{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:09:59Z","timestamp":1793495399029,"version":"4.5.0"},"reference-count":155,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"<jats:p>The aim of this review is to describe the role of water fluoridation in preventing dental caries worldwide. Community water fluoridation began in 1945 and over the past 20 years has reached over 400 million people. In several countries, such as USA, Australia, New Zealand, Ireland, Singapore, Hong Kong, Brunei, Malaysia, Oman, Chile, Gabon and Brazil, a high proportion of the population receives fluoridated water. The clinical effectiveness is well established. Both water fluoridation and fluoride-containing toothpaste are effective and each adds to the effect of the other. Coverage of water fluoridation is equitable so that those at greatest risk of dental caries benefit most. Water fluoridation is cost-effective and has low environmental impact. Below the usual permitted concentration of 1.5\u2005mgF\/L, there is no risk to health. Prevalence of dental fluorosis is higher in fluoridated communities but severity is mild to very mild and of little aesthetic concern. In this regard, advice should focus on early use of fluoride-containing toothpaste to reduce fluoride ingestion during infancy and early childhood. The cost of water fluoridation is low. With increasing global urbanisation and improved equipment, the future of water fluoridation is promising. The WHO urges member states to consider implementing community water fluoridation.<\/jats:p>","DOI":"10.3389\/froh.2026.1745916","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:49:34Z","timestamp":1774421374000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Water fluoridation today: \u2013 benefits and challenges"],"prefix":"10.3389","volume":"7","author":[{"given":"Andrew","family":"Rugg-Gunn","sequence":"first","affiliation":[{"name":"Professor Emeritus, Newcastle University","place":["Newcastle upon Tyne, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Lowry","sequence":"additional","affiliation":[{"name":"Retired, Department of Child Dental Health, Newcastle University , Newcastle upon Tyne","place":["United Kingdom"]},{"name":"Retired, Consultant in Public Health, Newcastle Health Authority , Newcastle upon Tyne","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Cockcroft","sequence":"additional","affiliation":[{"name":"Retired, Chief Dental Officer, Department of Health","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony Damien","family":"Walmsley","sequence":"additional","affiliation":[{"name":"Professor Emeritus, School of Dentistry, College of Medicine and Health, The University of Birmingham","place":["Birmingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1046\/j.2003.com122.x","article-title":"The world oral health report 2003: continuous improvement of oral health in the 21st century \u2013 the approach of the WHO global oral health programme","volume":"31","author":"Petersen","year":"2003","journal-title":"Community Dent Oral Epidemiol"},{"key":"B2","volume-title":"Nutrition and Dental Health. Chapter 6, Dental Caries \u2013 the Role of Dietary Sugars","author":"Rugg-Gunn","year":"1993"},{"key":"B3","first-page":"69","article-title":"Fluoride and oral health","volume":"33","author":"O\u2019Mullane","year":"2016","journal-title":"Community Dent Health"},{"key":"B4","volume-title":"Global Strategy and Action Plan on Oral Health 2023\u20132030","year":"2024"},{"key":"B5","article-title":"Global burden of disease 2019 (GBD 2019) results [online database]","year":"2020"},{"key":"B6","volume-title":"Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030","year":"2022"},{"key":"B7","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/0022034520908533","article-title":"Global, regional and national levels and trends in burden of oral conditions from 1990 to 2017: a systematic analysis for the global burden of disease 2017 study","volume":"99","author":"Bernab\u00e9","year":"2020","journal-title":"J Dent Res"},{"key":"B8","article-title":"AFRO","year":"2025"},{"key":"B9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1177\/0022034517750572","article-title":"Global-, regional-, and country-level economic impacts of dental diseases in 2015","volume":"97","author":"Righolt","year":"2018","journal-title":"J Dent Res"},{"key":"B10","article-title":"The state of oral health in Europe. Report commissioned