Fluoride Action Network

New Report: Oral Health in America: Advances and Challenges.

Source: National Institutes of Health and the National Institute of Dental and Craniofacial Research | December 21st, 2021
Industry type: NIDCR

Report: Oral Health in America Advances and Challenges
790 pages

By the National Institutes of Health
and the National Institute of Dental and Craniofacial Research

Fluoride mentioned 276 times
Fluoridation is mentioned 64 times
IQ is mentioned 0 times

Excerpts (page numbers are according to the pdf report):


PAGE 160. Recent concerns related to fluoride safety have emerged around neurotoxicity affecting cognition in young children as a result of prenatal exposure to higher maternal levels of fluoride (National Toxicology Program 2020). Although a National Toxicology Program monograph summarizing available science about fluoride exposure and cognitive health effects raised these concerns, a review of the monograph by the National Academies of Sciences, Engineering, and Medicine (2020) does not support classifying fluoride as a cognitive neurodevelopmental hazard in humans and suggests that additional analyses should be conducted.

National Academies of Sciences, Engineering, and Medicine. Review of the Draft NTP Monograph: Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Washington, DC: The National Academies Press; 2020.

National Toxicology Program. Fluoride: Potential Developmental Neurotoxicity. 2020. https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/completed/fluoride/index.html Accessed June 23, 2021.


PAGE 64: As part of the commitment by HHS to support improved health and well-being of the population, the Healthy People 2030 initiative sets 10-year measurable goals and objectives for the nation related to health promotion and disease prevention. Several of these objectives have an important role in oral health, such as reducing untreated dental disease, increasing water fluoridation, expanding access to dental insurance and improving access to care; improving population health through efforts to reduce added sugar consumption; and enhancing the dental public health infrastructure.

PAGE 97: Scalability of effective oral health prevention interventions in rural areas is a special challenge. Water fluoridation in small, rural communities is costlier than in cities; however, the estimated return on investment for community water fluoridation in communities of fewer than 5,000 people still approaches $30 per person (Griffin et al. 2001; O’Connell et al. 2016). Higher use of well water rather than community water sources further complicates efforts to provide this important preventive measure. Yet, prevention is especially important in rural areas because many patients face long travel times to reach a dentist in rural dental health professional shortage areas. Limited transportation options, especially for older rural dwellers, may further restrict access (Arcury et al. 2005).

PAGE 97: 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 (Slade et al. 1995; Riley et al. 1999; McLaren and Emery 2012; McLaren et al. 2016) and reducing the need for expensive dental treatment.

PAGE 107: Community-based prevention programs, a foundation of public health, occur outside of the clinical care delivery system (e.g., water fluoridation, school-based programs, health-promoting policies). As such they do not rely on access to dental offices and generally reach a broader population and fill in gaps in access to prevention services, particularly for those individuals.

PAGE 114-115: Low-Income Populations
Community water fluoridation achieved wide success in the mid-20th century for primary prevention of dental caries (Carstairs 2015). In the 21st century, community water fluoridation has again captured national public health interest, this time for its effects in reducing socioeconomic disparities in dental caries. Not only does water fluoridation confer a protective effect beyond that offered by other sources of fluoride (Slade et al. 2018), it can especially benefit children in low-income families (Sanders et al. 2019). A study compared levels of dental caries in two groups of children: those living in counties where at least 75% of the population received optimally fluoridated drinking water, versus those in counties with a lower percentage of the population with fluoridated drinking water (Sanders et al. 2019). Findings showed that living in a predominantly fluoridated county reduced the magnitude of income disparities in dental caries. The findings are important from a health policy perspective. Efforts to expand population coverage of community water fluoridation that intentionally target counties with high concentrations of families with lower income could yield greater benefits in reducing both dental caries and income disparities in dental caries.

PAGE 170: For some parents, fear of environmental, chemical, and pesticide contamination, including in well-water sources, increases the consumption of bottled water, which reduces the preventive effects of community water fluoridation even when it is available (Scherzer et al. 2010; VanDerslice 2011).

PAGE 174: There are many safe and effective ways to use fluoride, from community water fluoridation to toothpaste, mouth rinses, and professionally applied products such as gels and varnishes (Marinho et al. 2013; Wright et al. 2014).

