Funding Available to Install or Improve Community Fluoridation

Dentistry Today


In 2014, 74.4% of the US population were served by community water systems that received fluoridated water, according to the Centers for Disease Control and Prevention (CDC). Yet many of these systems are old and require significant maintenance and updates. Also, many towns and cities that don’t have fluoridation would like to add it to their systems, but they lack the money to do so. To help these communities, the CDC is working with the National Association of County and City Health Officials (NACCHO) to fund capital improvements.

“Tooth decay is one of the most chronic diseases in children. Left untreated, tooth decay can cause pain, infection, and problems eating, speaking, and learning,” said Jennifer Li, senior director of environmental health and disability at NACCHO. “Fluoride protects against tooth decay. Water fluoridation is the best method of delivering fluoride to all members of the community regardless of age, education, income level, or access to regular dental care.

NACCHO will award $2,000 to $35,000 to qualified applicants. These one-time awards must be used for capital improvements associated with purchasing new equipment to start water fluoridation or replacing aging water fluoridation equipment. State and local government entities, oral health coalitions, rural water associations, state dental organizations, and other organizations affiliated with public community water systems are eligible to submit applications for the funding.

“According to the ADA, more than 70 years of scientific research has consistently shown that people living in communities with an optimal level of fluoride in their water have up to 25% fewer cavities than people living in communities without water fluoridation,” said Li. “Simply by drinking water, Americans can benefit from fluoride’s cavity protection whether they are at home, work, or school.”

Technical assistance will be available as well throughout the term of the funded proposals to facilitate successful implementation. NACCHO will act as the central coordinator for technical assistance requests, providing the assistance or directing award winners to the state direct dental director or the CDC. Assistance may include facilitating the collaboration between health departments and public water agencies, feedback on equipment recommendations, and identification of possible training sources for operators.

Many grassroots efforts, however, have emerged on the local and national levels questioning the efficacy and even the safety of public fluoridation. In addition to dozens of smaller municipalities, many major cities have eliminated their fluoridation programs, including Albany in 1994; Colorado Springs in 2002; Quebec City in 2008; Calgary in 2011; Portland, Ore, in 2013; and Albuquerque in 2016.

“Many expert panels in the United States and other countries have studied the issue of water fluoridation and potential adverse health effects. The only documented risk of community water fluoridation is dental fluorosis, a change in the appearance of the tooth enamel. Most dental fluorosis is very mild to mild, appearing as white spots on the tooth surface and often barely noticeable,” said Li, who suggests communication in addressing activists’ concerns.

“Start with obtaining a better understanding of why local groups or grassroots efforts are concerned with fluoridation. Community leaders can help to develop messaging to emphasize local values. They should also consider the impact on the community if water fluoridation is removed,” said Li. “Even with the use of other fluoride products such as toothpaste, fluoridated water reduces tooth decay by 25% among children and adults. A recent Health Affairs study estimated that communities average a per capita savings of more than $32 in averted treatment costs.”

Applications are due by Wednesday, March 1. NACCHO and the CDC will review applications, awarding up to 50 points based on a statement of need, up to 30 points on the applicants’ collaboration plans between the public health department and water system in educating the public about their project and about fluoridation, and up to 20 points on their sustainability plans. The organization will notify award winners on March 17. Equipment purchases and installation will occur between April 7 and June 30.

For more information about community water fluoridation, Li suggests the websites of the CDC, including its information for state-based oral health programs, the Association of State and Territorial Dental Directors, and state affiliates of rural water associations.

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