What’s in Your Cup? A (Brief) History of Water Fluoridation

We all know that fluoride is one of the best ways to prevent tooth decay, but how much do you or your patients know of the history of water fluoridation? Here is a quick overview that may be of interest to you and your patient base. Feel free to share on your social media sites!


Water fluoridation became an official policy of the U.S. Public Health Services over 65 years ago. Today, approximately 75% of Americans live on a fluoridated water system. How did we get here?

Around the turn of the 20th century, the “brown stain” epidemic in Colorado Springs became a catalyst for the study and implementation of fluoridated water systems in America. Although the patients suffered unsightly staining, they showed a decreased rate of tooth decay. As it turns out, the brown stains was severe fluorosis caused by an excessive amount of naturally occurring fluoride in the water system. But the events spurred the question: If we could fluoridate the water system at a controlled level, could we decrease the rate of tooth decay, while avoiding fluorosis?

There are three essential periods of water fluoridation that got us to where we are today:

  1. Research into the cause of mottled tooth enamel: The Colorado Brown Stain. 1801 – 1933
  2. Research into the relationship between fluoride concentrations, fluorosis, and tooth decay found that moderate levels of fluoride prevents cavities. 1933 – 1945
  3. Fluoridated water supplies. 1945 – Present


The first fluoridated water supply in the world was in Grand Rapids, Michigan in 1945. During the last half of the 20th century, research was conducted on the effectiveness and side-effects of fluoridated water supplies. While there was evidence of decreased numbers of cavities, there was also an increase in the wide spread use of fluoridated oral healthcare products like toothpastes and rinses in 1960.

In 1960 water fluoridation became widely used in the U.S. Approximately 50 million people were now on fluoridated water systems. The rest of the world followed a similar pattern in researching and adopting the wide spread use of water fluoridation.


Today there is more debate than ever whether we still need fluoridated water systems, and if this is the best way to prevent tooth decay on a large scale; as many patients are leaning towards non-fluoride options, and fewer people actually drink tap water. There is evidence that water fluoridation decreases the decay rate among children in primary teeth, but there is not enough contemporary evidence supporting the same findings for adults.


Is this still something that’s effective and worthwhile for public health? Does each individual have the right to choose whether or not they ingest fluoride in their drinking water? I think it’s safe to say it’s time to sit down and discuss the future of fluoridated water in America. I look forward to that discussion and what the future of oral health has in store for us. 





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