data, the methods, and the analyses in the revised monograph and finds that the monograph falls short of providing a clear and convincing argument that supports its assessment. ... Much of the evidence presented in the report comes from studies that involve relatively high fluoride concentrations. Little or no conclusive information can be garnered from the revised monograph about the effects of fluoride at low exposure concentrations (less than 1.5 mg/mL).  NTP therefore should make it clear that the monograph cannot be used to draw any conclusions regarding low fluoride exposure concentrations, including those typically associated with drinking-water fluoridation. ... Given the substantial concern regarding health implications of various fluoride exposures, comments or inferences that are not based on rigorous analyses should be avoided.” (p. 14)

89. National Association of County and City Health Officials policy: “NACCHO recognizes the public health benefits of community water fluoridation as a safe and cost-effective measure for preventing tooth decay and encourages communities to fluoridate water systems at levels optimal for protection against tooth decay. ” 
    CWF Online Resources - "Community water fluoridation adjusts the amount of fluoride in drinking water to the level known to reduce tooth decay and promote good oral health. Water fluoridation’s biggest advantage is that it is the best method of delivering fluoride to all members of the community, regardless of age, education, income level, or access to routine dental care."

90. National Association of Local Boards of Health, Oral Health Guide: Community Water Fluoridation: “Water fluoridation is the most effective way of delivering the benefits of fluoride to all members of a community, regardless of age, education, or income level. ... This document specifically addresses prevention of tooth decay through community water fluoridation.  NALBOH’s goal is to inform BOHs about this effective public health intervention.”

91. National Black Caucus of State Legislators resolution ETE-13-02, “Recognizing the Importance of Community Water Fluoridation”

92. National Cancer Institute: “Water fluoridation is the process of adding fluoride to the water supply so the level reaches approximately 0.7 ppm, or 0.7 milligrams of fluoride per liter of water; this is the optimal level for preventing tooth decay. ... More recent population-based studies using cancer registry data found no evidence of an association between fluoride in drinking water and the risk of osteosarcoma or Ewing sarcoma."

93. National Dental Association: “It is therefore, the position of the National Dental Association that Community Water Fluoridation is safe, beneficial and cost effective and should be encouraged and supported under the following conditions:
    • Community water supplies should contain the optimal fluoride levels as recommended by the U.S. Public Health Service (a range from 0.7 – 1.2 parts per million)
    • Local communities and dental societies should be in agreement with and support the fluoridation project in their communities.
    • Appropriate resources monitoring capabilities should be available to ensure that the appropriate water fluoride monitoring infrastructures are in place at all times in the impacted communities.”

94. National Drinking Water Alliance lists fluoridation policies of the AWWA, ASTDD and ADA and links to a CfDH poster on the benefits of fluoridated water.

95. National Health and Medical Research Council (Australia) 2017 Public Statement confirmed “that community water fluoridation helps to reduce tooth decay, and that there is no reliable evidence that water fluoridation at current Australian levels causes health problems.”

96. National Health Service, UK states, “[Fluoride] can help prevent tooth decay, which is why it's added to many brands of toothpaste and, in some areas, to the water supply through a process called fluoridation. ... Over the past 50 years, there have been several reviews of the safety and effectiveness of water   fluoridation schemes. Recent large reviews that have been carried out. ... Overall, these reviews found that water fluoridation appears to contribute to reduced tooth decay levels and doesn't seem to be associated with any significant health risks.” 

97. National Kidney Foundation: Although the NKF does not formally endorse CWF, the organization states, “The benefits of water and dental products containing fluoride is the prevention of tooth decay and dental cavities in people of all ages.”

98. National Maternal and Child Oral Health Resource Center: “Community water fluoridation is the best method for delivering fluoride to all members of the community regardless of age, educational attainment, income level, or access to routine oral care.  Community water fluoridation is a major factor responsible for the decline in prevalence and severity of dental caries (tooth decay) during the second half of the 20th century.”

99. National Network for Oral Health Access (NNOHA): “Community water fluoridation is a population health program that is in a unique position to equitably prevent dental caries across all socioeconomic groups (1). While dental caries is still the most prevalent chronic disease that disproportionately effects lower socioeconomic status communities, community water fluoridation continues to decrease cavities by 25% at the population level."

