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Health Aff (Millwood). 2016 Dec 1;35(12):2224-2232.

Costs And Savings Associated With Community Water Fluoridation In The United States.

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Joan O'Connell ( is an associate professor in the Department of Community and Behavioral Health at the Colorado School of Public Health, in Aurora.
Jennifer Rockell is a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health.
Judith Ouellet is a senior professional research assistant in the Division of Health Care Policy and Research at the University of Colorado Denver School of Medicine, in Aurora.
Scott L. Tomar is a professor in the Department of Community Dentistry and Behavioral Science at the College of Dentistry, University of Florida, in Gainesville.
William Maas is a dental consultant at William Maas, LLC, in Rockville, Maryland.


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.


Health Economics; Oral Health Care; costs; economic benefits; water fluoridation

[Indexed for MEDLINE]

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