Community Water Fluoridation: The Pros and Cons

Junior (College 3rd year) ・Healthcare&Medicine ・APA ・11 Sources

Many healthcare providers advise people to take fluoridated water, which has several benefits including strengthening teeth. Research indicates that slightly above twenty percent of teenagers who are used to drinking fluoridated water since their childhood are utterly free from dental caries. Fluoridating community water is rated as one of the most economical ways of the preventive intervention program in public health (Armfield, 2010). A good proportion of the world’s policymakers insist the community water fluoridation is the best alternative to matters concerning care for groups at higher risks of dental caries. Nevertheless, other people, still feel that non-fluoridated water is the best. In essence, fluoridated water is highly beneficial to the health of many people, in particular by protecting the tooth against cavity formation or decay, hence should be used regularly.

Admittedly, dental caries is the most common form of oral health-related disorders affecting a good number of people globally. The process of developing dental carries is referred to as tooth decay. It affects children, teenagers as well as adults. Armfield (2010) states that dental caries is one of the major concerns of public health in most industrialized countries. Statistics indicate that about sixty to ninety percent of school going children and adults in the majority is affected. Fluoridation of water has been proved to reduce dental caries in children, but its efficacy in adults is not yet established (Pahel, 2007).

Although research studies have provided evidence that fluoridation can cause dental or enamel fluorosis, which is the alteration in the appearance of developing teeth, the effects are mild and can be assumed to be a matter of public concern. So far, there are no established adverse effects of community water fluoridation (Newburn, 2012). The impact depends on the daily fluoride total intake from all sources. The most significant source of fluorides is the drinking water. Other origins include fluoride therapy methods such as milk, salt, and toothpaste. According to Pollick (2004), people have mixed opinions on the active strategies for avoidance of tooth degeneration in communities (Pollick, 2004). The World Health Organization outlines that fluoridation of water is the most realistic and aesthetically acceptable means of expanding the exposure of populations to fluorides. The approach has substantial benefits especially when subgroups are at high risks of dental caries.

History of Community Water Fluoridation

The US was the first country to have community water fluoridation. By 2012, about twenty-five countries had adopted the practice of water fluoridation, however, at a small scale. Eleven out of the total number of countries, which practice water fluoridation, have about fifty percent of their populations consuming fluoridated water. About twenty-eight nations in the world have their water sources naturally fluoridated (Armfield, 2010). These, however, have been found to contain fluorides to the level above the recommended concentration. Statistics as well show that about 435 people worldwide have access to fluoridated water safety standards. FDI World Dental Federation and the World Health Organization have so far supported the idea of community water fluoridation in that they are practical as well as safe (Newbrun, 2016).

Controversies Surrounding Fluoridation of Community Water

Despite the increased emphasis on fluoridating community water, the idea still encounters many controversies, which arise from economic, moral, political, and safety aspects. Across the globe, public health policymakers have reached a medical harmony assuming that fluoridation of water is appropriately nontoxic and effective in the avoidance of dental caries. However, some people still have mixed views on which fluoride therapy is the best for communal prevention of tooth decay. The opponents outline that fluoridation entails minimal cariostatic advantages and might as well lead to serious health problems. They feel that fluoridation is pharmacologically obsolete and is not compelling enough to justify the associated costs (O'Connell, 2016).

Notably, fluoridation of water is beneficial to the society but goes against the individual rights of people. In some arguments, the common good associated tend to override the individual rights and can be equated to vaccination or fortification of food. Other groups claim that human rights are supreme over the treatment process. The argument is based on the fact that one should be allowed to select what to drink unless it is bottled and expensive. Unequivocally other people argue that such cannot be subjected to any form of scrutiny or legal protections based on medical ethics therein (Armfield, 2007).

Fluoridation has been criticized since time immemorial. It has been the source of a continuous debate between the advocates of its use as a public health measure and those against the treatment. Conspiracies in the 1950s outlined fluoridation as a tool used by the communists to undermine the public health of Americans (Marobia, 2016). Over time, community water fluoridation has become popular among communities and countries where some have expanded its use while others are discontinuing its use. The controversies surrounding fluoridation have been advanced by the very significant public opposition units, which are in essence backed by minority professionals such as health food enthusiast, religious groups, medical and dental professionals and researchers. Occasionally, environmentalists and consumer groups as well involved in the community water fluoridation controversies. Criticisms have been directed to both the proponents and opponents of the debate for citing exaggerated benefits as well as overstating the risks of fluoridation (Morabia, 2016). The understanding of both perspectives has been paralyzed since there exists no tangible research evidence to candidly outline the risks and the benefits thus making it difficult to address questions surrounding the topic. The gaps in scientific literature in support or opposition fuels the water fluoridation controversies.

