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ABSTRACT The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.
Asubstantial body of evidence demonstrates the impact of oral health on overall health and quality of life.1-3 Poor oral health is associated with poor nutrition; low birthweight; cardiovascular and diabetes complications; lower self-esteem; and pain affecting sleep, school performance, and work.1,2,4,5 One of the most common diseases that affects oral health is dental caries (tooth decay).1 Despite the implementation of interventions to prevent dental caries, it remains the most prevalent infectious chronic disease.1 The burden of poor oral health is greater among people in households with lower incomes in rural areas with limited access to affordable treatment.1,6-8 Furthermore, this oral disease burden is disproportionately higher among many members of racial/ethnic minority groups.1,7,8 If resources to prevent and treat dental disease are to be allocated efficiently, it is important to understand the costs and effectiveness of oral health interventions.
In 1999 the Centers for Disease Control and Prevention (CDC) recognized community water fluoridation as one of ten great public health achievements of the twentieth century, based on the relationship between the costs of providing fluoridation and its effectiveness at reducing caries.3The Community Preventive Services Task Force, established by the Department of Health and Human Services (HHS) to identify population health interventions shown to save lives, increase lifespans, and improve quality of life, reaffirmed and updated its recommendation for community water fluoridation programs (CWFPs) in 2013, based on strong evidence of their effectiveness in reducing dental caries.2 According...