Implementation of Evidence-Based Preventive Interventions: Coordinate Community Water Fluoridation Programs

For 70 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay. CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.

A state water fluoridation program is a collective effort to promote, implement, and maintain consistency of community water fluoridation efforts within a state. The state water fluoridation program also helps to create knowledge and awareness of community water fluoridation as an evidence-based intervention to prevent tooth decay.

This program may be jointly managed by the state oral health program and the state drinking water administrator. These entities should collaborate to plan, implement, and evaluate community water fluoridation oversight and management activities.

State water fluoridation program management should

• Conduct and report monthly monitoring through the Water Fluoridation Reporting System (WFRS) or an equivalent state system.
• Update Public Water Systems (PWS) information within WFRS to reflect new or deleted PWS; correct consecutive PWS relationships with changed fluoridation status, fluoride chemical used, and natural fluoride level.
• Track progress toward incorporating into practice, as appropriate, the CDC Engineering and Administrative Recommendations for Water Fluoridation (EARWF) [PDF–337KB].
• Identify communities and water systems that need replacement fluoridation equipment for water treatment plants, and develop a replacement plan with funding acquired from state and local governments, partners, and grants.
• Report on water systems receiving new or replacement fluoridation equipment and the communities and populations affected.
• Measure and report progress toward reaching or exceeding the Healthy People 2020 objective for 76.9% of the population using community water systems to receive optimally fluoridated water. Identify water systems that, if fluoridated, would enable the state to meet or exceed the Healthy People 2020 objective.
• Establish a water fluoridation quality-control program.
• Provide technical training for fluoridation engineers and water plant operators.
• Evaluate community water fluoridation program accomplishments, including advances in population coverage and systems where implemented.
• Participate in a fluoride proficiency testing program.

Once a state fluoridation program has established their fluoridation program, they should work to improve or expand efforts; such as,

• Enhance or expand existing fluoridation program management to a comprehensive level that meets or exceeds Healthy People 2020 objectives.
• Encourage attendance by the state fluoridation coordinator, engineers or specialists at the CDC fluoridation training or equivalent.
• Conduct comprehensive inspections of all adjusted fluoridated water systems every three years to assure that all the technical recommendations, including the safety requirements of EARWF, are followed.
• Increase percentage of fluoridated water systems consistently maintaining optimal levels of fluoride as defined by the state and consistent with recommendations outlined in EARWF.
• Promote fluoridation to decision makers and the public as appropriate.

Additional Resources

Healthy People 2020: Oral Health Objectives

Guide to Community Preventive Services [Community Guide] – Oral Health

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