100. Network for Public Health Law:  State Laws and Regulations Addressing Fluoridation in Water “Community water fluoridation is recommended by nearly all health organizations, including the American Dental Association, American Academy of Pediatrics, U.S. Public Health Service, and World Health Organization. Many studies have illustrated the benefits of a fluoridated community water supply, particularly in preventing tooth decay. According to the Centers for Disease Control and Prevention, community water fluoridation is a cost-effective, efficient way to deliver fluoride to all members of a community.”

101. New Zealand Dental and Oral Health Therapists Association (NZDOHTA) provides fluoridation support on both its regular and business Facebook pages.

102. New Zealand Dental Association (NZDA) “continues to strongly support and promote community water fluoridation as a safe and effective preventative measure to improve public oral health. It is the NZDA's position that all New Zealanders who could have access to optimally fluoridated water do so have access. Fluoride works in two ways: systemically and topically.
     Systemic: Fluoride builds into the developing tooth structure making them more resistant to decay. It is most effective when teeth get exposed to small levels of fluoride as they erupt through the gums.
     Topical: Fluoride helps repair the early stages of decay by replacing the minerals lost on the surface of the teeth.”

103. New Zealand Medical Association “supports the expanded use of community water fluoridation to reduce the burden of oral disease and reduce health inequities in New Zealand.”

104. New Zealand Ministry of Health states: “Adjusting the natural level of fluoride in our water supplies makes a significant difference in helping to prevent tooth decay for all New Zealanders.  The most recent New Zealand oral health survey (2009) showed that children and adolescents living in areas with fluoridated water have 40 percent less tooth decay than those living in areas without. The significant benefits of water fluoridation for oral health are also supported by over 60 years of studies around the world.”

105. New Zealand Nurses Association states, “The benefits of water fluoridation on dental health are widely accepted as the safest, most effective intervention in reducing the level of dental caries (World Health Organization 1994). However, there are still many areas in New Zealand where public water supplies are not fluoridated and where the protection it offers – estimated at 2.4 and 12 fewer decayed teeth per person in New Zealand - is not available.” (Discussion point #3) 

106. Oral Health Foundation (UK) states, “Local authorities from across the United Kingdom should add fluoride to water supplies, following new research confirms it has no negative effects. That is the message from the Oral Health Foundation, which is calling for the introduction of widespread community fluoridation schemes, a move they believe will help protect millions of Brits from tooth decay. The extensive research, carried out by the National Toxicology Program in the US where 80% of water is fluoridated, states that following years of analysis, there is ‘no link between elevated levels of fluoride and cognitive learning deficits.’”

107. Paediatric Society of New Zealand (KidsHealth): “Community water fluoridation is an effective, safe and affordable way to prevent and reduce tooth decay for everyone.  What are the facts about community water fluoridation? : 1) Numerous studies have shown that children and adults living in areas with community water fluoridation have significantly less tooth decay than those living in non-fluoridated areas. , 2) Evidence based on decades of community water fluoridation shows it is safe. 3) There is strong evidence that community water fluoridation is cost-effective. It saves much more in dental costs for individuals than it costs to run fluoridation programmes.”

108. Oral Health Group, Canada – News on oral health, including support of fluoridation issues.

109. Pan American Health Organization: “Water fluoridation is considered one of the most successful public health interventions of the 20th century and salt fluoridation has proven to be a cost-effective method for reducing caries in the Latin America and Caribbean Regions. The introduction of systemic and topical fluorides have drastically reduced the rate of dental decay worldwide.”

110. Pew Charitable Trusts “supports water fluoridation because it’s one of the most cost-effective strategies for states and communities to improve the oral health of their residents.” Fluoridation Advocacy

111. Platform for Better Oral Health in Europe states, “A range of effective population-based preventative initiatives have been implemented across Europe. These include water fluoridation programmes (Ireland, Poland, Serbia, Spain, UK); fluoridated salt programmes (Switzerland, Slovakia, France, Germany and the Czech Republic) and fluoridated milk programmes targeting children (Bulgaria, UK).”em>

112. Public Health Agency of Canada Position Statement on Community Water Fluoridation: “Community water fluoridation is an important and often overlooked public health measure that has contributed over the last 70 years to the health of Canadians by preventing tooth decay and thereby improving oral health. … The big advantage of community water fluoridation is that it benefits all residents in a community, regardless of age, socioeconomic status, education, oral hygiene practices,  employment or access to routine dental care, making it a truly equitable public health practice. Canadian and international studies agree that properly fluoridated water is safe. The likeliest adverse effect is an increased risk of mild dental fluorosis, which causes white specks to appear on the teeth and is usually unnoticeable. There is also no scientific evidence to suggest that children should avoid drinking fluoridated water at the accepted levels in Canadian drinking water.”

