Resolution on Community Water Fluoridation (CWF)
Adopted March 2010

WHEREAS, tooth decay (dental caries) is one of the most common diseases in the nation, affecting 28 percent of children aged 2-5, six out of ten adolescents (12-19 years), and more than 90 percent of adults (20-64 years).(1)

WHEREAS, it has been shown that children with the greatest dental need and who are at highest risk for tooth decay benefit the most from water fluoridation. (21-26)

WHEREAS, community water fluoridation is hailed as one of ten great public health achievements of the 20th century. (2)

WHEREAS, community water fluoridation benefits everyone in the community including adults and seniors as well as children. (2)

WHEREAS, the scientific evidence base continues to support CWF as a safe and effective public health measure, including national and international reviews conducted since 1990. (4-20)

WHEREAS, CWF is a highly cost-effective means of preventing tooth decay in the United States, regardless of socioeconomic status and every $1 (1995) invested in this preventive measure yields approximately $38 savings in dental treatment costs. (29-32)

WHEREAS, during the last sixty years, the legality of fluoridation in the United States has been thoroughly tested in our court systems and fluoridation is viewed by the courts as a proper means of furthering public health and welfare. (27-28) 

WHEREAS, the U.S. Task Force on Community Preventive Services strongly recommended CWF for the prevention of dental caries. (33)

WHEREAS, more than 100 national and international organizations recognize the public health benefits of community water fluoridation for preventing dental decay. (3)

WHEREAS, a national Healthy People 2010 health objective [21-9] is to increase to 75 percent the proportion of the U.S. population served by community water systems with optimally fluoridated water, yet many communities have not yet adopted fluoridation. (34-35)

Therefore be it resolved that: 
 
The American Association of Public Health Dentistry reiterates its strong endorsement and support for the fluoridation of all community water systems as a safe and effective public health measure for the prevention of tooth decay.
 
The Association recommends that federal, state, and local agencies and organizations promote water fluoridation as the foundation for better oral health.

The Association recommends promotion and increased support by federal, state, and local entities for adequate public health infrastructure to assure safe and effective water fluoridation practices, including monitoring, training, technical and financial assistance, and promotion to expand and maintain water fluoridation programs.
 
The Association recommends increased support by federal agencies for continued research on the safety and effectiveness of water fluoridation.

The Association supports efforts to educate public health and other health professionals, decision makers and the public on community water fluoridation and the consumption of fluoridated water, and other appropriate uses of fluoride in the prevention of tooth decay.

The Association encourages other professional groups to promote community water fluoridation and the consumption of fluoridated water by the public to improve oral health.

References:

1. Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, Eke PI, Beltrán-Aguilar ED, Horowitz AM, Li CH. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11. 2007 Apr;(248):1-92. Available at http://www.cdc.gov/nchs/data/series/sr_11/sr11_248.pdf Accessed on March 1, 2009.

2. Centers for Disease Control and Prevention (CDC). Ten great public health achievements--United States, 1900-1999. MMWR Morb Mortal Wkly Rep. 1999 Apr 2;48(12):241-3http://www.cdc.gov/mmwR/preview/mmwrhtml/00056796.htm Accessed on March 1, 2009.

3. American Dental Association. Compendium. Available at http://www.ada.org/public/topics/fluoride/facts/compendium.asp Accessed on March 1, 2009.

4. Australian Government. National health and medical research council. A Systematic Review of the Efficacy And Safety Of Fluoridation. 2007. Available at http://www.nhmrc.gov.au/publications/synopses/eh41syn.htm Accessed on March 1, 2009.

5. National Research Council. Health effects of ingested fluoride. Washington, DC: National Academy Press, 1993. Available at http://stills.nap.edu/books/030904975X/html Accessed on March 1, 2009.

6. National Research Council. Committee on Fluoride in Drinking Water, Board on Environmental Studies and Toxicology, Division on Earth and Life Studies. Fluoride in Drinking Water: A Scientific Review Of EPA’s Standards. THE NATIONAL ACADEMIES PRESS. Washington, D.C. 2006. Available at http://www.nap.edu/catalog.php?record_id=11571 Accessed on March 1, 2009.

7. World Health Organization. WHO technical report series #846: Report of a WHO expert committee on oral health status and fluoride use. Geneva, Switzerland: World Health Organization. 1994

8. Guidelines for Drinking-Water Quality, 2nd edition. Volume 2 - Health criteria and other supporting information. WHO, Geneva, 1996.

9. Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L and Magara Y. Fluoride in Drinking-water. World Health Organization (WHO) 2006. Available at http://whqlibdoc.who.int/publications/2006/9241563192_eng.pdf Accessed on March 1, 2009.

10. U.S. Department Of Health And Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry. Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine. September 2003.

11. International Programme on Chemical Safety (IPCS) Environmental health criteria, No. 227. Fluorides. Geneva : World Health Organization, 2002 Available at http://www.inchem.org/documents/ehc/ehc/ehc227.htm Accessed on March 1, 2009.

12. Forum on Water Fluoridation in Ireland. 2002. Available at http://www.dohc.ie/publications/fluoridation_forum.html Accessed on March 1, 2009.

13. Medical Research Council. Medical Research Council working group report: Water fluoridation and health. September 2002. Available at http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC002482 Accessed on March 1, 2009.

