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Using Fluoride to Prevent and Control
Dental Caries in the United States
U.S. Centerd for Disease Control and Prevention
Fact Sheet, August 2001
The Centers for Disease Control and Prevention (CDC) has issued
new recommendations on using fluoride to prevent dental caries
(tooth decay). The recommendations provide guidance to health
care providers, public health officials, policymakers, and the
general public on how to achieve maximum dental decay protection
while efficiently using dental care resources and minimizing any
cosmetic concerns. In 1999, CDC profiled the wide-spread practice
of fluoridating community drinking water to prevent dental decay
as one of 10 great public health achievements of the 20th Century
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This page was posted on August 28,
- Fluorine, from which fluoride is derived, is the 13th most
abundant element and is released into the environment naturally
in both water and air.
- Fluoride is naturally present in all water. Community water
fluoridation is the addition of fluoride to adjust the natural
fluoride concentration of a community's water supply to the level
recommended for optimal dental health, approximately 1.0 ppm
(parts per million). One ppm is the equivalent of 1 mg/L, or
1 inch in 16 miles.
- 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.
- Children and adults at high risk of dental decay may benefit
from using additional fluoride products, including dietary supplements
(for children who do not have adequate levels of fluoride in
their drinking water), mouthrinses, and professionally applied
gels and varnishes.
- Good scientific evidence supports the use of community water
fluoridation and the use of fluoride dental products for preventing
tooth decay for both children and adults.
- Fluoride was first used purposefully to prevent tooth decay
in Grand Rapids, Michigan, in 1945 by adjusting the level of
fluoride in drinking water. Fluoridation of drinking water has
been used successfully in the United States for more than 50
- Fluoridation of community water has been credited with reducing
tooth decay by 50%-60% in the United States since World War II.
More recent estimates of this effect show decay reduction at
18%-40%, which reflects that even in communities that are not
optimally fluoridated, people are receiving some benefits from
other sources (e.g., bottled beverages, toothpaste).
- Fluoride's main effect occurs after the tooth has erupted
above the gum. This topical effect happens when small amounts
of fluoride are maintained in the mouth in saliva and dental
plaque (the film that adheres to tooth enamel).
- Fluoride works by stopping or even reversing the tooth decay
process. It keeps the tooth enamel strong and solid by preventing
the loss of (and enhancing the reattachment of) important minerals
from the tooth enamel.
- Of the 50 largest cities in the United States, 43 have community
water fluoridation. Fluoridation reaches 62% of the population
on public water supplies-more than 144 million people.
- Water fluoridation costs, on average, 72 cents per person
per year in U.S. communities (1999 dollars).
- Consumption of fluids-water, soft drinks, and juice-accounts
for approximately 75 percent of fluoride intake in the United
- Children aged 6 years or less may develop enamel fluorosis
if they ingest more fluoride than needed. Enamel fluorosis is
a chalk-like discoloration (white spots) of tooth enamel. A common
source of extra fluoride is unsupervised use of toothpaste in
very young children.
- Fluoride also benefits adults, decreasing the risk of cavities
at the root surface as well as the enamel crown. Use of fluoridated
water and fluoride dental products will help people maintain
oral health and keep more permanent teeth.