by the Platform for Better Oral Health in Europe","author":"Patel","year":"2012"},{"key":"B11","article-title":"NHS Digital\u2019s Hospital Admitted Patient Care Activity, 2017\u201318","year":"2018"},{"key":"B12","volume-title":"One in a Million; the Facts About Water Fluoridation","year":"2004"},{"key":"B13","doi-asserted-by":"publisher","first-page":"CD002278","DOI":"10.1002\/14651858.CD002278","article-title":"Fluoride toothpastes for preventing dental caries in children and adolescents (review)","author":"Marinho","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"CD010856","DOI":"10.1002\/14651858.CD010856.pub3","article-title":"Water fluoridation for the prevention of dental caries","author":"Iheozor-Ejiofor","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B15","volume-title":"Fluorides in Caries Prevention","author":"Murray","year":"1991"},{"key":"B16","volume-title":"Fluoride in Drinking Water","author":"Fawell","year":"2006"},{"key":"B17","article-title":"World Bank country classifications by income level for 2024-2025","author":"Metreau","year":"2025"},{"key":"B18","doi-asserted-by":"publisher","first-page":"CD010856","DOI":"10.1002\/14651858.CD010856.pub2","article-title":"Water fluoridation for the prevention of dental caries","author":"Iheozor-Ejiofor","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"B19","volume-title":"Evaluation of Water Fluoridation Scheme in Cumbria: The CATFISH Prospective Longitudinal Cohort Study","author":"Goodwin","year":"2022"},{"key":"B20","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1111\/cdoe.12231","article-title":"Causal inference from observational data","volume":"44","author":"Listl","year":"2016","journal-title":"Community Dent Oral Epidemiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1177\/00220345221084283","article-title":"Causal inference: onward and upward!","volume":"101","author":"Listl","year":"2022","journal-title":"J Dent Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1001\/jama.2014.16153","article-title":"Methods for evaluating changes in health care policy: the difference-in-differences approach","volume":"312","author":"Dimick","year":"2014","journal-title":"JAMA"},{"key":"B23","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.jclinepi.2014.06.021","article-title":"Regression discontinuity designs are underutilized in medicine, epidemiology, and public health: a review of current and best practice","volume":"68","author":"Moscoe","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/cdoe.13002","article-title":"Causal analyses in longitudinal observational studies in oral health: a scoping review","volume":"53","author":"Dao","year":"2025","journal-title":"Community Dent Oral Epidemiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1111\/cdoe.12802","article-title":"Causal inference in dentistry: time to move forward","volume":"51","author":"Schuch","year":"2023","journal-title":"Community Dent Oral Epidemiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1093\/ije\/dyv341","article-title":"Causality and causal inference in epidemiology: the need for a pluralistic approach","volume":"45","author":"Vandenbroucke","year":"2016","journal-title":"Int J Epidemiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1093\/ije\/dyw314","article-title":"Triangulation in aetiological epidemiology","volume":"45","author":"Lawlor","year":"2016","journal-title":"Int J Epidemiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1111\/j.1600-0528.2012.00721.x","article-title":"Effectiveness of water fluoridation in caries prevention","volume":"40","author":"Rugg-Gunn","year":"2012","journal-title":"Community Dent Oral Epidemiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1111\/cdoe.12384","article-title":"Contemporary evidence on the effectiveness of water fluoridation in the prevention of childhood caries","volume":"46","author":"Spencer","year":"2018","journal-title":"Community Dent Oral Epidemiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1177\/0022034518774331","article-title":"Water fluoridation and dental caries in U.S. Children and adolescents","volume":"97","author":"Slade","year":"2018","journal-title":"J Dent Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1177\/2380084418824262","article-title":"Systematic review of evidence pertaining to factors that modify risk of early childhood caries","volume":"4","author":"Moynihan","year":"2019","journal-title":"JDR