A survey of community water fluoridation in the United States

Abstract

The geographic distribution of community water fluoridation (CWF) in the U.S. was surveyed using data for states, counties, and water systems. The distribution of CWF is not uniform within states and CWF is not available to many small or rural communities. Explanations for geographic variations in CWF were sought by performing quantitative analysis using variables related to the perceived need for fluoridation (percent of counties without a dentist, prevalence of caries, poverty, and Medicaid eligibility) and barriers to its adoption (rurality, population size). Need was not found to be a factor the adoption of CWF. The results of fluoridation decisions made between 1980 and 2008 were also analyzed to determine the effect of fluoridation decision-making structures. The type of authority was not found to be a predictor of the outcomes of fluoridation votes. A survey of the dental directors of each state was also conducted regarding states' support for CWF. The survey results indicated that states use a variety of means to promote CWF. Dental directors perceived community opposition and public apathy to be the greatest barriers to adoption of CWF. Recommendations for the future promotion of CWF and suggestions for further research are outlined.