The 70th Anniversary of Community Water Fluoridation

By Dr. Johnny Johnson Jr.

This year, the 70th anniversary of community water fluoridation (CWF) in the United States was celebrated on Jan. 25, signifying the hard work of many individuals over the years.

The first city in the U.S. to optimally fluoridate the water was Grand Rapids, Mich. in 1945. It didn’t take long to notice the dental benefits of 1.0 ppm of fluoride in the water. The reduction in the number and severity of cavities in children became rapidly apparent to both parents and clinicians. This was a major breakthrough at a public health level. Four years later, Gainesville followed suit and was the first city in Florida to fluoridate its water.

Seventy years is a huge anniversary, and I expected to see fireworks on that day — at least in Gainesville, where I was having lunch with my two daughters. We proudly toasted our lunch with a clear glass of fluoridated tap water to mark the 70th anniversary. However, the lack of fanfare inside and outside the dental community was rather disappointing to me, given the huge impact that CWF has made in our country’s dental and medical health. Had this just become another item in our lives that we took for granted?

We know it was important, yet it isn’t considered a milestone? Sadly, this seems to be my take on the feedback that I get on CWF from our communities, our parents and grandparents, colleagues and other health care providers. CWF is taken for granted as something that will always be there, but it will continue to expand because it is the right thing to do.

CWF is a fantastic public health measure. Nowhere else do we see a decrease in communicable and preventable disease by simply adjusting a natural mineral in the water to optimal levels for dental health. This adjustment, just a slight tick up from what the natural background level of fluoride is in our water, causes absolutely no adverse health effects whatsoever at that level.

However, with CWF’s great benefits and lack of risks, why are we not at 100 percent of our state community water systems being fluoridated? Have we taken this public health measure for granted and resolved in our minds that it is always going to be there? We absolutely know what occurs when it is stopped. The reduction in cavities for adults and children of at least 25 percent over their lifetimes returns within three to five years to their pre-CWF levels. Again, most of us think that this fact is something that everybody knows and understands, especially in the medical and dental fields, so why would it happen at all? Well, let’s look at a simple parallel that is occurring right now.

Around the turn of the century, the number one cause of death for children was communicable and preventable diseases of childhood: measles, mumps, rubella and whooping cough, among others. Generations of parents grew up with the vaccinations that prevented these diseases and firmly believed that vaccinating their children was the right thing to do. It became an expected standard, just as CWF is now, as the correct thing to do and it would continue.

Let’s just take a quick look at the immunization situation right now. In a few short years of parents being scared by claims of harm — including autism — a growing number of people have begun to refuse immunizations for their children. In some communities in the U.S., like some in California, it is not unusual for 30-50 percent of the children to not be immunized. What we are starting to see now is a safe and proven public health measure being withheld from children, which is resulting in the return of preventable childhood diseases. Not only are these children being infected with a disease that we declared eradicated a few short years ago (measles), these children may then pass it on to infants whose immune systems have not yet developed, as well as immunocompromised patients, the elderly and some who have had less than a full-strength dose of the vaccine. So, what’s the parallel to CWF?

Nationally, CWF of community water systems is nearing 75 percent. The number of people that are served by CWS has steadily grown in the U.S. by millions every year. Although some communities have discontinued CWF for various reasons, the number of people who have access continues to grow every year. Unfortunately, we now have a serious issue with a small group of people with an internet presence that are spreading unsubstantiated information about CWF just as they do about vaccinations. The regrettable result is that the unsuspecting public surfing the internet comes across this misinformation so often that they are beginning to think that it is correct.

I find it unsettling that every city and community in our state is constantly being bombarded with anti-fluoridation misinformation by email. This type of constant attack was difficult to accomplish in the past before the internet. But now it is a matter of routine for this information to be disseminated to our fluoridation decision makers — our elected officials — on a regular basis. It is my hope that we achieve as close to 100 percent daily access to CWF as possible in my lifetime. We absolutely cannot allow the clock to be turned back by our complacency. No one else is going to come running to our aid when challenges to CWF come knocking at the door. The responsibility lies with you and your community to advocate for access to CWF by educating residents, professionals and community decision makers.

CWF is socially equitable. It is a non-partisan issue. It works for everyone regardless of socio-economic status, race, education or religious beliefs. We need to promote water fluoridation in our community and with our friends and families. Here are some quick important facts to remember about CWF:

  1. It’s Safe: It reduces cavities for everyone by simply drinking the water. It causes no adverse health effects for anyone at optimal levels.
  2. It’s Effective: It reduces cavities by 25 percent or greater for adults and children over their lifetime. The benefits of cavity reductions do not require a single modification to a person’s behavior — you just need to drink the water!
  3. It’s Cost-effective: For every $1 invested in CWF, $38 in dental treatment costs is avoided per person each year! Where in our lives can we get any return on investment like that? Additionally, CWF is the gold standard for delivering fluoride to everyone in a community.

Now, get out there and defend and promote CWF in your backyard. If you need help, just ask me. I will always be there for you!

Dr. Johnson can be reached at

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