Community Water Fluoridation a Cost–Benefit–Risk Consideration

For over 70 years, the addition of fluoride to public water as community water fluoridation (CWF or fluoridation) with intent to prevent dental caries continues to be controversial, and risks are seldom included in monetary evaluations. Published operational costs and benefits of fluoridation are used, whereas published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient-perceived dental fluorosis and lost wages from lower IQ (intelligence quotient). Published estimated caries averted, less operational costs at $8 PPPY (per person per year) were used, compensation for functional and cosmetic dental fluorosis $126 PPPY, and lower earnings from presumed harm of developmental neurotoxicity estimated at $438 PPPY. Net loss from CWF is estimated at $556 PPPY, although some individuals will have significantly more or less loss. Previous economic evaluations of fluoridation have estimated caries averted and costs of operations; however, few evaluations include the costs of treating harm. Fluoridation is not cost-effective if the cost of harm is included. Alternatives for the prevention of dental caries should be promoted, and the cessation of fluoridation is indicated.