Since its inception in the 1940s, community water fluoridation has been lauded by public health agencies as one of the top public health achievements of the 20th century. Water fluoridation, the controlled addition of fluoride to public water supplies, is done to reduce tooth decay in children and adults. According to the Centers for Disease Control and Prevention, children living in communities with fluoridated water have about 2.25 fewer decayed teeth than those without it.

Despite adoption in many communities, water fluoridation is a contentious issue for some. One fear is that fluoride build-up in the bones can occur. However, this is only a threat after long-term exposure to fluoridation levels higher than 4.0 mg/L.

This is well beyond the fluoride level of 0.7mg/L recommended by the United States Public Health Service.

Other opponents argue that water fluoridation is a form of compulsory mass medication and that it denies consumers choice. While these arguments are valid, scientific studies underscore numerous benefits, leading policy makers to believe the pros outweigh the cons.

Because not all Americans have access to dental care, many view water fluoridation as a free preventative health measure, like enriched flour or fortified milk. Especially in low-income communities where there may not be many dentists or where people can’t afford to visit one, water fluoridation reduces the risk of serious oral health problems.

While much of the country fluoridates its water supply (nearly 75 percent of people on community water systems receive fluoridated water, according to the Centers for Disease Control and Prevention), some states fluoridate more of their water than others. Using data from the CDC, the experts at HealthGrove discovered which states fluoridate the most.

For this list, HealthGrove ranked the states, including the District of Columbia, by percent of people on community water systems that have fluoridated water. Additionally, density of dentists per 100,000 people (as of 2013) and the percent of people who visit a dentist or dental clinic within the past year (as of 2014) are included for context.

Note: In the case of ties, the higher ranking goes to the state with the largest number of people served by community water systems.

#51. Hawaii

Percent of Community Water Supply That is Fluoridated: 10.8%

Number of People Receiving Fluoridated Water: 139,598

Total Population Served by Community Water Supply: 1,290,549

Dentists per 100K People: 81.6

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 71.6%

#50. New Jersey

Percent of Community Water Supply That is Fluoridated: 14.6%

Number of People Receiving Fluoridated Water: 1,206,270

Total Population Served by Community Water Supply: 8,288,715

Dentists per 100K People: 80.7

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 70.2%

#49. Oregon

Percent of Community Water Supply That is Fluoridated: 22.6%

Number of People Receiving Fluoridated Water: 833,557

Total Population Served by Community Water Supply: 3,688,540

Dentists per 100K People: 73.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 65.7%

#48. Montana

Percent of Community Water Supply That is Fluoridated: 32%

Number of People Receiving Fluoridated Water: 252,299

Total Population Served by Community Water Supply: 788,805

Dentists per 100K People: 66.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 62.6%

#47. Idaho

Percent of Community Water Supply That is Fluoridated: 36.1%

Number of People Receiving Fluoridated Water: 395,863

Total Population Served by Community Water Supply: 1,097,332

Dentists per 100K People: 63.9

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 64.3%

#46. Louisiana

Percent of Community Water Supply That is Fluoridated: 43.4%

Number of People Receiving Fluoridated Water: 1,996,568

Total Population Served by Community Water Supply: 4,601,893

Dentists per 100K People: 50.6

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 58.3%

#45. Wyoming

Percent of Community Water Supply That is Fluoridated: 43.6%

Number of People Receiving Fluoridated Water: 195,891

Total Population Served by Community Water Supply: 449,223

Dentists per 100K People: 58.2

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 65%

#44. New Hampshire

Percent of Community Water Supply That is Fluoridated: 46%

Number of People Receiving Fluoridated Water: 383,333

Total Population Served by Community Water Supply: 832,631

Dentists per 100K People: 67.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 69.4%

#43. Utah

Percent of Community Water Supply That is Fluoridated: 51.7%

Number of People Receiving Fluoridated Water: 1,384,638

Total Population Served by Community Water Supply: 2,676,448

Dentists per 100K People: 66.6

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 68.9%

#42. Alaska

Percent of Community Water Supply That is Fluoridated: 52.9%

Number of People Receiving Fluoridated Water: 361,240

Total Population Served by Community Water Supply: 682,528

Dentists per 100K People: 86.2

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 64.4%

#41. Pennsylvania

Percent of Community Water Supply That is Fluoridated: 54.6%

Number of People Receiving Fluoridated Water: 5,885,390

Total Population Served by Community Water Supply: 10,780,146

Dentists per 100K People: 62.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 66.8%

#40. Vermont

Percent of Community Water Supply That is Fluoridated: 56.1%

Number of People Receiving Fluoridated Water: 252,920

Total Population Served by Community Water Supply: 450,483

Dentists per 100K People: 63.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 72.2%

