Clinical Oral Investigations

, Volume 11, Issue 3, pp 189–193 | Cite as

Community water fluoridation and caries prevention: a critical review

  • Giuseppe PizzoEmail author
  • Maria R. Piscopo
  • Ignazio Pizzo
  • Giovanna Giuliana


The aim of this paper was to critically review the current role of community water fluoridation in preventing dental caries. Original articles and reviews published in English language from January 2001 to June 2006 were selected through MEDLINE database. Other sources were taken from the references of the selected papers. For the past 50 years community water fluoridation has been considered the milestone of caries prevention and as one of the major public health measures of the 20th century. However, it is now accepted that the primary cariostatic action of fluoride occurs after tooth eruption. Moreover, the caries reduction directly attributable to water fluoridation have declined in the last decades as the use of topical fluoride had become more widespread, whereas enamel fluorosis has been reported as an emerging problem in fluoridated areas. Several studies conducted in fluoridated and nonfluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention, particularly in the industrialized countries where the caries level has became low. Although water fluoridation may still be a relevant public health measure in poor and disadvantaged populations, the use of topical fluoride offers an optimal opportunity to prevent caries among people living in both industrialized and developing countries.


Water fluoridation Systemic fluoride Caries prevention Fluorosis Topical fluoride Oral health 


