Scientific Reviews and Reports: Assessing the Evidence

Review of scientific literature is important to help judge the safety and benefits of community water fluoridation over time.
Science and public health organizations have conducted comprehensive reviews that offer strong evidence of community water fluoridation’s safety and effectiveness in reducing tooth decay for people of all ages.

United States

The Community Preventive Services Task Force, Preventing Dental Caries: Community Water Fluoridation, 2000, 2013

The Community Preventive Services Task Force (Task Force) was established in 1996 by the U.S. Department of Health and Human Services to identify population health interventions that have been shown to save lives, increase lifespans, and improve quality of life. The Task Force makes recommendations and identifies evidence gaps to help guide the decision making of federal, state, and local health departments, other government agencies, communities, health care providers, employers, schools, and research organizations.

The Task Force completed its most recent review of community water fluoridation in April 2013; it recommended water fluoridation based on strong evidence of effectiveness in reducing tooth decay across population groups.

National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA’s Standards, 2006

In 2006 the National Research Council (NRC), part of the National Academies of Science, Engineering, and Medicine, published the results of an extensive review of fluoride in drinking water. This review was completed by a multidisciplinary committee of 12 scientists at the request of the Environmental Protection Agency (EPA). That review focused only on potential unwanted effects of naturally occurring fluoride at concentrations of 2–4 mg/L, much higher than 0.7 mg/liter, the new recommendation for community water fluoridation. Even at these higher concentrations, the NRC panel found substantial evidence only for an increased likelihood of severe dental fluorosis and noted that severe fluorosis remains near zero in communities where the level of fluoride in drinking water is less than 2 mg/L.

US Public Health Service, Oral Health in America: A Report of the Surgeon General, 2000
Presents evidence for community water fluoridation for prevention of tooth decay.

Centers for Disease Control and Prevention, Achievements in Public Health 1900–1999 — Fluoridation of Drinking Water to Prevent Dental Caries, 1999 [PDF-133KB]
Recognized community water fluoridation as one of 10 great public health achievements of the 20th century, provides a brief history of water fluoridation, and describes the historical decline in tooth decay.

Institute of Medicine, Institute of Medicine Dietary Reference Guidelines, 1997
These guidelines describe the dietary reference intakes for specific nutrients known to be beneficial to health, including fluoride.

International

• The Cochran Collaboration, Water Fluoridation to Prevent Tooth Decay, 2015
• National Health and Medical Research Council, Australian Government, A Systematic Review of the Efficacy and Safety of Fluoridation, 2007
• World Health Organization, Nutrients in Drinking Water, 2005