#39. Arizona

Percent of Community Water Supply That is Fluoridated: 57.8%

Number of People Receiving Fluoridated Water: 3,199,068

Total Population Served by Community Water Supply: 5,536,324

Dentists per 100K People: 57.3

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 59%

#38. Mississippi

Percent of Community Water Supply That is Fluoridated: 58.2%

Number of People Receiving Fluoridated Water: 1,738,478

Total Population Served by Community Water Supply: 2,984,926

Dentists per 100K People: 43

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 56.8%

#37. Kansas

Percent of Community Water Supply That is Fluoridated: 63.6%

Number of People Receiving Fluoridated Water: 1,719,503

Total Population Served by Community Water Supply: 2,702,452

Dentists per 100K People: 52.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 67.3%

#36. Washington

Percent of Community Water Supply That is Fluoridated: 63.6%

Number of People Receiving Fluoridated Water: 3,515,797

Total Population Served by Community Water Supply: 5,525,840

Dentists per 100K People: 75.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 67%

#35. California

Percent of Community Water Supply That is Fluoridated: 63.7%

Number of People Receiving Fluoridated Water: 24,215,234

Total Population Served by Community Water Supply: 38,041,430

Dentists per 100K People: 77.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 65.1%

#34. Arkansas

Percent of Community Water Supply That is Fluoridated: 66.9%

Number of People Receiving Fluoridated Water: 1,785,679

Total Population Served by Community Water Supply: 2,669,485

Dentists per 100K People: 42.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 57.1%

#33. Oklahoma

Percent of Community Water Supply That is Fluoridated: 70.1%

Number of People Receiving Fluoridated Water: 2,486,718

Total Population Served by Community Water Supply: 3,548,057

Dentists per 100K People: 55.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 56.8%

#32. Massachusetts

Percent of Community Water Supply That is Fluoridated: 70.4%

Number of People Receiving Fluoridated Water: 4,681,038

Total Population Served by Community Water Supply: 6,646,144

Dentists per 100K People: 91.2

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 74.7%

#31. Nebraska

Percent of Community Water Supply That is Fluoridated: 71.2%

Number of People Receiving Fluoridated Water: 1,015,094

Total Population Served by Community Water Supply: 1,425,664

Dentists per 100K People: 69

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 66.4%

#30. New York

Percent of Community Water Supply That is Fluoridated: 71.8%

Number of People Receiving Fluoridated Water: 12,989,488

Total Population Served by Community Water Supply: 18,094,452

Dentists per 100K People: 76.6

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 67.3%

#29. Colorado

Percent of Community Water Supply That is Fluoridated: 72.4%

Number of People Receiving Fluoridated Water: 3,757,694

Total Population Served by Community Water Supply: 5,187,582

Dentists per 100K People: 73

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 67%

#28. Nevada

Percent of Community Water Supply That is Fluoridated: 73.5%

Number of People Receiving Fluoridated Water: 1,870,698

Total Population Served by Community Water Supply: 2,544,079

Dentists per 100K People: 55.9

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 59.9%

#27. Missouri

Percent of Community Water Supply That is Fluoridated: 76.4%

Number of People Receiving Fluoridated Water: 3,994,342

Total Population Served by Community Water Supply: 5,226,360

Dentists per 100K People: 52.1

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 58.6%

#26. New Mexico

Percent of Community Water Supply That is Fluoridated: 77%

Number of People Receiving Fluoridated Water: 1,210,877

Total Population Served by Community Water Supply: 1,571,600

Dentists per 100K People: 57.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 61.3%

#25. Florida

Percent of Community Water Supply That is Fluoridated: 78%

Number of People Receiving Fluoridated Water: 13,371,262

Total Population Served by Community Water Supply: 17,149,724

Dentists per 100K People: 53.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 61.9%

#24. Alabama

Percent of Community Water Supply That is Fluoridated: 78.4%

Number of People Receiving Fluoridated Water: 3,781,607

Total Population Served by Community Water Supply: 4,822,023

Dentists per 100K People: 44.3

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 60%

#23. Maine

Percent of Community Water Supply That is Fluoridated: 79.4%

Number of People Receiving Fluoridated Water: 527,163

Total Population Served by Community Water Supply: 664,063

Dentists per 100K People: 56.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 63.6%

#22. Texas

Percent of Community Water Supply That is Fluoridated: 79.6%

Number of People Receiving Fluoridated Water: 20,002,506

Total Population Served by Community Water Supply: 25,113,656

Dentists per 100K People: 51.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 58.2%

#21. Rhode Island

Percent of Community Water Supply That is Fluoridated: 83.9%

Number of People Receiving Fluoridated Water: 837,549

Total Population Served by Community Water Supply: 997,824

Dentists per 100K People: 61.2

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 72.1%

#20. Delaware

Percent of Community Water Supply That is Fluoridated: 86.3%

Number of People Receiving Fluoridated Water: 705,824

Total Population Served by Community Water Supply: 818,110

Dentists per 100K People: 45.2

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 66.5%

#19. North Carolina

Percent of Community Water Supply That is Fluoridated: 87.5%

Number of People Receiving Fluoridated Water: 6,164,847

Total Population Served by Community Water Supply: 7,042,655

Dentists per 100K People: 50.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 64.2%