113. Public Health Association of New Zealand “supports community water fluoridation as an effective, ethical public health measure which protects and promotes oral health, and reduces inequalities in New Zealand. ... International5and New Zealand research, confirms that community water fluoridation reduces the prevalence and severity of tooth decay. The NZOral Health Survey found a 40% reduction in tooth decay in communities with water fluoridation, compared to those without.  Community water fluoridation has particular benefits for people who do not use, or cannot afford, fluoridated toothpaste. ... Robust review has not found any evidence of adverse health effects from community water fluoridation at optimal levels such as those in New Zealand. ... Community water fluoridation is cost-effective. Preventing tooth decay with community water fluoridation is almost 30 times cheaper than treating decay.”

114. Public Health England:  “Water fluoridation is one of a range of interventions available to improve oral health, and the only one that does not require behaviour change by individuals. … Reviews of studies conducted around the world confirm that water fluoridation is an effective, safe public health measure suitable for consideration in localities where tooth decay levels are of concern.”

115. Robert Wood Johnson Foundation funded Healthy Drinks. Healthy Kids  which includes the recommendation, "Drinking fluoridated water is one of the best ways to reduce a child’s chances of having cavities. Fluoride is a naturally occurring mineral that helps prevent cavities. Fluoridation refers to how much fluoride is added to drinking water. The recommended level of fluoride in drinking water is 0.7 parts per million.”  These recommendations were developed by experts at the Academy of Nutrition and Dietetics (AND), the American Academy of Pediatrics (AAP), the American Academy of Pediatric Dentistry (AAPD), and the American Heart Association (AHA) under the leadership of Healthy Eating Research (HER).

116. Royal Australasian College of Physicians New Zealand (RACP) “and the Paediatric Society of New Zealand (PSNZ) support water fluoridation as a highly effective, safe, cost-saving and equitable measure to prevent dental caries and improve oral health across all sectors of society. ... Fluoridation of community water supplies is the single most effective public health measure to prevent dental decay. Community water fluoridation programmes have directly reduced the rate of dental caries in New Zealand and throughout the world, including Australia, Canada, the USA, Chile, Columbia, Britain and Ireland.”

117. Royal College of Paediatrics and Child Health “Areas with higher levels of fluoride in drinking water have lower rates of tooth decay and general anaesthetics for dental extraction. Department of Health and Social Care recommends water fluoridation as a safe and effective evidence-based public health measure to reduce the prevalence and severity of tooth decay, and reduce dental health inequalities.”

118. Royal Society of New Zealand and Office of the Prime Minister’s Chief Science Advisor report stated, “A large number of studies and systematic reviews have concluded that water fluoridation is an effective preventive measure against tooth decay that reaches all segments of the population, and is particularly beneficial to those most in need of improved oral health. Extensive analyses of potential adverse effects have not found evidence that the levels of fluoride used for community water fluoridation schemes contribute any increased risk to public health, though there is a narrow range between optimal dental health effectiveness and a risk of mild dental fluorosis. ... This analysis concludes that from a medical and public health perspective, water fluoridation at the levels used in New Zealand poses no significant health risks and is effective at reducing the prevalence and severity of tooth decay in communities where it is used. Communities currently without CWF can be confident that this is a safe option that is cost saving and of significant public health benefit – particularly in those communities with high prevalence of dental caries. ” (p. 10)

119. Singapore Ministry of Health recommends,  “Make sure that your children's drinking water is fluoridated. If your water supply does not contain fluoride, your dentist or pediatrician may prescribe daily fluoride supplements. … Studies since [the 1930s] have repeatedly shown that when fluoride is added to a community's water supply, tooth decay decreases.”

120. Singapore’s National Water Agency, PUB:  “Fluoridation is a requirement by the Ministry of Health and has been a practice since 1957. It helps in the prevention of dental caries.”

