Fluoride Action Network

Table 3: Water Fluoridation and Environmental Justice

Fluoride Action Network | Water Fluoridation & Environmental Justice |September 25, 2015

Water Fluoridation and Environmental Justice
Report by Fluoride Action Network
Submitted to: Environmental Justice Interagency Working Committee
Date: September 25, 2015

The report is available at http://fluoridealert.org/wp-content/uploads/ej-report.sept-25-2015.pdf

Unfortunately this is a user unfriendly pdf. We have made various parts of the report available with live links, including Table 3 below.

TABLE 3: Communities with water fluoridation and high dental decay

Fluoridation Status




Fluoridation since 1965 for water systems servicing a population of 20,000 or more

90.3% of the population receive fluoridated water as of 2012

… Peters [director of New Haven Public Schools school health centers] said this past June New Haven Public schools screened 484 Troup students, from kindergarten on up to grade 8, and found that 35 percent had moderate to severe dental needs.

“The need for dental care is very clear in Connecticut and New Haven,” Peters said at Troup Wednesday. “Tooth decay is the most common childhood disease. It is five times more common than asthma and its the leading reason for missed school across the state.” …

2015. Markeshia Ricks M. The dentist comes to Troup. New Haven Independent. September 11.


See above

“Dental decay remains the most common chronic disease among Connecticut’s children. Poor oral health causes Connecticut children to lose hundreds of thousands of school days each year. One in four Connecticut children is on Medicaid, but two of three Connecticut children receive no dental care. And DSS continues to exploit the seriously stretched public health providers and the few remaining private providers. There is an oral health crisis in Connecticut.”

2005. Slate R. State must fund plan to provide oral health care for the poor. New Haven Register. May 5.


Fluoridated since 1952

Washington DC has “one of the highest decay rates in children in the country.” The “typical new patient, age 6, has five or six teeth with cavities — a ‘staggering” number’” at the Children’s National Medical Center.

2002. Morse S. Bottled Water: Just add Fluoride. Washington Post. March 5.


Fluoridated since 1952

• Low-income Children in Washington, DC are at High Risk for Poor Oral Health and Consequently Inadequate School Readiness

• a large proportion (44 percent) of the 144 students examined had a history of dental caries,

• Examined students are primarily from some of the most impoverished Wards (5, 6, 7, & 8) and exhibit high caries incidence

2007. Issue Brief: Oral Health is Critical to the School Readiness of Children in Washington, DC. By Altarum Institute.


Fluoridation is mandatory

98.5% of the state’s population receive fluoridated water (as of 2012)

Thousands of low-income children and adults in Illinois suffer from untreated dental disease. They can’t eat or sleep properly, do their best at school or work or smile and are at risk for other serious health problems…

… Illinois has among the lowest rates in the nation for government funded dental care. As a result we face an oral health care crisis… Illinois currently has just one clinic per 8,400 children who rely on government insurance…

2009. Support Bill HB 388 for dental care. By Lauri Frichtl, Executive Director, Illinois Head Start. Pioneer Press.


94.8% of the state’s population receive fluoridated water (as of 2012)


Results from the 2006 BRFSS also indicated that 47 percent of Hoosiers ages 18 and older have had permanent teeth extracted—a percentage that was significantly higher than the national median of 44 percent (see Figure 2).

Groups with the highest prevalence of tooth extractions included blacks; individuals with an annual household income of less than $35,000; and individuals with lower educational attainment. Prevalence of extractions was highly associated with age – as age increased so did the percentage of Hoosiers who reported having had any permanent teeth extracted.

… The elderly, minorities, and low income citizens often face the unfortunate need to have some or all of their teeth extracted.

2009. Oral Health Needs in Indiana: Developing an Effective and Diverse Workforce. Center for Health Policy. May.



Fluoridated since 1967



Excerpt from abstract: To describe the epidemiology of dental caries among low-income African American children 5 years old and younger in the City of Detroit.
Conclusion: Dental Caries in primary teeth in children 5 years of age and younger in Detroit is a major dental public health problem.2006. Severity of Dental Caries Among African American Children in Detroit.
By Ismail AI, Tellez M, Sohn W. Presented at the 35th Annual Meeting & Exhibition of the American Assoc. for Dental Research in Orlando, Florida. March.



Fluoridated since 1967



From abstract: The aim of this study was to examine the relationship between dietary patterns and caries experience in a representative group of low-income African-American adults. Participants were residents of Detroit, Michigan, with household incomes below 250% of the federally-established poverty level (n = 1,021)… This population had severe caries, poor oral hygiene, and diets that are high in sugars and fats and low in fruits and vegetables. Apart from tap water, the most frequently consumed food item by adults of all ages was soft drinks; 19% of all energy from sugar came from soft drinks alone.

2006: Dietary Patterns Related to Caries in a Low-income Adult Population. By Burt BA, Kolker JL, Sandretto AM, et al. Caries Research 40(6):473–80.


