Preventing Dental Caries: Community Water Fluoridation
Task Force Finding
The Community Preventive Services Task Force recommends community water fluoridation based on strong evidence of effectiveness in reducing dental caries across populations. Evidence shows the prevalence of caries is substantially lower in communities with CWF. In addition, there is no evidence that CWF results in severe dental fluorosis.
Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.
Community water fluoridation (CWF) is the controlled adjustment of fluoride in a public water supply to optimal concentration in order to prevent caries (tooth decay) among members of the community. Fluoride acts to impede demineralization and to enhance the remineralization of dental enamel, both of which prevent dental caries. While fluoride occurs naturally in water across the U.S., it is usually lower than the optimal concentration needed to prevent caries.
About the Systematic Review
The Task Force finding presented on this page was made in April 2013 and updates a previous finding from October 2000. It is based on 28 studies about the effect of CWF on caries; 16 about oral health disparities, and 117 about dental fluorosis. Most of these studies were included in an existing systematic review (McDonough 2000, search period 1966-1999; 26 studies on caries; 13 on oral health disparities; 88 on fluorosis), combined with more recent evidence (search period 1999-2012; 2 on caries; 3 on oral health disparities and 29 on fluorosis). Based on this updated review, the Task Force finding of strong evidence for this intervention remains the same.
The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to oral health. Subscribe to be notified as new materials on this topic become available.
- Analytic Framework [PDF - 249 kB]
- Summary Evidence Table - Economic Review [PDF - 173 kB]
- Included Studies - Effectiveness Review
Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.
McDonough M, Whiting P, Bradley M, Cooper J, Sutton A, Chestnutt I, Misso K, Wilson P, Treasure E, Kleinjen J. A Systematic Review of Public Water Fluoridation. National Health Service Centre for Reviews and Dissemination. York(UK): University of York; 2000. Available at URL: http://www.nhs.uk/Conditions/Fluoride/Documents/crdreport18.pdf.
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing dental caries: community water fluoridation (abbreviated). www.thecommunityguide.org/oral/fluoridation.html. Last updated: MM/DD/YYYY.
Review completed: April 2013
- Page last reviewed: September 12, 2014
- Page last updated: October 19, 2015
- Content source: The Guide to Community Preventive Services