Preventing Dental Disease

Water Fluoridation and Sealant Programs


Dental disease is preventable. By treating children early on, we can prevent painful—and costly—dental health problems that often continue into adulthood.

Community water fluoridation and sealant programs go a long way in protecting teeth from developing cavities, the most common cause of more severe dental health problems.

Promoting Community Water Fluoridation

Fluoride counteracts tooth decay and strengthens the teeth by fighting harmful acids and drawing calcium back into the teeth. Numerous studies demonstrate that fluoridated water protects teeth, even in adults. Community water fluoridation can reduce tooth decay in children by up to 60 percent, and it costs as little as $1 per person, per year.

Research shows that community water fluoridation offers perhaps the greatest return-on-investment of any dental care strategy. The reduction in just the costs of filling and extracting diseased teeth (not counting reductions in lost work time and dental pain) more than makes up for the cost of fluoridation. Consider these facts:

For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. More than a billion dollars could be saved annually if the remaining water supplies in the United States were fluoridated, according to the Centers for Disease Control.

Yet too many communities in the U.S. are not fluoridated. While approximately 70 percent of the nation drinks fluoridated water, there are major pockets that do not, representing tens of millions of Americans. In California, only 27 percent of the state uses fluoridated water. New Jersey and Oregon are almost entirely un-fluoridated.

Pew's effort to improve children’s dental policy is working to help states and communities adopt policies to fluoridate their water. Pew's efforts are backed by substantial evidence showing both the safety and effectiveness of fluoridated water. Several health and medical experts have shared their conclusions about fluoridation based on the science.

Expanding Sealant Programs

Dental sealants—a thin plastic film that is placed on the chewing surfaces of molars, where 90 percent of cavities in children occur—are a proven, effective public health measure. Sealants cost one-third as much as filling a cavity, and prevent painful toothaches, lost school time for kids, and lost work time for parents.

Many children who would benefit from dental sealants don’t have them. Fewer than one-quarter of six- to 11-year-olds in low-income families have sealants, making these children much more susceptible to developing cavities and other dental problems.

Research has found that school-based programs, where dental hygienists or dentists travel to schools and screen and apply sealants to all students in the optimal age group, are effective in providing sealants. School-based programs are timely, reaching seven- and eight-year olds shortly after their first molars have come in. Bringing services into schools effectively reaches children who normally face significant obstacles in obtaining dental care.

Pew's effort to improve children’s dental policy is working with experts in dental public health to identify the best strategies to expand sealant programs, develop guidance on using Medicaid and CHIP to fund sealant programs, and research best practices.

Learn More About Reimbursing Physicians

Read a Pew factsheet on reimbursing physicians for fluoride varnish.

Additional Resources