Clin Trans Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1111\/ipd.12928","article-title":"Effectiveness of water fluoridation in an upper-middle-income country: a systematic review and meta-analysis","volume":"32","author":"Belotti","year":"2022","journal-title":"Int J Paediatr Dent"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1177\/23800844251342804","article-title":"Water fluoridation and dental caries prevention globally: a systematic review and meta-analysis","author":"Nascimento","year":"2025","journal-title":"JDR Clin Trans Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/154405910708600504","article-title":"Effectiveness of fluoride in preventing caries in adults","volume":"86","author":"Griffin","year":"2007","journal-title":"J Dent Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1177\/0022034513481190","article-title":"Effects of fluoridated drinking water on dental caries in Australian adults","volume":"93","author":"Slade","year":"2013","journal-title":"J Dent Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/adj.12243","article-title":"The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults","volume":"60","author":"Crocombe","year":"2015","journal-title":"Austr Dent J"},{"key":"B37","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1177\/0022034516643064","article-title":"Access to fluoridated water and adult dental caries","volume":"95","author":"Peres","year":"2016","journal-title":"J Dent Res"},{"key":"B38","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1111\/cdoe.12280","article-title":"Effectiveness of water fluoridation in the prevention of dental caries across adult age groups","volume":"45","author":"Do","year":"2017","journal-title":"Community Dent Oral Epidemiol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1111\/jphd.12207","article-title":"Preventive benefit of access to fluoridated water for young adults","volume":"77","author":"Spencer","year":"2017","journal-title":"J Public Health Dent"},{"key":"B40","volume-title":"Fluorides and Oral Health. Report of a WHO Expert Committee on Oral Health Status and Fluoride Use","year":"1994"},{"key":"B41","article-title":"Ending childhood dental caries: WHO implementation manual","year":"2019"},{"key":"B42","volume-title":"Findings and Recommendations of the Fluoride Expert Panel (January 2007)","year":"2008"},{"key":"B43","volume-title":"Information Paper \u2013 Water Fluoridation: Dental and Other Human Outcomes","year":"2017"},{"key":"B44","article-title":"Review of the benefits and costs of water fluoridation in New Zealand","author":"Moore","year":"2015"},{"key":"B45","article-title":"Promoting oral health through water fluoridation","year":"2014"},{"key":"B46","article-title":"Improving oral health: community water fluoridation toolkit","year":""},{"key":"B47","article-title":"Position statement on community water fluoridation","year":"2022"},{"key":"B48","doi-asserted-by":"publisher","first-page":"100833","DOI":"10.1016\/j.identj.2025.04.013","article-title":"Facts and fallacies of the fluoride controversy: a contemporary perspective","volume":"75","author":"Samaranayake","year":"2025","journal-title":"Int Dent J"},{"key":"B49","article-title":"Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries","year":"1999"},{"key":"B50","article-title":"2025 Pinellas County to stop adding fluoride to water after new state law","year":""},{"key":"B51","article-title":"Water fluoridation health monitoring report for England 2022","year":"2022"},{"key":"B52","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1177\/2380084418764312","article-title":"Reducing potentially preventable dental hospitalizations of young children: a community-level analysis","volume":"3","author":"Rogers","year":"2018","journal-title":"JDR Clin Trans Res"},{"key":"B53","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1038\/sj.bdj.4803927","article-title":"Fluoridation in Newcastle and Northumberland: a clinical study of 5 year old children","volume":"142","author":"Rugg-Gunn","year":"1977","journal-title":"Br Dent J"},{"key":"B54","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1111\/adj.13063","article-title":"Why policy relevant research still matters for community water fluoridation","volume":"70","author":"Nguyen","year":"2025","journal-title":"Austr Dent J"},{"key":"B55","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/sj.bdj.4806919","article-title":"The relationship