April JADA evaluates water fluoridation benefits, impact of discontinuation

Other articles discuss silver diamine fluoride, temporomandibular disorders

Community water fluoridation is effective at preventing caries and dentists should advise policymakers and their patients not to abandon the practice, according to the cover story of the April issue of The Journal of the American Dental Association.

“An Update on Community Water Fluoridation, Part 1: Mechanism of Action, Effectiveness, and Cost Savings” is the latest addition to JADA’s Oral Science Trends series, which consists of invited reviews that explain where current biomedical and clinical sciences are leading to impactful changes in dentists’ ability to provide care and improve health.

The authors reviewed evidence on the benefits and cost-effectiveness of community water fluoridation as well as the impact of discontinuing the practice, focusing on observational studies published between 2014 and 2025. The studies were peer reviewed and conducted in the U.S. or other countries with highly developed economies, and some were part of government-commissioned reports.

The studies found community water fluoridation typically reduced caries by about 25% and its cost was a small fraction of the increased treatment costs expected in the absence of fluoridation. Stopping water fluoridation consistently resulted in higher caries levels and greater restorative needs, according to the studies.

“[Community water fluoridation] is effective for all age groups, is low cost and accessible to nearly everyone, does not require visits to the dentist or physician, and does not require any active change in behavior to be effective,” the authors said in the JADA article. “On the basis of these factors, the overwhelming evidence of its effectiveness, and the many substantial and serious flaws in several studies in which researchers suggested [community water fluoridation] has harmful effects (discussed in our next article), now is not the time to abandon water fluoridation for the prevention of caries.”

A second article from the authors, “An Update on Community Water Fluoridation, Part 2: Fluoride Exposure and Children’s IQ Scores — Relevance of Systematic Reviews and Meta-Analyses to Community Water Fluoridation,” will be published soon in JADA.

To read the first article online, visit JADA.ADA.org.

Other articles in the April issue of JADA discuss the effectiveness of silver diamine fluoride on caries in adults, factors associated with silver diamine fluoride adoption in clinics, and pain and psychosocial profiles in adolescents with temporomandibular disorders.

Every month, JADA articles are published online at JADA.ADA.org. ADA members can access JADA content with their ADA username and password.