Dental Caries Interview

Environmental and Policy Changes vs. Changing Individual’s Behavior

Dr. Scott Tomar of the University of Florida College of Dentistry discusses the effectiveness of community water fluoridation in providing access to dental health and saving money.


One of the principles of public health is we want to create a situation where the default behavior is conducive to preventing disease and promoting health. And water fluoridation really is just such an ideal example of that.

There’s fluoride toothpaste, mouth rinses, and so on, but there’s really nothing else like community water fluoridation where it provides the preventive measure without the person having to to do any special behavior to take any specific action.

One of the nice things about the way fluoridation works, even though it’s providing a very, very low concentration of fluoride, less than one part per million, compared to for example in toothpaste which is about 1,100 parts per million or 11 hundred times the concentration. Water fluoridation has the fluoride available at the surface of the tooth and so the fluoride is available at a time when it’s needed.

It doesn’t require the person to go out and either purchase a specific product or to use it a certain number of times. In many ways, it’s similar to other types of public health measures. For example, adding folic acid to certain grains that prevents a number of forms of birth defects. We just create an environment that’s conducive to health.

We’re talking about you know pennies per person per year. There’s nothing else that comes close to that in terms of cost effectiveness. In fact, community water fluoridation, not only is it inexpensive, it’s actually one of very, very few public health measures that not only prevents disease, it actually reduces the amount of money that we spend. There’s very, very few things in public health that truly save money. Community water fluoridation is one of the few examples, and it really has been shown regardless of the the size of the community and underlying disease rates in pretty much all communities. It’s been shown to save money.

What’s even more powerful about community water fluoridation is it has its greatest effect on those at greatest risk for disease. So we’ve seen the greatest benefits, the greatest amount of reduction in tooth decay in communities where people have the lowest access to other forms of fluorides or to dental care.

There’s almost nothing they can do that would be as beneficial for the community and as cost saving and as cost effective as instituting and maintaining community water fluoridation for their citizens.

It prevents disease. It saves money. It doesn’t require individual behavior change, and it’s been shown for about 60 years to be safe and effective. This is why it continues to be endorsed by virtually every major medical public health and dental organization in the world.