121. Special Care Dentistry Association 'Fluoride Use' Policy links to the 2018 American Academy of Pediatric Dentistry Position Statement supporting CWF.

122. State of Israel Ministry of Health:  “The fluoridation of drinking water is considered an achievement of the public health system, through its beneficial influence on dental health. It can spare people pain, suffering and hospitalizations, and constitutes a part of the basic human right for health. ... Drinking water fluoridation is the most efficient, safest, simplest, cheapest, and most equal measure, by a significant margin, among all methods for preventing dental diseases in the general public."

123. U.S. Department of Defense:  “The Assistant Secretary of Defense for Health Affairs has determined that providing optimally fluoridated water at DoD installations helps to improve and sustain the military readiness and health of military personnel.”

124. U.S. Department of Health and Human Services report states, “Through this final recommendation, the U.S. Public Health Service (PHS) updates and replaces its 1962 Drinking Water Standards related to community water fluoridation—the controlled addition of a fluoride compound to a community water supply to achieve a concentration optimal for dental caries prevention.1 For these community water systems that add fluoride, PHS now recommends an optimal fluoride concentration of 0.7 milligrams/liter (mg/L). In this guidance, the optimal concentration of fluoride in drinking water is the concentration that provides the best balance of protection from dental caries while limiting the risk of dental fluorosis.”
     Head Start: CWF: "Community water fluoridation works in two ways. First, drinking tap water with fluoride strengthens children's permanent teeth that have not come into the mouth yet. This helps prevent tooth decay. Second, when children and adults drink tap water with fluoride, fluoride goes into the saliva. Fluoridated saliva washes the teeth and makes the outsides of the teeth strong. This also helps prevent tooth decay. Children and adults who drink tap water with fluoride have: Fewer cavities, Less need to have teeth pulled, Less pain and suffering from tooth decay.”

125. U.S. National Institutes of Health 2021 report, Oral Health in America, states "Decreasing health disparities depends in large part on programs and policies aimed at providing more equitable distribution of evidence-based, health-promoting interventions. Generally, this means programs that are not dependent on individual behavior change or compliance, such as community water fluoridation programs. Increasing the proportion of the population served by community water fluoridation not only benefits the entire population but disproportionally benefits economically vulnerable groups, producing a flatter socioeconomic gradient in dental caries among children ... and reducing the need for expensive dental treatment." (p. 1-39)
     “Although the efficacy of water fluoridation to prevent caries is well known, the number of people with access to this preventive measure remains low in some areas of the country. In fact, some communities have discontinued optimal water fluoridation. While budgetary concerns may contribute to these decisions, community water fluoridation has been discontinued in some locations as the result of organized opposition based on false and unscientific arguments. Unfortunately, communities not fluoridating their water supplies will usually have higher rates of dental caries (McLaren et al. 2016; Meyer et al. 2018).” (p.2A-16)
     

     • National Institute of Dental and Craniofacial Research states, “Fluoride (said like floor-eyed) is a mineral that occurs naturally in soil, water, and air that has been shown to prevent cavities, or tooth decay. For the past several decades, fluoride has been added to community water supplies and oral care products such as toothpaste and mouth rinse. Fluoride works by strengthening the tooth’s hard outer surface called enamel. ... Fluoride can prevent tooth decay across the lifespan; both children and adults benefit from it."
     • Office of Dietary Supplements (ODS) states, “Water fluoridation protects teeth in two main ways—by preventing the development of caries through ingestion of drinking water during the tooth-forming years and through direct contact of fluoride with teeth throughout life.” 

126. U.S. Preventive Services Task Force (USPSTF): “All children are at potential risk of dental caries; those whose primary water supply is deficient in fluoride (defined as LT 0.6 parts per million) are at particular risk. … the Community Preventive Services Task Force recommended fluoridation of community water sources based on strong evidence of effectiveness in reducing dental caries.”

127. U.S. Public Health Service  Statement July 7, 2020 from eight former Chief Dental Officers of the USOHS, “As the former chief dental officers of the USPHS, we have spent our entire careers dedicated to improving the Nation’s oral health. Continued efforts to support CWF anchors our efforts to achieve health equity. With the forthcoming release of the second-ever Surgeon General’s Report on Oral Health, and in commemoration of the 75th anniversary of CWF in Grand Rapids, we reaffirm our support and commitment to CWF.”