#18. Wisconsin

Percent of Community Water Supply That is Fluoridated: 89.4%

Number of People Receiving Fluoridated Water: 3,597,525

Total Population Served by Community Water Supply: 4,025,756

Dentists per 100K People: 61.3

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 70.1%

#17. Tennessee

Percent of Community Water Supply That is Fluoridated: 89.7%

Number of People Receiving Fluoridated Water: 5,229,461

Total Population Served by Community Water Supply: 5,826,866

Dentists per 100K People: 50.1

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 58.3%

#16. Michigan

Percent of Community Water Supply That is Fluoridated: 90.2%

Number of People Receiving Fluoridated Water: 7,218,670

Total Population Served by Community Water Supply: 7,999,859

Dentists per 100K People: 67.3

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 68.6%

#15. Connecticut

Percent of Community Water Supply That is Fluoridated: 90.3%

Number of People Receiving Fluoridated Water: 2,350,532

Total Population Served by Community Water Supply: 2,603,377

Dentists per 100K People: 77.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 74.9%

#14. West Virginia

Percent of Community Water Supply That is Fluoridated: 91.1%

Number of People Receiving Fluoridated Water: 1,365,697

Total Population Served by Community Water Supply: 1,499,749

Dentists per 100K People: 48.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 54.2%

#13. Iowa

Percent of Community Water Supply That is Fluoridated: 92%

Number of People Receiving Fluoridated Water: 2,555,593

Total Population Served by Community Water Supply: 2,778,894

Dentists per 100K People: 59.9

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 69.4%

#12. Ohio

Percent of Community Water Supply That is Fluoridated: 92.2%

Number of People Receiving Fluoridated Water: 9,716,289

Total Population Served by Community Water Supply: 10,537,957

Dentists per 100K People: 57.3

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 65.3%

 

#11. South Dakota

Percent of Community Water Supply That is Fluoridated: 93.6%

Number of People Receiving Fluoridated Water: 646,671

Total Population Served by Community Water Supply: 690,759

Dentists per 100K People: 55.2

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 70.5%

#10. South Carolina

Percent of Community Water Supply That is Fluoridated: 93.8%

Number of People Receiving Fluoridated Water: 3,602,956

Total Population Served by Community Water Supply: 3,839,526

Dentists per 100K People: 49.9

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 58.3%

#9. Indiana

Percent of Community Water Supply That is Fluoridated: 94.8%

Number of People Receiving Fluoridated Water: 4,342,273

Total Population Served by Community Water Supply: 4,582,496

Dentists per 100K People: 50.7

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 61.5%

#8. Virginia

Percent of Community Water Supply That is Fluoridated: 96%

Number of People Receiving Fluoridated Water: 6,159,737

Total Population Served by Community Water Supply: 6,416,760

Dentists per 100K People: 62.1

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 69.3%

#7. Georgia

Percent of Community Water Supply That is Fluoridated: 96.3%

Number of People Receiving Fluoridated Water: 9,551,793

Total Population Served by Community Water Supply: 9,919,945

Dentists per 100K People: 47.6

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 60.6%

#6. North Dakota

Percent of Community Water Supply That is Fluoridated: 96.7%

Number of People Receiving Fluoridated Water: 612,560

Total Population Served by Community Water Supply: 633,645

Dentists per 100K People: 58.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 65.5%

#5. Maryland

Percent of Community Water Supply That is Fluoridated: 97.2%

Number of People Receiving Fluoridated Water: 5,060,379

Total Population Served by Community Water Supply: 5,204,155

Dentists per 100K People: 71.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 70.2%

#4. Illinois

Percent of Community Water Supply That is Fluoridated: 98.5%

Number of People Receiving Fluoridated Water: 12,682,543

Total Population Served by Community Water Supply: 12,875,255

Dentists per 100K People: 68.8

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 63.9%

#3. Minnesota

Percent of Community Water Supply That is Fluoridated: 98.8%

Number of People Receiving Fluoridated Water: 4,134,663

Total Population Served by Community Water Supply: 4,184,753

Dentists per 100K People: 65.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 72.6%

#2. Kentucky

Percent of Community Water Supply That is Fluoridated: 99.9%

Number of People Receiving Fluoridated Water: 4,375,026

Total Population Served by Community Water Supply: 4,380,415

Dentists per 100K People: 59.4

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 61%

#1. District of Columbia

Percent of Community Water Supply That is Fluoridated: 100%

Number of People Receiving Fluoridated Water: 595,000

Total Population Served by Community Water Supply: 595,000

Dentists per 100K People: 116.5

Percent of Population That Visited a Dentist or Dental Clinic in Past Year: 70.8%

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