between fluoridation, social class and caries experience in 5 year-old children in Newcastle and Northumberland in 1987","volume":"167","author":"Carmichael","year":"1989","journal-title":"Br Dent J"},{"key":"B56","doi-asserted-by":"publisher","first-page":"dyaf080","DOI":"10.1093\/ije\/dyaf080","article-title":"Water fluoridation as a population strategy for reducing oral health inequalities: high-dimensional effect heterogeneity analysis using machine learning","volume":"54","author":"Matsuyama","year":"2025","journal-title":"Int J Epidemiol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12903-020-01100-y","article-title":"Economic evaluations in water-fluoridation: a scoping review","volume":"20","author":"Mari\u00f1o","year":"2020","journal-title":"BMC Oral Health"},{"key":"B58","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/j.amepre.2015.10.014","article-title":"Economic evaluation of community water fluoridation: a community guide systematic review","volume":"50","author":"Ran","year":"2016","journal-title":"Am J Prev Med"},{"key":"B59","volume-title":"The Bangkok Declaration \u2013 No Health Without Oral Health","year":"2025"},{"key":"B60","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1111\/cdoe.12958","article-title":"Economic evaluation of a water fluoridation scheme in Cumbria, UK","volume":"52","author":"Whittaker","year":"2024","journal-title":"Community Dent Oral Epidemiol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1186\/s12903-021-01490-7","article-title":"A cost-effectiveness analysis of community water fluoridation for schoolchildren","volume":"21","author":"Cronin","year":"2021","journal-title":"BMC Oral Health"},{"key":"B62","first-page":"61","article-title":"The health equity implications of health (fluoridation of drinking water) amendment act 2021 for access to (and performance of) community water fluoridation in New Zealand","volume":"121","author":"Chambers","year":"2025","journal-title":"NZ Dent J"},{"key":"B63","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1111\/j.1753-6405.2001.tb01841.x","article-title":"The cost-effectiveness of fluoridating water supplies in New Zealand","volume":"25","author":"Wright","year":"2001","journal-title":"Aust NZ J Public Health"},{"key":"B64","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1111\/j.1600-0528.2012.00684.x","article-title":"Cost-effectiveness of extending the coverage of water supply fluoridation for the prevention of dental caries in Australia","volume":"40","author":"Cobiac","year":"2012","journal-title":"Community Dent Oral Epidemiol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1001\/jamapediatrics.2019.1729","article-title":"Association between maternal fluoride exposure during pregnancy and IQ scores in offspring in Canada","volume":"173","author":"Green","year":"2019","journal-title":"JAMA Pediatr"},{"key":"B66","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1289\/ehp.1104912","article-title":"Developmental fluoride neurotoxicity: a systematic review and meta-analysis","volume":"120","author":"Choi","year":"2012","journal-title":"Environ Health Perspect"},{"key":"B67","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1111\/cdoe.12954","article-title":"Flawed MIREC fluoride and intelligence quotient publications: a failed attempt to undermine community water fluoridation","volume":"52","author":"Guichon","year":"2024","journal-title":"Community Dent Oral Epidemiol"},{"key":"B68","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1159\/000279325","article-title":"Relationships between fluoride intake, urinary fluoride excretion and fluoride retention in children and adults: an analysis of available data","volume":"44","author":"Villa","year":"2010","journal-title":"Caries Res"},{"key":"B69","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1159\/000325137","article-title":"Contemporary biological markers of exposure to fluoride","volume":"22","author":"Rugg-Gunn","year":"2011","journal-title":"Fluoride Oral Environ"},{"key":"B70","volume-title":"Basic Methods for Assessment of Renal Fluoride Excretion in Community Prevention Programmes for Oral Health","year":"2014"},{"key":"B71","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.yrtph.2015.04.005","article-title":"Biomonitoring equivalents for interpretation of urinary fluoride","volume":"72","author":"Aylward","year":"2015","journal-title":"Regul Toxicol