A critique of recent economic evaluations of community water fluoridation

Int J Occup Environ Health. 2015;21(2):91-120. doi: 10.1179/2049396714Y.0000000093. Epub 2014 Dec 3.


Background: Although community water fluoridation (CWF) results in a range of potential contaminant exposures, little attention has been given to many of the possible impacts. A central argument for CWF is its cost-effectiveness. The U.S. Government states that $1 spent on CWF saves $38 in dental treatment costs.

Objective: To examine the reported cost-effectiveness of CWF.

Methods: Methods and underlying data from the primary U.S. economic evaluation of CWF are analyzed and corrected calculations are described. Other recent economic evaluations are also examined.

Results: Recent economic evaluations of CWF contain defective estimations of both costs and benefits. Incorrect handling of dental treatment costs and flawed estimates of effectiveness lead to overestimated benefits. The real-world costs to water treatment plants and communities are not reflected.

Conclusions: Minimal correction reduced the savings to $3 per person per year (PPPY) for a best-case scenario, but this savings is eliminated by the estimated cost of treating dental fluorosis.

Keywords: Caries prevention,; Cost benefit,; Cost effectiveness,; Cost of water fluoridation,; Dental fluorosis; Economic evaluation,; Effectiveness in adults,; Water fluoridation,.

Publication types

  • Review

MeSH terms

  • Cost-Benefit Analysis*
  • Dental Care / economics*
  • Dental Caries / economics*
  • Dental Caries / prevention & control*
  • Fluoridation / economics*
  • Fluorosis, Dental / economics
  • Humans
  • United States