JAMA releases study on elimination of community water fluoridation

Estimates fluoride removal would cost billions, deteriorate oral health

Removing fluoride from U.S. public water systems would increase tooth decay by 7.5% and cost at least $9.8 billion over five years, according to estimates in a study published by the Journal of the American Medical Association Health Forum. The study, released May 30, seeks to determine the oral health outcomes for children and associated health care costs when water fluoridation stops. 

The ADA said in a news release that this report validates both the financial and health consequences of discontinuing water fluoridation programs reported in previous studies, adding that the impacts will be hardest felt by Medicaid beneficiaries. 

“The simulation model of oral health outcomes again shows the negative health outcomes if we remove fluoride from the water in this country, particularly without any counter measures in place to prevent and treat oral diseases,” ADA President Brett Kessler, D.D.S., said in the release.  

JAMA researchers conducted a cost-effectiveness analysis to estimate changes in total tooth decay, quality-adjusted life-years and costs associated with removal of fluoride in public water systems during five- and 10-year periods. The study, which used nationally representative data of over 8,400 children ages 0-19 from the National Health and Nutritional Examination Survey, found that increased tooth decay would disproportionately affect publicly insured and uninsured children compared to those with private dental insurance.  

“This cost-effectiveness analysis found that cessation of public water fluoridation would increase tooth decay and health system costs in the U.S. Despite concerns regarding toxic effects associated with high levels of fluoride, this model demonstrates the substantial ongoing benefits of water fluoridation at safe levels currently recommended by the U.S Environmental Protection Agency, National Toxicity Program, and Centers for Disease Control and Prevention,” the JAMA authors wrote.  

In the release, the ADA reaffirmed its support for community water fluoridation, noting that previous research has confirmed that increased treatment costs and surgical interventions are associated with a loss of access to community water fluoridation. In Juneau, Alaska, children enrolled in Medicaid experienced an average increase in cavity-related treatment costs of 47% within nine years of discontinuing fluoride in the water. In Calgary, Canada, researchers reported a 78% increase in the use of general anesthesia needed to treat young children with severe dental decay when fluoridation stopped. Calgary will resume fluoridation in June. 

The current study comes after Florida and Utah became the first two U.S. states to place complete bans on community water fluoridation, a move the ADA has called “irresponsible and misinformed.” 

“The ADA follows research on the best ways to advance public health and welcomes research upheld with scientific rigor and statistically significant, evidence-based data to advance oral health care policy,” according to the release. “To date, the data continually shows that when fluoride is discontinued, disease also increases.”