Pharm"},{"key":"B72","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1177\/00220345221119431","article-title":"Early childhood exposures to fluorides and child behavioural development and executive function: a population-based longitudinal study","volume":"102","author":"Do","year":"2023","journal-title":"J Dent Res"},{"key":"B73","article-title":"Fluoride: dose-response analysis for non-cancer effects","year":"2010"},{"key":"B74","article-title":"Review of the revised NTP monograph on the systemic review of fluoride exposure and neurodevelopmental and cognitive health effects: a letter report. Washington: National Academies Press","year":"2021"},{"key":"B75","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1001\/jamapediatrics.2024.5542","article-title":"Fluoride exposure and children\u2019s IQ scores: a systematic review and meta-analysis","volume":"179","author":"Taylor","year":"2025","journal-title":"JAMA Pediatr"},{"key":"B76","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/cdoe.70027","article-title":"Fluoride and neurodevelopmental hazard modelling: an assessment of concentration-response analysis","volume":"54","author":"Kumar","year":"2025","journal-title":"Community Dent Oral Epidemiol"},{"key":"B77","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1111\/cdoe.12685","article-title":"Fluoridation cessation and children\u2019s dental caries: a 7-year follow-up evaluation of grade 2 schoolchildren in calgary and Edmonton, Canada","volume":"50","author":"McLaren","year":"2022","journal-title":"Community Dent Oral Epidemiol"},{"key":"B78","doi-asserted-by":"publisher","first-page":"305","DOI":"10.17269\/s41997-024-00858-w","article-title":"Community water fluoride cessation and rate of caries-related pediatric dental treatments under general anesthesia in Alberta, Canada","volume":"115","author":"Yazdanbakhsh","year":"2024","journal-title":"Canadian J Public Health"},{"key":"B79","doi-asserted-by":"publisher","first-page":"72","DOI":"10.2105\/AJPH.2013.301857","article-title":"Community water fluoridation and intelligence: prospective study in New Zealand","volume":"105","author":"Broadbent","year":"2015","journal-title":"Am J Public Health"},{"key":"B80","doi-asserted-by":"publisher","first-page":"112181","DOI":"10.1016\/j.envres.2021.112181","article-title":"Prenatal exposure to fluoride and neuropsychological development in early childhood: 1 to 4 years old children","volume":"207","author":"Ibarluzea","year":"2022","journal-title":"Environ Res"},{"key":"B81","doi-asserted-by":"publisher","first-page":"164322","DOI":"10.1016\/j.scitotenv.2023.164322","article-title":"Fluoride exposure during pregnancy from a community water supply is associated with executive function in preschool children: a prospective ecological cohort study","volume":"891","author":"Dewey","year":"2023","journal-title":"Sci Total Environ"},{"key":"B82","doi-asserted-by":"publisher","DOI":"10.1177\/00220345251394295","article-title":"Controversies and public health implications of community water fluoridation","author":"Do","year":"2025","journal-title":"J Dent Res"},{"key":"B83","doi-asserted-by":"publisher","first-page":"e9478","DOI":"10.2903\/j.efsa.2025.9478","article-title":"Updated consumer risk assessment of fluoride in food and drinking water including the contribution from other sources of oral exposure","volume":"23","year":"2025","journal-title":"EFSA Journal"},{"key":"B84","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/0003-9969(79)90168-7","article-title":"Classification and prevalence of enamel opacities in the human deciduous and permanent dentitions","volume":"24","author":"Murray","year":"1979","journal-title":"Archs Oral Biol"},{"key":"B85","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000325101","article-title":"Fluoride intake of children: considerations for dental caries and dental fluorosis","volume-title":"Fluoride and the Environment","author":"Buzalaf","year":"2011"},{"key":"B86","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1080\/000163599428652","article-title":"Risk periods\u2019 associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis","volume":"57","author":"B\u00e5rdsen","year":"1999","journal-title":"Acta Odontol Scand"},{"key":"B87","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1111\/j.1600-0528.2006.00281.x","article-title":"Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors","volume":"34","author":"Hong","year":"2006","journal-title":"Community