PAGE 174: 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). The original recommendation for the optimum level of fluoride in drinking water ranged from 0.7 mg/L to 1.2 mg/L (U.S. Department of Health, Education, and Welfare 1962), depending on children’s estimated water intake and the area’s mean maximum air temperature. Because Americans now have access to more sources of fluoride than they did when water fluoridation was first introduced, and national surveillance data was indicating higher levels of dental fluorosis, among other reasons, the U.S. Department of Health and Human Services updated its recommendation for the fluoride concentration in drinking water to 0.7 mg/L in 2015 (U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation 2015). Efforts are underway to align the level of fluoride added to bottled water with this recommendation (U.S. Food and Drug Ad(U.S. Food and Drug Administration 2019).
In addition to the systemic caries-preventive effects of community water fluoridation, fluorides also are applied topically to increase the concentration of fluoride ion at the enamel surface.

PAGE 262: 73% of the U.S. population served by community water systems (accounting for 63% of total U.S. population) has access to community water fluoridation (Centers for Disease Control and Prevention 2020), and fluoride is more readily available through various products.

PAGE 362: Although some studies have suggested that community water fluoridation can be effective in preventing caries in adults (Griffin et al. 2007; Slade et al. 2013b), a large scale systematic study found insufficient evidence among adults, because the available studies did not meet the study criteria (Iheozor-Ejiofor et al. 2015).

References for Fluoridation:

Carstairs C. Debating water fluoridation before Dr. Strangelove. American Journal of Public Health. 2015;105(8):1559–69.

Centers for Disease Control and Prevention. Achievements in public health, 1900–1999. Fluoridation of drinking water to prevent dental caries. MMWR Morbidity and Mortality Weekly Report. 1999a;48(41):933?40.

Centers for Disease Control and Prevention. Timeline for Community Water Fluoridation. 2021. https://www.cdc.gov/fluoridation/basics/timeline.html Accessed November 1, 2021.

Centers for Disease Control and Prevention. 2018 Fluoridation Statistics. 2020b. https://www.cdc.gov/fluoridation/statistics/2018stats.htm Accessed June 11, 2021.

Curiel JA, Slade GD, Christian T-ML, Lafferty-Hess S, Carsey TM, Sanders AE. Referendum opposition to fluoridation and health literacy: a cross-sectional analysis conducted in three large U.S. cities. BMJ Open. 2019;9(2):e022580.

Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. Journal of Public Health Dentistry. 2001;61(2):78–86.

Horowitz HS. The effectiveness of community water fluoridation in the United States. Journal of Public Health Dentistry. 1996;56(5):253–8.

Iheozor-Ejiofor Z, Worthington HV, Walsh T et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews. 2015(6):Cd010856.

Kumar JV, Adekugbe O, Melnik TA. Geographic variation in Medicaid claims for dental procedures in New York State: role of fluoridation under contemporary conditions. Public Health Reports. 2010;125(5):647–54.

McLaren L, Emery JCH. Drinking water fluoridation and oral health inequities in Canadian children. Canadian Journal of Public Health. 2012;103(S1):S49–56.

McLaren L, McNeil DA, Potestio M et al. Equity in children’s dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation. International Journal for Equity in Health. 2016;15(1):24.

McLaren L, Patterson S, Thawer S et al. Measuring the short-term impact of fluoridation cessation on dental caries in grade 2 children using tooth surface indices. Community Dentistry and Oral Epidemiology. 2016;44(3):274–82.

Meyer J, Margaritis V, Mendelsohn A. Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska. BMC Oral Health. 2018;18(1):215.

O’Connell J, Rockell J, Ouellet J, Tomar SL, Maas W. Costs and savings associated with community water fluoridation in the United States. Health Affairs. 2016;35(12):2224–32.

Riley JC, Lennon MA, Ellwood RP. The effect of water fluoridation and social inequalities on dental caries in 5-year-old children. International Journal of Epidemiology. 1999;28(2):300–5.

Sanders AE, Grider WB, Maas WR, Curiel JA, Slade GD. Association between water fluoridation and income-related dental caries of U.S. children and adolescents. JAMA Pediatrics. 2019;173(3):288.

Scherzer T, Barker JC, Pollick H, Weintraub JA. Water consumption beliefs and practices in a rural Latino community: implications for fluoridation. Journal of Public Health Dentistry. 2010;70(4):337–43.

Slade GD, Grider WB, Maas WR, Sanders AE. Water fluoridation and dental caries in U.S. children and adolescents. Journal of Dental Research. 2018;97(10):1122–8.

U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Reports. 2015;130(4):318?31.

*PDF of report online at http://fluoridealert.org/wp-content/uploads/nih-nidcr.report.health-in-america.dec-21-2021.pdf