2001 Surgeon General’s Statement on Community Water Fluoridation

December 3, 2001—For more than half a century, community water fluoridation has been the cornerstone of caries prevention in the United States. As noted in my May 2000 report, Oral Health in America: A Report of the Surgeon General, community water fluoridation continues to be the most cost-effective, practical and safe means for reducing and controlling the occurrence of tooth decay in a community. In thousands of communities in the United States where naturally-occurring fluoride levels are deficient, small amounts of fluoride have been added to drinking water supplies with dramatic results. More than 50 years of scientific research has found that people living in communities with fluoridated water have healthier teeth and fewer cavities than those living where the water is not fluoridated.

Almost two-thirds of the United States population served by public water supplies consume water with optimal fluoride levels. Of the 50 largest cities in the country, 43 are fluoridated. A significant advantage of water fluoridation is that anyone, regardless of socioeconomic level, can enjoy these health benefits during their daily lives—at home, work, or at school or play—simply by drinking fluoridated water or beverages prepared with fluoridated water. Water fluoridation is a powerful strategy in our efforts to eliminate health disparities among populations. Unfortunately, over one-third of the United States population (100 million people) is without this critical public health measure.

The U.S. Centers for Disease Control and Prevention has recognized the fluoridation of drinking water as one of ten great public health achievements of the twentieth century. Water fluoridation has helped improve the quality of life in the United States through reduced pain and suffering related to tooth decay, reduced time lost from school and work, and less money spent to restore, remove, or replace decayed teeth. Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults.

Water fluoridation continues to be a highly cost-effective strategy, even in areas where the overall caries level has declined and the cost of implementing water fluoridation has increased. Compared to the cost of restorative treatment, water fluoridation actually provides cost savings, a rare characteristic for community-based disease prevention strategies.
While we can be pleased with what has already been accomplished, it is clear that there is much yet to be done. I join previous Surgeons General in acknowledging the continuing public health role for community water fluoridation in enhancing the oral health of all Americans.

David Satcher, MD, PhD
United States Surgeon General

This statement is also available as a PDF file [PDF– 399K].