Dent Oral Epidemiol"},{"key":"B88","first-page":"300","article-title":"Abstract: chiaie teeth","volume":"44","author":"Eager","year":"1902","journal-title":"Dent Cosmos"},{"key":"B89","first-page":"627","article-title":"An investigation into mottled teeth (II)","volume":"58","author":"McKay","year":"1916","journal-title":"Dent Cosmos"},{"key":"B90","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1021\/ie50261a007","article-title":"Occurrence of fluorides in some waters of the United States","volume":"23","author":"Churchill","year":"1931","journal-title":"Ind Eng Chem"},{"key":"B91","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1001\/jama.1936.02770420007002","article-title":"Chronic endemic dental fluorosis (mottled enamel)","volume":"107","author":"Dean","year":"1936","journal-title":"J Am Med Assoc"},{"key":"B92","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.2307\/4584182","article-title":"Domestic water and dental caries, V, additional studies of the relation of fluoride domestic waters to dental caries experience in 4,425 white children aged 12\u201314 years of 13 cities in 4 states","volume":"57","author":"Dean","year":"1942","journal-title":"Public Health Rep"},{"key":"B93","first-page":"1421","article-title":"Classification of mottled enamel diagnosis","volume":"21","author":"Dean","year":"1934","journal-title":"J Am Dent Assoc"},{"key":"B94","first-page":"23","article-title":"The investigation of physiological effects by the epidemiological method","volume-title":"Fluorine and Dental Health. Publ.No.19","author":"Dean","year":"1942"},{"key":"B95","first-page":"51","volume-title":"Oral Health Surveys: Basic Methods","year":"2013"},{"key":"B96","doi-asserted-by":"publisher","first-page":"497","DOI":"10.2307\/4588461","article-title":"Climate and endemic dental fluorosis","volume":"68","author":"Galagan","year":"1953","journal-title":"Public Health Rep"},{"key":"B97","first-page":"294","article-title":"Japanese Studies on water and food fluoride and general dental health","volume-title":"Fluorides and Human Health","author":"Minoguchi","year":"1970"},{"key":"B98","volume-title":"Dental Fluorosis of Caries","author":"M\u00f8ller","year":"1965"},{"key":"B99","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1159\/000016451","article-title":"Malnutrition and developmental defects of enamel in 2\u20136 year old Saudi boys","volume":"32","author":"Rugg-Gunn","year":"1998","journal-title":"Caries Res"},{"key":"B100","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1038\/sj.bdj.4803359","article-title":"Enamel mottling in a fluoride and in a non-fluoride community","volume":"138","author":"Al-Alousi","year":"1975","journal-title":"Br Dent J"},{"key":"B101","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1111\/j.1600-0528.1978.tb01173.x","article-title":"Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes","volume":"6","author":"Thylstrup","year":"1978","journal-title":"Community Dent Oral Epidemiol"},{"key":"B102","first-page":"159","article-title":"An epidemiological index of developmental defects of dental enamel (DDE index). technical report No. 15","volume":"32","year":"1982","journal-title":"Int Dent J"},{"key":"B103","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1177\/00220345890680030201","article-title":"A modified DDE index for use in epidemiological studies of enamel defects","volume":"68","author":"Clarkson","year":"1989","journal-title":"J Dent Res"},{"key":"B104","doi-asserted-by":"publisher","first-page":"37","DOI":"10.14219\/jada.archive.1984.0268","article-title":"A new method for assessing the prevalence of dental fluorosis \u2013 the tooth surface Index of fluorosis","volume":"109","author":"Horowitz","year":"1984","journal-title":"J Am Dent Assoc"},{"key":"B105","first-page":"179","article-title":"Indices for measuring dental fluorosis","volume":"46","author":"Horowitz","year":"1986","journal-title":"J Public Health Rep"},{"key":"B106","first-page":"195","article-title":"Caries incidence and enamel defects in areas with different levels of fluoride in the drinking water","volume":"100","author":"Forrest","year":"1956","journal-title":"Br Dent J"},{"key":"B107","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1111\/j.1600-0528.1993.tb01099.x","article-title":"Aesthetic concerns of children and parents in relation to different classifications of the tooth surface index of