Community water fluoridation still cost-effective


This was confirmed by a study reported this month in the New Zealand Medical Journal:

Caroline Fyfe, Barry Borman, Guy Scott, S. B. (2015). A cost effectiveness analysis of community water fluoridation in New Zealand. New Zealand Medical Journal, 128(1427).

The study is available to download as a poster presentation here.

Previous studies – most recently in 2001 – had shown CWF to be cost-effective. However, oral health has improved in both fluoridated and fluoridated areas so the new study was undertaken to check if CWF “remained a cost-effective public health intervention in New Zealand in the 21st century.”

The results show that CWF is still cost-effective. The post concludes:

“This cost effectiveness analysis supports an earlier economic analysis of community water fluoridation in New Zealand by Wright et. al. (2001) 3 . CWF remained a cost effective public health intervention in New Zealand despite an overall reduction in dental caries. This finding also agrees with a number of economic analyses of CWF conducted in countries similar to New Zealand, 7, 9-11 . It should be noted however, that for smaller communities cost effectiveness was more marginal. Wright et. al. (2001) identified a ‘break even’ community size for CWF of 700-900 people 3 . In smaller communities cost effectiveness was more dependent on the risk profile of the population. CWF would be more cost effective in communities with a higher risk of dental caries.”

The reduced cost-effectiveness for smaller communities is due to the relatively greater per-capita cost of the fluoridation plants and chemicals in such situations. This table below from the poster gives an idea of how community size influences the cost-effectiveness of CWF. It might need a bit of thinking – the negative values are the average annual per capita net cost of CWF per unit of decayed, missing and filled teeth (dmft/DMFT).

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7 responses to “Community water fluoridation still cost-effective

  1. Have they allowed for reduced rugby success related to fluoridation and the follow on?


  2. No reference to Ko and Thiessen
    A critique of recent economic evaluations of community water fluoridation

    International Journal of Occupational and Environmental Health, Volume 21, Issue 2 (March 2015), pp. 91-120

    Lee Ko1; Kathleen M. Thiessen2

    1: Oakland, CA, USA
    2: Oak Ridge Center for Risk Analysis, Oak Ridge, TN, USA

    [Open access at

    Although community water fluoridation (CWF) results in a range of potential contaminant exposures, little attention has been given to many of the possible impacts. A central argument for CWF is its cost-effectiveness. The U.S. Government states that $1 spent on CWF saves $38 in dental treatment costs.

    To examine the reported cost-effectiveness of CWF.

    Methods and underlying data from the primary U.S. economic evaluation of CWF are analyzed and corrected calculations are described. Other recent economic evaluations are also examined.

    Recent economic evaluations of CWF contain defective estimations of both costs and benefits. Incorrect handling of dental treatment costs and flawed estimates of effectiveness lead to overestimated benefits. The real-world costs to water treatment plants and communities are not reflected.

    Minimal correction reduced the savings to $3 per person per year (PPPY) for a best-case scenario, but this savings is eliminated by the estimated cost of treating dental fluorosis.”


  3. rdfknz, I am familiar with Lee and Theissen. It suffers from a big problem – attribution of moderate and severe dental fluorosis to CWF.

    It is well known that CWF does not cause moderate or severe dental fluorosis – so the inclusion of treatment for this as a cost against CWF was not warranted.

    However, anti-fluoride campaigners love to quote this as Theissen is one of “theirs.”

    The Oral Health Survey in NZ did not find any severe dental fluorosis and only 2.0% moderate dental fluorosis (1.7% in fluoridated areas and 2.3% in non-fluoridated areas).


  4. Re Ko and Thiessen . . who is Ko. The paper gives no address, no degrees, no affiliations. Perhaps it is a pseudonym for the Cookie Monster. That the senior author of a paper can be unidentifiable reflects the current abysmal lack of standards even among journals allowed in the National Library of Medicine’s database PubMed.


  5. Ko and Thiessen totally fail to consider the expense side of cavities. Even the Griffin paper which concluded there is $38 saved in dental bills for every dollar invested made assumptions which grossly underestimate the cost of dental care.

    The reality is that all restorations for cavities are at risk of failure.

    Griffin only assumed that cavities would be maintained with repeated amalgam (silver fillings) or extraction. Modern restorative dentistry is way more complicated and expensive. Ask any older person about their root canals, crowns, bridges, and implants not to mention the more expensive modern white “composite” reconstructions (fillings).

    The Delta Dental company analyzed their billing data and found that a single filling in a molar acquired as a 10 year old costs $2,187 (2003 dollars).

    Delta Dental’s more recent accounting of the lifetime cost of a molar cavity (2013) is a whopping $6,105.

    A life-time of water fluoridation in current dollars is only about $80.

    And neither Ko/Thiessen nor Griffin include the payback for baby teeth. The data from New York is a $900 saving for every dollar invested in fluoridation, mostly from avoiding very expensive operations for rotten teeth in preschool kids.

    One can only hope that a current study which accurately accounts for both all costs and all benefits will soon be done. Given the inflation of dental care costs I’m betting that the payback is considerably higher than the 3800% Griffin reported.


  6. Bruce, were you unable to read to the end of the Guardian article you cite where it says?:

    PHE’s director of dental public health, Dr Sandra White, said: “Reviews of the evidence from around the world agree that water fluoridation is a safe and effective measure to help reduce tooth decay. None of the reports on water fluoridation by international health bodies have identified any evidence of harm.

    “Water fluoridation is one of a range of actions, including supervised tooth brushing, that councils can consider to improve oral health in their area. Ultimately it’s beneficial to get fluoride from toothpaste when brushing teeth as well as from water which offers a background level throughout the day.”


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