Background Community water fluoridation (CWF) is considered one of the 10 greatest public health achievements of the twentieth century and has been a cornerstone strategies for the prevention and control of dental caries in many countries. However, for decision-makers the effectiveness and safety of any given intervention is not always sufficient to decide on the best option. Economic evaluations (EE) provide key information that managers weigh, alongside other evidence. This study reviews the relevant literature on EE in CWF. Methods A systematic database search up to August 2019 was carried out using MEDLINE, EMBASE, Cochrane Library, LILACS, Paediatric Economic Database Evaluation and National Health Service Economic Evaluation Database. The review included full economic evaluations on CWF programs, written in English, Spanish or Portuguese. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. Results Of 498 identified articles, 24 studies met the inclusion criteria; 11 corresponded to cost-benefit analysis; nine were cost-effectiveness analyses; and four cost-utility studies. Two cost-utility studies used Disability-Adjusted Life Years,, one used Quality-Adjusted Tooth Years, and another Quality-Adjusted Life Years. EEs were conducted in eight countries. All studies concluded that water fluoridation was a cost-effective strategy when it was compared with non-fluoridated communities, independently of the perspective, time horizon or discount rate applied. Four studies adopted a lifetime time horizon. The outcome measures included caries averted ( n  = 14) and savings cost of dental treatment ( n  = 4). Most of the studies reported a caries reduction effects between 25 and 40%. Conclusion Findings indicated that CWF represents an appropriate use of communities’ resources, using a range of economic evaluation methods and in different locations. These findings provide evidence to decision-makers which they could use as an aid to deciding on resource allocation.

<h4>Aim</h4>This was to present a summary of the evidence from systematic reviews of the effectiveness and safety of water fluoridation.<h4>Methods</h4>A search for relevant systematic reviews was conducted using the terms Fluoridation [Mesh] OR "water fluoridation" OR fluoridation OR (water AND fluoride) and was run from 01/01/2000 to 17/10/2008 in Pubmed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects in the Cochrane Library. The quality of the systematic reviews was assessed using Scottish Intercollegiate Guideline Network (SIGN) methodology checklists for systematic reviews. Websites of guideline organisations were also searched for relevant evidence-based guidelines, which were appraised using the AGREE instrument.<h4>Results</h4>Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included in this review. While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality. The results of the three reviews showed that water fluoridation is effective at reducing caries in children and adults. With the exception of dental fluorosis, no association between adverse effects and water fluoridation has been established. Water fluoridation reduces caries for all social classes, and there is some evidence that it may reduce the oral health gap between social classes.<h4>Conclusion</h4>Water fluoridation, where technically feasible and culturally acceptable, remains a relevant and valid choice as a population measure for the prevention of dental caries.

Background: Dental caries remains one of the most prevalent chronic diseases worldwide. Fluoride has long been recognized as a cornerstone of caries prevention through enamel remineralization, inhibition of demineralization, and antibacterial activity. However, controversies persist regarding systemic exposure, potential health risks, and ethical debates over community water fluoridation. Previous reviews often focused on isolated interventions, whereas a critical synthesis of mechanisms, clinical efficacy, safety, and public health perspectives is still lacking. Methods: This narrative review synthesized peer-reviewed publications from 2000 to 2025 retrieved from PubMed, Scopus, Web of Science, and leading dental journals. Emphasis was placed on randomized controlled trials, systematic reviews, meta-analyses, and major policy documents. Evidence was thematically appraised across mechanisms of action, clinical applications, comparative efficacy, safety, and sociocultural considerations. Results: Fluoride consistently shows preventive and therapeutic benefits across multiple delivery forms, including toothpaste, varnishes, mouthrinses, supplements, and silver diamine fluoride, with particular advantages for high-risk groups such as children, orthodontic patients, and older adults. Nonetheless, study heterogeneity, variations in protocols, and concerns regarding fluorosis and possible neurodevelopmental effects highlight persistent uncertainties. Comparative analyses reveal trade-offs between efficacy and acceptance, for example, the high caries-arrest rate of silver diamine fluoride compared with its esthetic drawback. Emerging alternatives such as nano-hydroxyapatite, fluoride-containing bioactive glass, and probiotic-based approaches are promising but currently supported by limited clinical data. Conclusions: Fluoride remains central to caries prevention, yet its optimal use requires balancing benefits against risks, addressing cultural and socioeconomic barriers, and tailoring strategies to individual and community contexts. This narrative synthesis underscores the need for well-designed multicenter randomized controlled trials, longitudinal studies to refine safe exposure thresholds, evaluations of novel biomaterials and delivery systems, and the incorporation of patient-reported outcomes to guide future evidence-based policies and clinical practices.

urfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child’s fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit. Discussion waterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water. Trial registration ClinicalTrials.gov NCT04893681 . Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1 Keywords: Primary prevention, Community drinking water, Dental caries, Primary prevention, Randomized controlled trial Introduction Background and rationale {6a} Community water fluoridation is the controlled adjustment of fluoride in a public water system to a level that is optimal for preventing dental caries (i.e., tooth decay) while minimizing the risk of dental fluorosis (i.e., enamel hypomineralization). At the recommended concentration of 0.7 mg/L [ 1 ], fluoridated water reduces the prevalence and severity of dental caries in both primary and permanent dentitions. In fact, because water fluoridation reduces the excess fraction of dental caries in children in low-income relative to higher-income households [ 2 ], it also reduces income-related disparities in the disease. A 2015 Cochrane review of the public health impact of community water fluoridation synthesized observational studies worldwide that compared a population receiving fluoridated water against

Health protection: Fluoridation and dental health. Tooth decay, which affects 95 percent of Americans, is our most common health problem, costing an estimated +2 billion yearly for treatment. By the time children reach 17 years of age, 94 percent have experienced caries and 36 percent have lost one or more permanent teeth due to caries. Dental disease prevention embodies the spectrum of many activities from the fluoridation of community and school water supplies to the dental health education of the child and adult. At this stage of our knowledge, the most effective and cost-beneficial intervention is fluoridation. Fluoridation can reduce the incidence of dental caries by about 65 percent, reduce the need for multiple surface fillings, crowns and extractions, and significantly increase the number of children who are completely free of cavities. No other public health measure is as effective in building a decay-resistant tooth while being available to all without regard to education or socio-economic background. The number of people served by fluoridated water systems has increased steadily since its introduction.

Drinking water fluoridation and caries prophylaxis: with special consideration of the experience in the former East Germany. Drinking water fluoridation for caries prophylaxis is not a means of primary prevention: i.e., avoidance of sugar and microorganisms in the oral cavity; but rather a means of secondary prevention: e.g., prevention of bacterial production of carboxylic acid from sugar, and therapy: e.g., enhancement of enamel resistance to demineralization by incorporation of fluoride in remineralization of the enamel surface. Currently available epidemiologic studies on the effects of drinking water fluoridation reveal: reduction of the incidence of caries, particularly in children no detrimental health effects; cosmetically undesirable dental fluorosis may occur, however. Nevertheless, introduction of drinking water fluoridation in Germany is not recommendable because of: the greater effectiveness of primary caries prevention, the acceptance of which is reduced, however, by drinking water fluoridation the at least equal prophylactic effect of fluoride via other routes, e.g.

The aim of this review is to describe the role of water fluoridation in preventing dental caries worldwide. Community water fluoridation began in 1945 and over the past 20 years has reached over 400 million people. In several countries, such as USA, Australia, New Zealand, Ireland, Singapore, Hong Kong, Brunei, Malaysia, Oman, Chile, Gabon and Brazil, a high proportion of the population receives fluoridated water. The clinical effectiveness is well established. Both water fluoridation and fluoride-containing toothpaste are effective and each adds to the effect of the other. Coverage of water fluoridation is equitable so that those at greatest risk of dental caries benefit most. Water fluoridation is cost-effective and has low environmental impact. Below the usual permitted concentration of 1.5 mgF/L, there is no risk to health. Prevalence of dental fluorosis is higher in fluoridated communities but severity is mild to very mild and of little aesthetic concern. In this regard, advice should focus on early use of fluoride-containing toothpaste to reduce fluoride ingestion during infancy and early childhood. The cost of water fluoridation is low. With increasing global urbanisation and improved equipment, the future of water fluoridation is promising. The WHO urges member states to consider implementing community water fluoridation.

the incidence of dental caries among 4-year-old children had increased by 62%. The fluoridation reduced the number of cavities, but increased dental fluorosis; Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay, and is handled differently by countries across the world. Water fluoridation is considered very common in the United States, Canada, Ireland, Chile and Australia where over 50% of the population drinks fluoridated water. Most European countries including Italy, France, Finland, Germany, Sweden As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation. In 2010, 66% of all U.S. residents and 74% of U.S.…