Patient Management

Important Facts on Optimal Community Water Fluoridation

Prepared by the Massachusetts Dental Society Task Force on Access, Prevention and Interprofessional Relations, with information prepared and reviewed by the Centers for Disease Control and the National Fluoridation Advisory Committee of the American Dental Association. 

1. The Centers for Disease Control (CDC) considers fluoridation of community water supplies to be the single most effective public health measure to prevent tooth decay, going so far as to call it “One of the 10 great public health achievements of the 20th century.” 
   
2. Throughout more than 75 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe.
3. Studies prove that water fluoridation continues to be effective in reducing tooth decay by more than 25% in children and adults, even in an era with the widespread availability of fluoride from other sources, such as fluoride toothpaste. 
4. There are no current, credible, peer-reviewed studies in the United States that prove, without any doubt, that optimal community water fluoridation is anything but effective, safe, and cost-efficient. 
5. Community water fluoridation is the controlled adjustment of fluoride that occurs naturally in all water to optimal levels to prevent tooth decay. 
6. Optimal community water fluoridation benefits everyone, especially those without access to regular dental care. Fluoridation is a powerful tool in the fight for social justice and health equity, particularly important because SNAP benefits (food stamps) do not allow for the purchase of toothpaste with and without fluoride, toothbrushes, or fluoride rinses. 
7. By simply drinking water, people benefit from the cavity protection provided by fluoridation, whether at home, work, or school. 
8. Water that has been fortified with fluoride works similarly to the public health practice of fortifying salt with iodine, milk with vitamin D, and orange juice with vitamin C — none of which are medications. Many countries that do not utilize community water fluoridation add fluoride to salt. 
9. When compared to the cost of other prevention programs, water fluoridation is the most cost-effective means of preventing tooth decay for both children and adults in the United States. The cost of a lifetime of water fluoridation for one person is less than the cost of one filling. 
10. For community water systems that serve more than 1,000 people, the economic benefit of fluoridation exceeds the cost. The benefit-cost ratio increases as the size of the population served increases (mainly due to economies of scale). Fluoridation is a cost-saving method to prevent tooth decay. 
11. According to CDC data from 2022, nearly 73% of the population (3 out of 4 people) in the United States are served by public water systems that are optimally fluoridated. 
12. Fluoridation has been thoroughly tested in the United States court system and found to be a proper means of furthering public health and welfare. No court of last resort has ever determined fluoridation to be unlawful. Cases have been lost in lower courts, as happened recently in California, but have continually been won on appeal to the higher court.
13. One of the most widely respected sources for information regarding fluoridation and fluorides is the American Dental Association (ADA). The ADA maintains fluoride and fluoridation web pages at www.ADA.org/fluoride. Other accurate sites include the American Academy of Pediatrics, www.ilikemyteeth.org, www.AmericanFluoridationSociety.org, www.cdc.gov, and www.mass.gov.

The Massachusetts Dental Society (MDS) and the American Dental Association discourage the use of direct-to-consumer dental products, including aligners, veneers, mouthguards, snoring appliances, teeth whitening trays, and bleaching products. Self-administered, unsupervised dental treatments have the potential to cause damage and irreversible complications for patients.

The MDS has communicated its concerns in 2019 regarding DIY or remote orthodontics in letters to the Massachusetts Board of Registration in Dentistry and the Massachusetts Attorney General.

Deciding to terminate a relationship with an insurance company is a difficult decision. If you decide to move forward with terminating network participation, it is important that you inform your patients of your reasons for this decision. Most insurance providers will send letters to your patients suggesting the patient changes to a "network dentist" so don't let them have the last word. 

Send a letter to your corresponding patient base informing them that you are terminating participation, and explain your decision, what the change will mean, and the high value you place on the dentist-patient relationship. You may use the sample template provided here.

What to include in your letter:

1. Thank you for being my patient. The relationship between a dentist and patient is a vitally important one based on trust, comfort, and communication.  
2. My patient philosophy is [...]
3. After long and careful consideration, I want to share with you that starting [insert date], I have decided to end my practice’s relationship with [company]. Most importantly, this decision does not change our relationship. Your insurance will still be accepted here. I will still continue to offer you all the advantages my practice has to offer. We will continue to work with you to process your benefit claims. 
4. I decided to end my practice's relationship with [company] because [...] 
5. Here’s what the change will mean for you. Because I am no longer an in-network provider, there could be an increase in treatment costs. Also, because [company] does not allow its members to assign benefits directly to their dental care providers, your insurance company may pay your benefits directly to you, which means that we may invoice you for payment. We can discuss these changes now or the next time we meet. But please know that we will continue to have your best interests in mind and value the relationship we have built.