Fluoride Action Network

Water Fluoridation, Tooth Decay, & Poverty

Fluoride Action Network | August 2012

Water fluoridation is routinely proposed by public health officials as an effective way of preventing the high rates of tooth decay now found in low-income populations throughout the United States. As the reports and studies below demonstrate, there are at least three problems with this position:

  • First and foremost, most of the oral health crises occurring in the United States right now are taking place in low-income urban areas that have been fluoridated for decades. It is unclear, therefore, how fluoridation can be expected to prevent oral health crises in newly fluoridated areas when it has failed to prevent such crises in areas that have been fluoridated for 30 to 60 years.
  • Second, published studies have repeatedly found that fluoridation does not prevent the type of tooth decay (“baby bottle tooth decay”) that is the hallmark of the current oral health crises.
  • Third, despite claims by some fluoridation advocates that water fluoridation can reduce social inequalities in oral health status, the research on this has been found severely lacking in quality and reliability.

1. Oral Health Crises in Fluoridated Cities:

San Antonio – Fluoridated since early 2000’s

“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.”
SOURCE: KENS 5. (2011). Added to our drinking water: A chemical more toxic than lead? November 11, 2002. (See article).

Cincinnati, Ohio (Fluoridated since 1979): 

“City and regional medical officials say tooth decay is the city’s No. 1 unmet health-care need. ‘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.’”
SOURCE: Solvig E. (2002). Cincinnati’s dental crisis. The Cincinnati Enquirer October 6. (See article)

Concord, NH – Fluoridated 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.”
SOURCE: Gerth U. (2005). Nothing to smile about. Fosters Daily Democrat, May 22. (See article)

Boston – Fluoridated since 1978:

“With a study estimating that the number of untreated cavities among Boston students greatly exceeds the national average, public health officials are about to launch an offensive against what they say is a growing dental crisis in the city… According to statistics cited in the city’s latest annual health report, ”The Health of Boston 1999”: Eighteen percent of children 4 years old and younger who were seen in the pediatric program at Tufts University School of Dental Medicine in 1995 had baby-bottle tooth decay, a painful condition that arises when a baby is given a bottle of juice or milk at bedtime. Treatment can cost up to $4,000 per child.  About 90 percent of 107 Boston high school students were found to need dental treatment, according to a 1996 unpublished study. That report also estimated that the city’s students had four times more untreated cavities than the national average…”
SOURCE: Kong D. (1999). City to launch battle against dental ‘crisis’. Boston Globe November 27.

Connecticut – Statewide mandatory fluoridation since 1960s:

“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.”
SOURCE: Slate R. (2005). State must fund plan to provide oral health care for the poor. New Haven Register May 5. (See article)

South Bronx, NY – 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.”
SOURCE: Kozol J. (1991). Savage Inequalities. Harper Perennial.

Pittsburgh, PA – Fluoridated since 1953:

“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.”
SOURCE: Law V. (2005). Sink your teeth into health care. Pittsburgh Tribune-Review February 13.

San Antonio, TX – Fluoridated since 2003:

“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.”
SOURCE: Conger J. (2011). San Antonio: Added to our drinking water: a chemical ‘more toxic than lead?’ KENS 5 News. (see article)

Washington DC – 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.
SOURCE: Morse S. (2002). Bottled Water: Just add Fluoride. Washington Post March 5. (See article)


“Water fluoridation status of the children’s area of residence did not have a significant effect on Early Childhood Caries (ECC) at the 0.1 level of significance in the unadjusted logistic regression analysis, nor was it found to be a confounder of the effect of race/ethnicity on ECC prevalence in the multivariable model.”
SOURCE: Shiboski CH, et al. (2003). The association of early childhood caries and race/ethnicity among California preschool children. Journal of Public Health Dentistry63(1):38-46.

“Data from Head Start surveys show the prevalence of baby bottle tooth decay is about three times the national average among poor urban children, even in communities with a fluoridated water supply.” 
SOURCE: Von Burg MM et al. (1995). Baby Bottle Tooth Decay: A Concern for All Mothers. Pediatric Nursing 21: 515-519.

“Children attending centers showed no significant differences (in baby bottle tooth decay) based on fluoride status for the total sample or other variables.”
SOURCE: Barnes GP, et al. (1992). Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of head start children.Public Health Reports 107: 167-73.

“Regardless of water fluoridation, the prevalence of BBTD (baby bottle tooth decay) remained high at all of the sites surveyed. More research needs to be done on the relationship of fluoridated water and BBTD.
SOURCE: Kelly M, Bruerd B. (1987). The Prevalence of Baby Bottle Tooth Decay Among Two Native American Populations. Journal of Public Health Dentistry47:94-97.


“Water fluoridation aims to reduce social inequalities in dental health, but few relevant studies exist. The quality of research was even lower than that assessing overall effects of fluoridation.”
SOURCE: Cheng KK, et al. (2007). Adding fluoride to water supplies. British Medical Journal 335:699-702.

“There was little evidence to show that water fluoridation has reduced social inequalities in dental health.”
SOURCE: Centre for Reviews and Dissemination. (2003). What the ‘York Review’ on the fluoridation of drinking water really found. University of York.

“In this study in oral epidemiology, officially collected statistics are presented which show that, 15 yr after fluoridation commenced in Auckland, New Zealand, there was still a significant correlation between dental health of children and their social class. They also show that treatment levels have continued to decline in both fluoridated and unfluoridated areas, and are related to social class factors rather than to the presence or absence of water fluoridation… When the socioeconomic variable is allowed for, dental health appears to be better in the unfluoridated areas.”
SOURCE: Colquhoun J. (1985). Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology 13:37-41.