Further, arguments have put in place in that ending fluoridation is a way of saving on the tax dollars. It is not true in that ending fluoridation imposes a hidden tax where families will be forced to increase their dental spending. Evidence shows that fluoridation, in the long run, saves money on matters of oral health. Taxpayers, in essence, save money because fluoridation acts to reduce expenses on dental treatments. Statistics indicate that states save at least twenty-four dollars per person annually in Medicaid expenses the reason being; cavities were avoided by fluoridating drinking water.

Goal of Community Water Fluoridation

The chief aim of fluoridating water is to reduce or entirely prevent the cases of tooth decay by modifying the concentrations of fluorides in communal water supply systems. Worldwide, tooth decay is among the most prevalent chronic diseases (Cho, 2014). Though it is not a threat to life, it can cause unbearable pains to an individual to the extent of impairing speaking, eating, and the appearance of the face as well as the acceptance of an individual in the society. The quality of life is in turn affected especially among families of lower economic status. Tooth decay is more prevalent in industrialized countries than in the developing nations. In all honesty, these variations can be attributed to differences in diet as well as exposure to fluorides. The poor and the minority groups in the United States show higher rates of tooth decay and lack appropriate dental care strategies.

Above all, water fluoridation aims at reducing the rates of chronic diseases, which affect the poor and children. Another goal of water fluoridation is to bridge inequalities that exist in dental care and dental health. Arguments have been put forth in line that fluoridation minimizes the differences established between the poor and the rich regarding oral health such evidence are however insufficient thus a conclusion about the same cannot be made. There is no scientific proof, but anecdotal evidence points out to the fact that fluoridation can slow the process of tooth decay thus a critical element in the treatment process (Mount and Hume, 2005).

Advantages of Community Water Fluoridation

Accordingly, community water fluoridation is one of the most efficient ways of reducing dental carries on a large scale. According to Mount (2005), the fluorides are significant in enhancing dental health in that they are incorporated into the tooth’s crystalline pattern to form fluorapatite. The form of treatment involves the most stable form of hydroxyapatite responsible for inhibiting the demineralization process in the teeth. In essence, fluorides promote remineralization of the surface teeth, inhibition of the formation of dental plaques as well as inhibiting the metabolism of bacteria.

A good number of individuals argue that topical fluoride such as wash pastes and salt can replace fluoridation since they are highly safe. Researchers, on the other hand, have considerably supported fluoridation in that fluoridated water is more beneficial compared to non-fluoridated water. Communities that are exposed to non-fluoridated water normally register higher rates of bone cancer compared to those exposed to fluoridated water (Cho, 2014). Though topical fluoridation is beneficial, they present outward effects compared to fluoridated water, which acts both systemically and topically.

Subsequently, fluoridation is beneficial over non-fluoridated water in the essence that it protects all ages in the community against cavities (Broadbent et al., 2015). Dental caries is infectious and can be transmitted in the process where bacterial by-products dissolve the tooth enamel. More importantly, if the bacteria are unchecked, they can penetrate the teeth and affect the delicate inner tissues such as the pulp. Fluoride acts in a manner to control carries in the early stages.

Fluoridated water is advantageous in that it affects the cryogenic bacteria. In the process where the fluorides accumulate in the dental plaque, it changes the cryogenic bacteria in that they are unable to metabolize the carbohydrates to produce the acids that in turn corrode the tooth enamel (Cho, 2014). Furthermore, the fluoride limits the bacteria from producing adhesive polysaccharides that affect the enamel as well. Studies have established that low concentrations of fluorides affect the bacteria in considerable levels leading to reduced acid production.
The human saliva has been found to be carrying significant amounts of topical fluorides. The concentrations are higher in the ductal saliva secreted by the salivary glands. This level, however, does not affect significantly on the cryogenic activities of bacteria. Therefore drinking fluoridated water raises the standards that are more important in teeth remineralization and reduction of the effects of plaque. Investigators have come up with the hypothesis that fluoride protects the enamel only when it is incorporated into the developing enamel. There is evidence to support this theory; however, higher fluoride concentrations on the enamel alone cannot be the only explanation for the reduced dental carries (Whyman, 2016). The meaning of such is that dental caries prevalence in a community is not in a way related to the concentrations of fluoride on the enamel. Further, high concentrations of fluoride do not mean efficiency in preventing dental caries.

