Eliminating fluoridation estimated to increase dental caries prevalence, total number of decayed teeth, and up costs
By Elana Gotkine HealthDay Reporter
TUESDAY, June 10, 2025 (HealthDay News) — Cessation of public water fluoridation would increase tooth decay and health system costs in the United States, according to a study published online May 30 in JAMA Health Forum.
Sung Eun Choi, Ph.D., from Harvard School of Dental Medicine, and Lisa Simon, M.D., D.M.D., from Brigham and Women’s Hospital, both in Boston, examined the cost-effectiveness of cessation of public water fluoridation and associations with oral health among children aged 0 to 19 years. Changes in total tooth decay, quality-adjusted life-years (QALYs), and costs associated with removal of fluoride in public water systems during five- and 10-year periods were estimated in a microsimulation model constructed based on oral health and water fluoridation data for 8,484 children from the National Health and Nutrition Examination Survey 2013 to 2016.
The researchers found that dental caries prevalence and total number of decayed teeth were estimated to increase by 7.5 percentage points and by 25.4 million cases in the base-case scenario of eliminating fluoridation, with a loss of 2.9 million QALYs at a cost of $9.8 billion over five years. Lower, but still substantial harms were seen in sensitivity analyses estimating less efficacy from fluoridation. For a 10-year horizon, estimates increased compared to a five-year horizon. Compared to those with private dental insurance, increased tooth decay would disproportionately affect publicly insured and uninsured children.
“These findings suggest that, despite the potential harms of excessive fluoride exposure, fluoridation at safe levels offers both individual and societal benefits that would be at risk,” the authors write.
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