If you are new to fluoride in water, look here for an introduction

The format of this page is

  • A summary of the key points relevant up to 2020
  • An online and printable version of the 2012/3 publication “one in a million”
  • A summary of the main points raised by more recent papers and reports
  • Access to a list of the key papers and reports published since 2012/3
  • Access to an archive of other reports etc.

Key Points

  • The World Health Organisation states that “Community water fluoridation is safe and cost-effective and should be introduced and maintained where ever is it socially acceptable and feasible”. (1)
  • Studies suggest that, in terms of cost, effect and the certainty of that effect, the most cost-effective policy for reducing tooth decay is fluoridation of water supplies.
  • The higher the incidence of tooth decay before fluoridation starts and the larger the population to be served, the greater the economic benefits are likely to be.
  • In the parts of the UK where tooth decay remains a significant public heath problem, patients and the NHS economy would benefit hugely from water fluoridation.

One in a Million

Our One in a Million online database includes a comprehensive section on the cost-effectiveness of fluoridation.


The cost and cost-effectiveness of water fluoridation (3rd edition, 2012)


The cost and cost-effectiveness of water fluoridation - Printable

Summary of Data Published Post 2012/2013

  • New studies in New Zealand (Moore and Poynton, 2015) and the US (Ran et al 2016; Meyer et al 2018; Meyer et al 2021) provide further evidence of the value for money provided by community water fluoridation.
  • However, given the variation in prices from country to country, one must be cautious in generalising these data to the UK.
  • The study commissioned by the South-Central Strategic Health Authority in 2008 probably remains the most applicable to the UK.
  • A new study published by BMC Oral Health assesses the costs and savings of water fluoridation in the Republic of Ireland: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-021-01490-7 Excerpts: The net cost of CWF (cost of CWF provision minus the expected treatment savings associated with dental caries prevented) for 5-, 8-, and 12-year-old schoolchildren was estimated at -€2.63 million in 2017, or an average cost of -€17.68 per child ($21.42 US dollars), with negative costs representing a cost saving to the health-payer.
  • Health economists have reached important conclusions about the benefits and safety of fluoride at the level used for CWF: First, we reconfirm the long-established positive effect of fluoride on dental health. Second, we estimate a zero effect on cognitive ability in contrast to several recent debated epidemiological studies. Third, fluoride is furthermore found to increase labor income. This effect is foremost driven by individuals from a lower socioeconomic background.  The co-authors point out that their conclusions were based on data from Sweden’s health registry. These data amount to more than 47,000 research observations, compared to only 600 from the Green study in JAMA Pediatrics. Below is a link to the article. The full text of the online version is accessible:https://www.journals.uchicago.edu/doi/full/10.1086/711915