128. U.S. Surgeons General’s statements on CWF:  “Since the 1950s, U.S. Public Health Service Surgeons General have committed his or her support for community water fluoridation. Below are endorsements supporting community water fluoridation from various Surgeons General:” (additional info)

129. WebMD states, “Fluoride is a mineral that occurs naturally in many foods and water. … Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay. In children under 6 years of age, fluoride becomes incorporated into the development of permanent teeth, making it difficult for acids to demineralize the teeth. Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.”

130. FDI World Dental Federation Policy Statement: “In recognition of the importance of promoting oral health through water fluoridation, the FDI World Dental Federation states that: Water fluoridation is particularly appropriate for populations demonstrating moderate to high risk of dental decay.  Water fluoridation confers positive health savings and contributes to reducing disparities in the rates of dental decay in communities.  At the fluoride concentrations recommended for the prevention of dental decay, scientific research and reviews show that human general health is not adversely affected.  The public health benefits of water fluoridation in the prevention of dental decay far outweigh the possible occurrence of very mild/mild dental fluorosis”

131. World Health Organization (WHO) states, “The appropriate use of fluoride for the prevention of dental caries has been a major dental public health strategy.33,34 Methods of delivering fluoride are well known, and those appropriate for the prevention of Early Childhood Caries (ECC) were considered in more detail. These included fluoride delivered through either water, salt or milk, fluoridated toothpaste and intra-oral topical fluoride application.24 Exposure to optimum fluoride concentration in drinking water from birth not only benefits the primary dentition, helping to control ECC, but also provides some pre-eruptive effect for the permanent teeth.” 
     2022 WHO Guidelines for drinking-water quality "There are few chemicals for which the contribution from drinking-water to overall intake is an important factor in preventing disease. One example is the effect of fluoride in drinking-water in protecting against dental caries." (p. 7)   "In some countries, fluoride may also be added to table salt or drinking-water in order to provide protection against dental caries. The amounts added to drinking-water are such that final concentrations are usually between 0.5 and 1 mg/l. The fluoride in final water is always present as fluoride ions, whether from natural sources or from artificial fluoridation." (p.402)  "Low concentrations provide protection against dental caries, both in children and in adults. The protective effects of fluoride increase with concentration up to about 2 mg of fluoride per litre of drinking-water; the minimum concentration of fluoride in drinking-water required to produce it is approximately 0.5 mg/l. However, fluoride can also have an adverse effect on tooth enamel and may give rise to mild dental fluorosis (prevalence: 12–33%) at drinking-water concentrations between 0.9 and 1.2 mg/l, depending on drinking water intake and exposure to fluoride from other sources. Mild dental fluorosis may not be detectable except by specialist examination." (p.404)
     2022 WHO Global oral health status report: towards universal health coverage for oral health by 2030 
     2.2.3 Water Fluoridation: "Adjusting the level of fluoride in drinking water is a safe, cost-effective public health measure for the prevention of caries. This includes adding fluoride in areas where the natural fluoride levels of drinking water are too low as well as eliminating fluoride from drinking water in areas where natural fluoride concentrations are too high. As a population-based health strategy, water fluoridation does not discriminate by social class and provides universal health benefit to all groups within a community, thereby reducing inequalities. The estimated reduction rates for caries range between 25% and around 60% depending on the study, location and population.  WHO and other public health agencies recommend that appropriate fluoride levels range between 0.5 mg/l and 1.0 mg/l of water, depending on average water consumption and climate as well as the population’s exposure to other sources of fluorides." (p.69)
     Fluoride and Oral Health: "At the 2007 WHO World Health Assembly, a resolution was passed that universal access to fluoride for caries prevention was to be part of the basic right to human health."
     Inadequate or excess fluoride: "It is estimated that caries of the permanent teeth is the most prevalent of all conditions assessed, with 2.4 billion people globally suffering from caries of permanent teeth and 486 million children from caries of primary teeth. Public health actions are needed to provide sufficient fluoride intake in areas where this is lacking, so as to minimize tooth decay. This can be done through drinking-water fluoridation or, when this is not possible, through salt or milk fluoridation or use of dental care products containing fluoride, and by advocating a low-sugar diet.
     2016 World Health Organization report: Fluoride and Oral Health