70.4% of the state residents receive fluoridated water

Children from low-income families and children from certain racial/ethnic groups not only have a much higher prevalence of oral disease but are also less likely to have had their dental caries treated. (Page 4)

Significant racial, ethnic and socioeconomic disparities exist within all oral health indicators, at each grade level, and among the state’s 14 counties. (page 5


• 39.4% of non-Hispanic Black kindergarten children have been affected by dental caries, 1.7 times higher than non-Hispanic white kindergarten children;

• 40.9% of Hispanic kindergarten children have been affected by dental caries, 1.8 times higher than non-Hispanic white kindergarten children; and

• 41.5% of kindergarten children from low-income families have been affected by dental caries, 1.9 times higher than kindergarten children from families with higher incomes.

2008. The Oral Health of Massachusetts’ Children. By White BA, Monopoli MP, Souza BS. Catalyst Institute. January.


70.4% of the state residents receive fluoridated water

…”Children are going to school with cavities, gum infections, rotting teeth. I don’t think people know how serious a problem it is,” said Ms. Cepeda, who has served as coordinator of the volunteer committee.

The problem is one that a special state legislative commission last year called an oral health crisis in Massachusetts: Not enough dentists are available for people on MassHealth, the state’s health plan that includes Medicaid and the Children’s Health Insurance Program…

2001. Fluoridated Water Not Preventing Rampant Decay Among Southbridge’s Poor. Telegram & Gazette (Massachusetts). October 14.

ConcordFluoridated since 1978


“It’s overwhelming,” said Deb Bergschneider, dental clinic coordinator at the Concord center. “Because we serve the uninsured, we see the lower level of the community and the need is just astronomical. … By the time they get to us, their mouths are bombed out. They are all emergency situations. It’s a severe, severe, problem. It’s sad.”

2005. Gerth U. Nothing to smile about. Fosters Daily Democrat, May 22.



Fluoridated since 1965

The level of untreated decay, %d/ dft, was 91%, significantly higher than the US national population which is 76% overall, and 76% for African Americans and Mexican Americans within the US national population.

CONCLUSIONS: The children in this population have higher caries prevalence and a higher level of untreated caries than the national means as reported in NHANES III. The high level of untreated decay found in this particularly disadvantaged community suggests that enhanced dental services targeting the very young are needed in these communities.

2002. Dental caries among disadvantaged 3- to 4-year old children in northern Manhattan. By Albert DA, Park K, Findley S, et al. Pediatric Dentistry, May;24(3):229-33. http://fluoridealert.org/studytracker/19188/



Fluoridated since 1965

“Bleeding gums, impacted teeth and rotting teeth are routine matters for the children I have interviewed in the South Bronx. Children get used to feeling constant pain. They go to sleep with it. They go to school with it. Sometimes their teachers are alarmed and try to get them to a clinic. But it’s all so slow and heavily encumbered with red tape and waiting lists and missing, lost or canceled welfare cards, that dental care is often long delayed. Children live for months with pain that grown-ups would find unendurable. The gradual attrition of accepted pain erodes their energy and aspiration. I have seen children in New York with teeth that look like brownish, broken sticks. I have also seen teen-agers who were missing half their teeth. But, to me, most shocking is to see a child with an abscess that has been inflamed for weeks and that he has simply lived with and accepts as part of the routine of life. Many teachers in the urban schools have seen this. It is almost commonplace.”

1991. Kozol J. Savage Inequalities. Harper Perennial.



Fluoridated since 1969-1970

“We cannot meet the demand,” says Dr. Larry Hill, Cincinnati Health Department dental director.

“It’s absolutely heartbreaking and a travesty. We have kids in this community with severe untreated dental infections. We have kids with self-esteem problems, and we have kids in severe pain and we have no place to send them in Cincinnati. People would be shocked to learn how bad the problem has become.”

… An estimated 43 percent of the city’s 8-year-olds living in low-income homes have significant teeth decay. The rate of infection stood at 37 percent in 1996.

2002. Solvig E. Special Report: Cincinnati’s Dental Crisis. The Enquirer (Cincinnati, Ohio). October 6.



Fluoridated since 1952

“Nearly half of children in Pittsburgh between 6 and 8 have had cavities, according to a 2002 state Department of Health report. More than 70 percent of 15-year-olds in the city have had cavities, the highest percentage in the state. Close to 30 percent of the city’s children have untreated cavities. That’s more than double the state average of 14 percent.”

2005. Law V. Sink your teeth into health care. Pittsburgh Tribune-Review February 13.


San Antonio

Fluoridated since 2002

“After 9 years and $3 million of adding fluoride, research shows tooth decay hasn’t dropped among the poorest of Bexar County’s children it has only increased—up 13 percent this year. One out of two children in the Head Start program who were checked for cavities had some last year.”

2011. Conger J. Added to our drinking water: A chemical more toxic than lead? KENS 5. November 11.

For live links for References

For live links for 119 state Oral Health Reports