fluorosis","volume":"21","author":"Clark","year":"1993","journal-title":"Community Dent Oral Epidemiol"},{"key":"B108","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1177\/00220345930720090201","article-title":"Perceptions of dental fluorosis","volume":"72","author":"Riordan","year":"1993","journal-title":"J Dent Res"},{"key":"B109","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/j.1600-0528.2009.00507.x","article-title":"A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects\/oral health-related quality of life","volume":"38","author":"Chankanka","year":"2010","journal-title":"Community Dent Oral Epidemiol"},{"key":"B110","doi-asserted-by":"publisher","first-page":"25","DOI":"10.5694\/mja15.00703","article-title":"Natural history and long-term impact of dental fluorosis: a prospective cohort study","volume":"204","author":"Do","year":"2016","journal-title":"Med J Austr"},{"key":"B111","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/cdoe.12213","article-title":"Longitudinal changes in developmental defects of enamel","volume":"44","author":"Wong","year":"2016","journal-title":"Community Dent Oral Epidemiol"},{"key":"B112","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1177\/0022034520906089","article-title":"Decline in dental fluorosis severity during adolescence: a cohort study","volume":"99","author":"Curtis","year":"2020","journal-title":"J Dent Res"},{"key":"B113","doi-asserted-by":"publisher","first-page":"1198167","DOI":"10.3389\/froh.2023.1198167","article-title":"Generalized permanent dentition fluorosis severity becomes less evident over time among a birth cohort","volume":"4","author":"Levy","year":"2023","journal-title":"Front Oral Health"},{"key":"B114","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1111\/j.1752-7325.1986.tb03140.x","article-title":"Prevalence of dental fluorosis in fluoridated and nonfluoridated communities \u2013 a preliminary investigation","volume":"46","author":"Leverett","year":"1986","journal-title":"J Public Health Dent"},{"key":"B115","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1177\/00220345880670050101","article-title":"Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren","volume":"67","author":"Szpunar","year":"1988","journal-title":"J Dent Res"},{"key":"B116","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1111\/j.1600-0528.1994.tb01832.x","article-title":"Trends in prevalence of dental fluorosis in North America","volume":"22","author":"Clark","year":"1994","journal-title":"Community Dent Oral Epidemiol"},{"key":"B117","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1177\/154405910708600807","article-title":"Risk-benefit balance in the use of fluoride among young children","volume":"86","author":"Do","year":"2007","journal-title":"J Dent Res"},{"key":"B118","first-page":"383","article-title":"Changes in dental health in Hong Kong after 25 years of water fluoridation","volume":"4","author":"Evans","year":"1987","journal-title":"Community Dent Health"},{"key":"B119","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/j.1600-0528.1990.tb00653.x","article-title":"Dental caries status and treatment needs of the permanent dentition of 6\u201312 year olds in Hong Kong","volume":"18","author":"Lo","year":"1990","journal-title":"Community Dent Oral Epidemiol"},{"key":"B120","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1111\/j.1600-0528.2007.00389.x","article-title":"Changing risk factors for fluorosis among South Australian children","volume":"36","author":"Spencer","year":"2008","journal-title":"Community Dent Oral Epidemiol"},{"key":"B121","article-title":"How to keep your teeth clean","year":"2025"},{"key":"B122","first-page":"6","volume-title":"Fluoride in Drinking Water","author":"Fawell","year":"2006"},{"key":"B123","article-title":"Freedom of Information response confirming that fluoride released from fluoridated drinking water is not expected to exceed environmental quality standards","year":"2021"},{"key":"B124","article-title":"Opinion on critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water","year":"2011"},{"key":"B125","volume-title":"Annual Water Quality Report","year":"2023"},{"key":"B126","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1038\/s41415-022-4251-5","article-title":"The environmental impact of community caries prevention \u2013 part 3: water fluoridation","volume":"233","author":"Duane","year":"2022","journal-title":"Brit Dent