  1. 1.
    Birkeland JM, Ibrahim YE, Ghandour IA, Haugejorden O (2005) Severity of dental caries among 12-year-old Sudanese children with different fluoride exposure. Clin Oral Investig 9:46–51PubMedCrossRefGoogle Scholar
  2. 2.
    Bottenberg P, Declerck D, Ghidey W et al (2004) Prevalence and determinants of enamel fluorosis in Flemish schoolchildren. Caries Res 38:20–28PubMedCrossRefGoogle Scholar
  3. 3.
    Browne D, Whelton H, O’Mullane D (2005) Fluoride metabolism and fluorosis. J Dent 33:177–186PubMedCrossRefGoogle Scholar
  4. 4.
    Burt BA (2002) Fluoridation and social equity. J Public Health Dent 62:195–200PubMedCrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (1999) Achievements in public health, 1990–1999: fluoridation of drinking water to prevent dental caries. MMWR Morb Mortal Wkly Rep 48:933–940Google Scholar
  6. 6.
    Centers for Disease Control and Prevention (2001) Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR Morb Mortal Wkly Rep 50:1–42Google Scholar
  7. 7.
    Cochran JA, Ketley CE, Árnadóttir IB et al (2004) A comparison of the prevalence of fluorosis in 8-year-old children from seven European study sites using a standardized methodology. Community Dent Oral Epidemiol 32(Suppl 1):28–33PubMedCrossRefGoogle Scholar
  8. 8.
    Cross DW, Carton RJ (2003) Fluoridation: a violation of medical ethics and human rights. Int J Occup Environ Health 9:24–29Google Scholar
  9. 9.
    Cury JA, Tenuta LMA, Ribeiro CCC et al (2004) The importance of fluoride dentifrices to the current dental caries prevalence in Brazil. Braz Dent J 15:167–174PubMedCrossRefGoogle Scholar
  10. 10.
    Downer MC, Drugan CS, Blinkhorn AS (2005) Dental caries experience of British children in an international context. Community Dent Health 22:86–93PubMedGoogle Scholar
  11. 11.
    Featherstone JDB (1999) Prevention and reversal of dental caries: role of low level fluoride. Community Dent Oral Epidemiol 27:31–40PubMedCrossRefGoogle Scholar
  12. 12.
    Fejerskov O (2004) Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res 38:182–191PubMedCrossRefGoogle Scholar
  13. 13.
    Fluoride Action Network. Water fluoridation status worldwide. Available at: (Accessed December 18, 2006)
  14. 14.
    Harding MA, Whelton H, O’Mullane DM et al (2005) Primary tooth fluorosis in 5-year-old schoolchildren in Ireland. Eur J Paediatr Dent 6:155–161PubMedGoogle Scholar
  15. 15.
    Hellwing E, Lennon AM (2004) Systemic versus topical fluoride. Caries Res 38:258–262CrossRefGoogle Scholar
  16. 16.
    Istituto Superiore di Sanità-Centro Nazionale di Epidemiologia, Sorveglianza, Promozione della Salute (EpiCentro). La fluorazione delle acque in Italia. Available at: (Accessed December 18, 2006)
  17. 17.
    Jones S, Burt BA, Petersen PE et al (2005) The effective use of fluorides in public health. Bull World Health Organ 83:670–676PubMedGoogle Scholar
  18. 18.
    Jones CM, Worthington H (2000) Water fluoridation, poverty and tooth decay in 12-year-old children. J Dent 28:389–393PubMedCrossRefGoogle Scholar
  19. 19.
    Kargul B, Caglar E, Tanboga I (2003) History of water fluoridation. J Clin Pediatr Dent 27:213–217PubMedGoogle Scholar
  20. 20.
    König KG (2000) Diet and oral health. Int Dent J 50:163–174Google Scholar
  21. 21.
    Künzel W, Fisher T (2000) Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res 34:20–25PubMedCrossRefGoogle Scholar
  22. 22.
    Levy SM (2003) An update on fluorides and fluorosis. J Can Dent Assoc 69:286–291PubMedGoogle Scholar
  23. 23.
    Limeback H (1999) A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any anti-caries benefit from swallowing fluoride? Community Dent Oral Epidemiol 27:62–71PubMedCrossRefGoogle Scholar
  24. 24.
    Lynch RJM, Navada R, Walia R (2004) Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes. Int Dent J 54:304–309PubMedGoogle Scholar
  25. 25.
    Marshall TA, Levy SM, Warren JJ et al (2004) Associations between intakes of fluoride from beverages during infancy and dental fluorosis of primary teeth. J Am Coll Nutr 23:108–116PubMedGoogle Scholar
  26. 26.
    Marthaler TM (2004) Changes in dental caries 1953–2003. Caries Res 38:173–181PubMedCrossRefGoogle Scholar
  27. 27.
    McDonagh M, Whiting P, Bradley M et al (2000) A systematic review of public water fluoridation. York, NHS Centre for Reviews and Dissemination, University of York (Report 18)Google Scholar
  28. 28.
    McDonagh MS, Whiting PF, Wilson PM et al (2000) Systematic review of water fluoridation. Br Med J 321:855–859CrossRefGoogle Scholar
  29. 29.
    Mullen J (2005) History of water fluoridation. Br Dent J 199(7 Suppl):1–4CrossRefGoogle Scholar
  30. 30.
    National Institute of Dental and Craniofacial Research. The story of fluoridation. Available at: (Accessed December 18, 2006)
  31. 31.
    Palmer C, Wolfe SH (2006) Position of the American Dietetic Association: the impact of fluoride on health. J Am Diet Assoc 105:1620–1628Google Scholar
  32. 32.
    Petersen PE, Lennon MA (2004) Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach. Community Dent Oral Epidemiol 32:319–321PubMedCrossRefGoogle Scholar
  33. 33.
    Spencer AJ, Slade GD, Davies M (1996) Water fluoridation in Australia. Community Dent Health 13(Suppl 2):27–37PubMedGoogle Scholar
  34. 34.
    Wang B, Zheng B, Zhai C, Yu G, Liu X (2004) Relationship between fluorine in drinking water and dental health of residents in some large cities in China. Environ Int 30:1067–1073PubMedCrossRefGoogle Scholar
  35. 35.
    Warren JJ, Levy SM (1999) Systemic fluoride-sources, amounts, and effects of ingestion. Dent Clin North Am 43:695–711PubMedGoogle Scholar
  36. 36.
    Weyant RJ (2004) Seven systematic reviews confirm topical fluoride therapy is effective in preventing dental caries. J Evid Dent Base Pract 3:129–135CrossRefGoogle Scholar
  37. 37.
    Whelton H, Crowley E, O’Mullane D et al (2006) Dental caries and enamel fluorosis among the fluoridated population in the Republic of Ireland and non fluoridated population in Northern Ireland in 2002. Community Dent Health 23:37–43PubMedGoogle Scholar
  38. 38.
    Zimmer S, Jahn KR, Barthel CR (2003) Recommendations for the use of fluoride in caries prevention. Oral Health Prev Dent 1:45–51PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Giuseppe Pizzo
    • 1
    • 2
    Email author
  • Maria R. Piscopo
    • 1
  • Ignazio Pizzo
    • 1
  • Giovanna Giuliana
    • 1
  1. 1.Department of Oral SciencesUniversity of PalermoPalermoItaly
  2. 2.Dipartimento di Scienze StomatologichePalermoItaly

Personalised recommendations