Preventing Dental Caries Through Community Water Fluoridation

Heralded as 1 of the 10 greatest public health achievements of the 20th century [1], community water fluoridation is a safe, effective, and cost-effective strategy for reducing the incidence of dental caries in people of all ages. In 1949 Charlotte became the first municipality in North Carolina to adopt this preventive measure [2]; at that time, its water system was the largest in the world to adjust fluoride to the optimal level of 1 part per million. Since then, community water fluoridation has expanded; currently, 87.5% of North Carolina residents who access water from a community water system—about 63% of the state’s total population—receive the benefits of drinking fluoridated water [3]. Nationally, North Carolina ranks 18th among the states in terms of the percentage of community water systems with added fluoride [3]. A broad range of dental and nondental health organizations support community water fluoridation, including the North Carolina Department of Health and Human Service’s Division of Public Health [4]. Dental caries result from bacterial metabolism in biofilms and the interaction of these biofilms with the tooth structure [5]. All humans have this biofilm, which usually forms within 20 minutes after brushing. When the pH of this biofilm drops below 5.5, minerals in the tooth enamel—especially calcium—leach out. When the pH of the biofilm rises again, the enamel will remineralize. This cycle of demineralization and remineralization happens constantly in all people with natural teeth. When demineralization exceeds remineralization, there is a net mineral loss, which results in white spot lesions