14. NHS Centre for Reviews and Dissemination, University of York. A systematic review of public water fluoridation. York, UK: York Publishing Services Ltd. 2000. Available at http://www.york.ac.uk/inst/crd/fluores.htm Accessed on March 1, 2009.

15. McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J. Systematic review of water fluoridation. BMJ. 2000 Oct 7;321(7265):855-9.

16. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine (1999). Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, D.C.: National Academy Press. Available at http://books.nap.edu/books/0309063507/html/288.html#pagetop Accessed on March 1, 2009.

17. Locker, D. Benefits and risks of water fluoridation. An update of the 1996 federal-provincial sub-committee report. Prepared under contract for the Public Health Branch, Ontario Ministry of Health, First Nations Inuit Health Branch, Health Canada. University of Toronto: Community of Dental Health Services Research Unit, Faculty of Dentistry, 1999
Available at http://www.health.gov.on.ca/english/public/pub/ministry_reports/fluoridation/fluor.pdf Accessed on March 1, 2009.

18. Lewis DW, Banting DW. Water fluoridation: current effectiveness and dental fluorosis. Community Dent Oral Epidemiol. 1994 Jun;22(3):153-8.

19. Report of the subcommittee on fluoride of the Committee to Coordinate Environmental Health and Related Programs, USPHS. Review of fluoride: Benefits and Risks. Public Health Service: Department of Health and Human Services. 1991. Available at http://www.health.gov/environment/ReviewofFluoride/default.htm Accessed on March 1, 2009.

20. Kaminsky LS, Mahoney MC, Leach J, Melius J, Miller MJ. Fluoride: benefits and risks of exposure. Crit Rev Oral Biol Med. 1990;1(4):261-81 Available at http://crobm.iadrjournals.org/cgi/reprint/1/4/261 Accessed on March 1, 2009.

21. Jones CM, Taylor GO, Whittle JG, Evans D, Trotter DP. Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveys. BMJ. 1997 Aug 30;315(7107):514-7

22. Jones C, Taylor G, Woods K, Whittle G, Evans D, Young P. Jarman underprivileged area scores, tooth decay and the effect of water fluoridation. Community Dent Health. 1997 Sep;14(3):156-6

23. Jones CM, Worthington H. The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children. Br Dent J. 1999 Apr 24;186(8):397-400. Erratum in: Br Dent J 2000 Oct 14;189(7):390

24. Jones CM, Worthington H. Water fluoridation, poverty and tooth decay in 12-year-old children. J Dent. 2000 Aug;28(6):389-93

25. Riley JC, Lennon MA, Ellwood RP. The effect of water fluoridation and social inequalities on dental caries in 5-year-old children. Int J Epidemiol. 1999 Apr;28(2):300-5

26. Evans DJ, Rugg-Gunn AJ, Tabari ED, Butler T. The effect of fluoridation and social class on caries experience in 5-year-old Newcastle children in 1994 compared with results over the previous 18 years. Community Dent Health. 1996 Mar;13(1):5-10

27. American Dental Association. Fluoridation Facts. 2005. Question 51. Has the legality of water fluoridation been upheld by the courts? http://www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf Accessed on March 1, 2009.

28. Safe Water Association, Inc., Plaintiff-Appellant, v. City of Fond Du Lac. Court of Appeals of Wisconsin. 184 Wis. 2d 365; 516 N.W.2d 13; 1994 Wisc. App. LEXIS 529. Available at http://www.actionpa.org/fluoride/lawandcourts/wi-fond-du-lac.html Accessed on March 1, 2009.

29. Klein SP, Bohannan HM, Bell RM, Disney JA, Foch CB, Graves RC. The cost and effectiveness of school-based preventive dental care. Am J Public Health. 1985 Apr;75(4):382-91

30. Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. Journal Public Health Dentistry 2001;61(2):78-86

31. O’Connell JM, Brunson D, Anselmo T, Sullivan PW. Costs and savings associated with community water fluoridation programs in Colorado. Prev Chronic Dis [serial online] 2005 Nov [date cited]. Available from: URL:http://www.cdc.gov/pcd/issues/2005/nov/05_0082.htm Accessed on March 1, 2009.

32. Centers for Disease Control and Prevention. Cost Savings of Community Water Fluoridation. Available at http://www.cdc.gov/fluoridation/fact_sheets/cost.htm Accessed on March 1, 2009.

33. Centers for Disease Control and Prevention. Promoting oral health: interventions for preventing dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. A report on recommendations of the task force on community preventive services. MMWR Recomm Rep. 2001 Nov 30;50(RR-21):1-13 Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5021a1.htm Accessed on March 1, 2009.

34. Healthy People 2010 Midcourse Review. Available at http://www.healthypeople.gov/data/midcourse/html/focusareas/FA21ProgressHP.htm Accessed on March 1, 2009.

35. Centers for Disease Control and Prevention (CDC). Advancing the Nation’s Health: A Guide to Public Health Research Needs, 2006-2015. December 2006. Available athttp://www.cdc.gov/od/science/PHResearch/cdcra/Guide_to_Public_Health_Research_Needs.pdf and http://www.cdc.gov/od/science/PHResearch/cdcra/AdvancingTheNationsHealth.pdf Accessed on March 1, 2009.