Three out of four Americans drink fluoridated water through their community water systems, according to the Centers for Disease Control and Prevention. The CDC said fluoride in water helps prevent and even reverse tooth decay. The organization declared fluoridation of the public water supply one of the 10 greatest health achievements of the 20th century.
But not all places in the U.S. have pipes flowing with fluoridated-enhanced water. Of the 50 largest cities in the country, six do not add fluoride to their water and or have enough naturally occurring fluoride to optimally prevent tooth decay. These cities include:
For years, dentists in Tucson have fought to add fluoride to their water supply systems.
"Virtually every health organization recommends that communities have fluoridated water," said Dr. Richard Chaet, a Scottsdale pediatric dentist who is a former president of the Arizona Academy of Pediatric Dentistry and consultant to the Arizona Board of Dental Examiners. "It reduces decay a minimum of 50 percent. It is the easiest, least expensive public health measure that can be used basically in the world to reduce cavities in children."
Other cities are lobbying for fluoridation, too. In Portland, city officials commissioned a study on the issue, and the council voted to fluoridate its water supply in 2012. After a failed public referendum in May 2014, Portland still does not fluoridate its water. San Jose's water district has voted in favor of fluoridating, but the process of retrofitting its complex water system is expected to take a few years.
What is fluoride?
Fluoride is a mineral found naturally in water and many foods. Scientifically speaking, it is a reduced form of the element fluoride, which exists in plants, air, fresh water and ocean water. Thanks to its ability to strengthen tooth surfaces and prevent harmful bacteria from forming cavities, the mineral has been dubbed "nature's cavity fighter." Fluoride is often put into a variety of toothpaste and mouthwash formulas with a main goal of bolstering dental enamel.
The World Health Organization said fluoridation of water supplies "is the most effective public health measure for the prevention of dental decay."
The bad rap
In the last few years, there has been growing opposition to fluoridated water. But most of their dissent, fueled by a distrust in government, revolves around dosage. Like other minerals we consume, the amount makes a difference in their effects. There is a target dosage, and at higher levels fluoride can be unhealthy. That's why the federal definition of fluoridated is 0.7 milligrams of fluoride per liter or more in the water supply.
Science is on supporters' side. On the CDC's website, it reads "For 65 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay." Since fluoride's integration in public water supplies, it has reduced childhood cavities by an estimated 40 to 70 percent, the CDC said.
Dr. Daniel Derksen, a professor at the Mel and Enid Zuckerman College of Public Health at the University of Arizona, and director of its Center for Rural Health, agrees with the CDC whole-heartedly.
"The overwhelming public health evidence supports getting the level to 0.7," Derksen told the Arizona Daily Star.
The American Dental Association (ADA) said that fluoride supplementation is advised for children who drink water with less than 0.6 milligrams per liter.
Fluoride in the US
Public health officials have added fluoride to municipal water supplies since the 1940s. San Francisco started fluoridated its water in the 1950s. New York City began in 1965, and Dallas integrated it in 1966.
The ADA reported that community water fluoridation is one of the few public health measures that saves more money than it costs. Because fluoride helps fortify teeth against cavities, the mineral also reduces the likelihood of bad breath and other oral health problems. For people who live in one of the six mentioned cities or other parts of the country without optimal amounts of fluoride, it's even more important to brush your teeth with toothpaste that contains fluoride and rinse your mouth with fluoridated mouthwash.
Today three major cities don't add fluoride to their water, but they already have naturally occurring levels at or above the 0.7 milligram-per-liter CDC recommendation to reduce decay. Those cities include Jacksonville, Florida; Colorado Springs, Colorado; and El Paso, Texas.
To find out whether your city has fluoridated water, and if so, how much, check your water bill or the local government listings online. You can also contact your water utility. The Environmental Protection Agency requires all community water systems to deliver an annual consumer confidence report (sometimes called a water quality report) for their customers by July 1 of each year. If your water provider is not a community water system, or if you have a private water supply, request a copy from a nearby community water system.