Evidence has been documented in various peer-reviewed articles indicating that prolonged use of fluorides in high concentrations has adverse effects on health (Pollick, 2004). This, however, cannot be justified by any true means that non-fluoridated water is better than fluoridated water. Higher concentrations of total ingested fluoride found in food, drinking water, toothpaste and any other source could translate into severe effects on human beings. Some of the effects of drinking highly fluoridated water include bone cancer, skeletal fluorosis, dental fluorosis, and even bone fractures. Fluorosis in often occur when we drinking too much of high fluoride concentrated water. Fluoride binds with the enamel easily, in high concentrations, cases of enamel loss, brown staining and surface pitting might be experienced. Children are the most affected by the enamel fluorosis cases (Pahel et al., 2007). Their critical periods are between the ages of six and eight compared to adults. In severe cases, enamel fluorosis can lead to the loss of dental function.

In this context, before modalities for the use of fluorides in dental care are promoted, the persons’ or groups’ risk to dental carries must be considered. The reason for this is to make sure that programs such as community water fluoridation act for the benefit of the community without bringing about chances of side effects. In addition to this, it is a responsibility of a health care provider to determine the group, which is more at risk of dental caries, and assess the other alternatives in countering the same (Whyman, 2016). If water fluoridation is the best alternative available then, it would be appropriate to extend into assessing to what levels are most appropriate. The risk category, in fact, liable to changes over time. It, therefore, means that the type and the frequency of preventive programs must change with these changes. That is to say, fluoridated water is, in essence, is more critical than non-fluoridated water, but this is only applicable when there are a risk group and the levels of impact assessed.

Non-fluoridated water does not have any significant advantages or rather benefits to human beings compared to fluoridated water. Fluoridated water occurs in nature, and this could mean that is a necessity. Agencies have been formed, and there is increased awareness on the very definite advantages of fluoridated water. Evidence indicates that it is beneficial for dental health in that it is the most efficient and economical means of controlling dental carries among a larger population with the potential risk. All ages are protected in by the fluoridation process in that the chances of developing tooth decay are minimized (Morabia, 2016). Community water fluoridation is safe and effective. It has been endorsed by more than one hundred organization in the world including the World Health Organization. Again it is a natural process because fluoridated water occurs naturally in groundwater, oceans thus very vital for the wholesome development of the tooth as well as bones.


Armfield, J.M. (2007). When Public Action Undermines Public Health: A Critical Examination of Antifluoridationist Literature. Australian & New Zealand Health Policy 2007; 4: 25. Retrieved from

Armfield, J.M. (2010). Community Effectiveness of Public Water Fluoridation in Reducing Children's Dental Disease. Public Health Reports, 125(5), pp.655-664

Broadbent, J.M., Thomson, W.M., Ramrakha, S., Moffitt, T.E., Jiaxu, Z., Foster Page, L.A., & Poulton, R. (2015). Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. American Journal of Public Health, 105(1), 72-76.

Cho, H.J., Jin, B.H., Park, D.Y., Jung, S.H., Lee, H.S., Paik, D.L., & Bae, K.H. (2014). Systemic Effect of Water Fluoridation on Dental Caries Prevalence. Community Dentistry and Oral Epidemiology, 42(4), pp.341-348

Morabia, A. (2016). Community Water Fluoridation: Open Discussions Strengthen Public Health. American Journal of Public Health, 106(2), 209-210.

Mount, G.J. and Hume W.R. (2005). Preservation and restoration of tooth structure. 2nd ed. Brighton (Australia): Knowledge Books and Software.

Newbrun, E. (2016). Historic Early Endorsement of Community Water Fluoridation. American Journal of Public Health, 106(2), 210-211. doi:10.2105/AJPH.2015.302914

O'Connell, J., Rockell, J., Ouellet, J., Tomar, S.L., & Maas, W. (2016). Costs And Savings Associated With Community Water Fluoridation in the United States. Health Affairs, 35(12), 2224-2232. doi:10.1377/hlthaff.2016.0881

Pahel, B.T., Rozier R.G. and Slade, G.D. (2007). Parental Perceptions of Children's Oral Health: The Early Childhood Oral Health Impact Scale (''- HIS). Health and Quality of Life Outcomes, 5(1), pp.5-6

Pollick, H. F. (2004). Water Fluoridation and the Environment: Current Perspective in the United States. International Journal of Occupational and Environmental Health, 2004;10:343–350. Retrieved from Whyman, R.A., Mahoney, E.K., & Børsting, T. (2016). Community Water Fluoridation: Attitudes and Opinions from the New

Zealand Oral Health Survey. Australian & New Zealand Journal Of Public Health, 40(2), 186-192. doi:10.1111/1753-6405.12408

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