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Water Fluoridation and Dental Caries in U.S. Children and Adolescents

Dr. Gary Slade accepted my invitation to speak about his recent article on the benefits of water fluoridation on dental caries for US children and adolescents. The article clearly states if community water fluoridation were extended to 4.8 million children, and they experienced the prevented fractions found in the study, it would translate to 6.2 million fewer primary tooth surfaces developing caries and 1.4 million fewer permanent tooth surfaces developing caries. The interview further explores the findings of the same study. 

Dr. Slade is is the John W. Stamm Distinguished Professor of Dentistry at the University of North Carolina at Chapel Hill. He has training in dentistry, public health and epidemiology. He conducts epidemiological studies of oral diseases including research in the UNC Center for Pain Research and Innovation that focuses on etiology of chronic pain and clinical interventions to prevent its development.

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Until next time!

Chiraz Guessaier, CDA Oasis Manager


  • Fluoridation of America’s drinking water was among the great public health achievements of the 20th century. Yet, there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. population.
  • This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population.
  • County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention’s Water Fluoridation Reporting System were merged with dental examination data from 10 years of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y.
  • Linear regression models estimated associations between % CWF and dental caries experience with adjustment for socio-demographic characteristics: age, sex, race/ethnicity, rural/urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998.
  • In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF than in counties with <75% CWF, a prevented fraction of 30%. The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS was 2.2 and 1.9, respectively, representing a prevented fraction of 12%. Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis.
  • These findings confirm a substantial caries-preventive benefit of community water fluoridation for U.S. children and that the benefit is most pronounced in primary teeth.

Slade GD, Grider WB, Maas WR, Sanders AE. Water Fluoridation and Dental Caries in U.S. Children and Adolescents. J Dent Res. 2018 May 1:22034518774331. doi: 10.1177/0022034518774331. [Epub ahead of print]

Read/download the interview transcript (PDF)


Oasis Moment (2.29″)


Full Conversation (10.02″)




  1. Greg July 26, 2018

    Hi Chiraz:
    Is there a reference from the Journal of Dental Research?

    1. JCDA Oasis July 27, 2018

      Hi Greg, Yes of course. Here it is:

      Water Fluoridation and Dental Caries in U.S. Children and Adolescents
      G.D. Slade, W.B. Grider, W.R. Maas, and A.E. Sanders

      Journal of Dental Research
      First Published June 14, 2018
      First Published June 14, 2018

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