As the United States marks its 250th anniversary, WTOP presents “250 Years of America,” a multipart series examining the innovations, breakthroughs and pivotal moments that have shaped the nation since 1776.
Delta Dental is proud to partner with WTOP to bring you this series.
In the mid-20th century, a public health intervention began flowing through American communities — not through the hospitals, but through the tap.
Recognized by the Centers for Disease Control and Prevention as one of the 10 greatest public health achievements of the 20th century, community water fluoridation is the controlled adjustment of fluoride levels in public drinking water to the concentration recommended for preventing tooth decay.
Unlike some medical achievements that can often depend on an individual’s access to care, fluoridated water reaches entire populations at once. Research shows fluoridated water prevents at least 25% of tooth decay in both children and adults.
The CDC also found that communities with populations of 1,000 or more experience an average return on investment of about $20 for every $1 spent on community water fluoridation. On average, people living in areas with fluoridated water save approximately $32 per year by avoiding the costs associated with treating tooth decay.
Dr. Myron Allukian, Jr., a board-certified public health dentist and former president of the American Public Health Association, noted that the first controlled studies conducted in 1945 showed a dramatic reduction in tooth decay, with rates declining by roughly 50 to 70%. As a result, national organizations started supporting fluoridation as a public health measure.
“In 1950, the American Public Health Association supported fluoridation, as did the ADA (American Dental Association), as did the federal government,” Dr. Allukian said. “Since then, we’ve had thousands of studies done on fluorides and fluoridation, and we have found that it’s really the foundation for better oral health.”
Dr. Allukian explained that fluoride strengthens tooth enamel, making it more resistant to the acids produced by bacteria in the mouth.
He said the process is especially important during childhood, when teeth are still developing because it helps to make teeth more decay-resistant over time.
“So we already have fluoride in the water. We already have it as part of our body, but with fluoridation, we increase the amount slightly. So while the teeth are growing, the fluoride becomes part of the tooth to make it stronger.”
Dr. Allukian described dental disease as a neglected epidemic due to its widespread impact on communities — particularly during World War II, when many military draftees were rejected because of poor oral health and untreated tooth decay. He also pointed to the oral health struggles of the nation’s first president as an example.
“George Washington, as President, had four sets of false teeth because he lost all his teeth due to tooth decay, and gum disease. So when you have a disease that affects everyone, what can you do to benefit everyone? And that’s what water fluoridation does.”
Dr. Allukian emphasized that community water fluoridation was developed as a solution to a widespread public health problem. Rather than relying on individual dental care, he said fluoridation provides consistent protection to entire communities.
“So we’ve had over 80 years of experience showing that fluoridation is safe and effective, irrespective of age, gender, income, education, culture and ethnicity, so it helps everybody.”
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