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Americans enjoyed savings of $32 per capita in tooth decay prevention, according to a national assessment of fluoridation by Colorado School of Public Health (ColoradoSPH) researchers published in Health Affairs.

The work updates a 2001 comprehensive study of U.S. community water fluoridation program costs and benefits. Joan O’Connell, PhD, associate professor in the Community & Behavioral Health Department of the ColoradoSPH at CU Anschutz, and coauthors developed a model to update that national study using more recent information on fluoridation costs, the incidence of tooth decay and treatment costs.

They used data from multiple sources including the Centers for Disease Control, NNER, 2013 administrative data from private dental insurers and from water systems located throughout the U.S. They estimated the types of initial and follow-up treatment for dental caries, or tooth decay, and their associated costs to treat over time.

Researchers found that in 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. They estimated 2013 savings associated with caries averted as a result of fluoridation to be $6.8 billion, or $32 per capita. The estimated cost to community water fluoridation programs providing fluoridation was $324 million, with net savings estimated at $6.5 billion and a $20 return on investment for each $1 spent. Estimates of per capita savings associated with community water fluoridation may be used by states to estimate net savings and a return on investment using local data on fluoridation costs.

Approximately 75 percent of Coloradans served by public water systems receive optimal levels of fluoride.  Community water fluoridation has been identified as the most cost-effective method of delivering fluoride to all members of the community regardless of race/ethnicity, age, gender, educational attainment or income.

The Colorado Department of Public Health and Environment’s Oral Health Unit oversees the Community Water Fluoridation program. The Oral Health Unit, in collaboration with the Safe Drinking Water Program, administers the community water fluoridation program, ensuring that the addition of fluoride is in accordance with the latest scientific, dental and health guidelines.

The Oral Health Unit collaborates with local communities to increase awareness of the benefits, safety and efficacy of water fluoridation; provide technical assistance to communities who are considering implementing a water fluoridation program; address possible community water fluoridation rollback attempts, provide funding for new or replacement fluoridation equipment, and support public water systems that are fluoridating meet operational guidelines.

In 2015, the U.S. Public Health Service updated its recommendation on fluoridation levels to 0.7 milligrams per liter (mg/L) from the previous 1962 recommendation range of 0.7 to 1.2 mg/L. This updated recommendation was initiated in 2011 and decided by a panel of scientists from several federal agencies after public comment. The panel reviewed a substantial body of peer-reviewed evidence to ensure optimal health and reduction in tooth decay while minimizing the risk of cosmetic fluorosis in the general population.