J"},{"key":"B127","article-title":"Carbon modelling within dentistry: towards a sustainable future","year":"2018"},{"key":"B128","article-title":"Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water","year":"2011"},{"key":"B129","article-title":"Community Water Fluoridation Programs: A Health Technology Assessment \u2013 Environmental Assessment","year":"2019"},{"key":"B130","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1159\/000325161","article-title":"Systemic fluoride","volume-title":"Fluoride and the Oral Environment","author":"Sampaio","year":"2011"},{"key":"B131","article-title":"Water fluoridation: health monitoring report for England 2022","year":"2022"},{"key":"B132","first-page":"402","volume-title":"Guidelines on Fluoride in Drinking-Water","year":"2021"},{"key":"B133","doi-asserted-by":"publisher","first-page":"140","DOI":"10.5644\/ama2006-124.82","article-title":"Salt fluoridation","volume":"42","author":"Marthaler","year":"2013","journal-title":"Acta Med Acad"},{"key":"B134","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1159\/000260468","article-title":"Effect of an interruption in water fluoridation on the caries prevalence of the primary and permanent dentition","volume":"14","author":"K\u00fcnzel","year":"1980","journal-title":"Caries Res"},{"key":"B135","article-title":"The development of Federal recommendations and regulations for fluoride in drinking water","year":"2025"},{"key":"B136","doi-asserted-by":"publisher","first-page":"e0322027","DOI":"10.1371\/journal.pone.0322027","article-title":"Topical fluoride hesitancy and opposition are significantly and positively associated: a cross-sectional study","volume":"20","author":"Lim","year":"2025","journal-title":"PLoS One"},{"key":"B137","article-title":"Water fluoridation: statement from the UK Chief Medical Officers","year":"2021"},{"key":"B138","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780199290697.001.0001","volume-title":"Ethics, Prevention, and Public Health","author":"Dawson","year":"2007"},{"key":"B139","volume-title":"Principles of Biomedical Ethics","author":"Beauchamp","year":"2019"},{"key":"B140","volume-title":"Public Health: Ethical Issues","year":"2007"},{"key":"B141","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1038\/s41415-024-8058-4","article-title":"The ethics of community water fluoridation: part 1 \u2013 an overview of public health ethics","volume":"238","author":"Patel","year":"2025","journal-title":"Br Dent J"},{"key":"B142","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1038\/s41415-024-8057-5","article-title":"The ethics of community water fluoridation: part 2 \u2013 how has the ethics of community water fluoridation been appraised in the literature? A scoping review","volume":"238","author":"Patel","year":"2025","journal-title":"Br Dent J"},{"key":"B143","volume-title":"Information Paper \u2013 Water Fluoridation: Dental and Other Human Health Effects","year":"2017"},{"key":"B144","first-page":"80","article-title":"Is New Zealand water fluoridation justified?","volume":"127","author":"Jiang","year":"2014","journal-title":"NZ Med J"},{"key":"B145","volume-title":"Oral Health Policy Statement","year":"2013"},{"key":"B146","article-title":"Consultants in Dental Public Health & Chief Administrative Dental Officers and the Directors of Dentistry in Scotland","year":""},{"key":"B147","article-title":"UK Public General Acts","year":"2022"},{"key":"B148","volume-title":"Water Fluoridation: Legislation Changes and Guidance","year":"2022"},{"key":"B149","doi-asserted-by":"publisher","DOI":"10.1038\/s41415-021-3074-0","article-title":"Public attitudes to water fluoridation in the north east of England","author":"Lowry","year":"2021","journal-title":"Br Dent J"},{"key":"B150","doi-asserted-by":"publisher","DOI":"10.1038\/s41415-022-4506-1","article-title":"Public attitudes to water fluoridation in Scotland","author":"Jones","year":"2022","journal-title":"Br Dent J"},{"key":"B151","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1038\/sj.bdj.2016.257","article-title":"Critique of the review of \u2018water fluoridation for the prevention of dental caries\u2019 published by the cochrane collaboration in 2015","volume":"220","author":"Rugg-Gunn","year":"2016","journal-title":"Br Dent J"},{"key":"B152","article-title":"Water Fluoridation by Country","year":"2025"},{"key":"B153","volume-title":"One in a Million: The Facts About Water Fluoridation","year":"2004"},{"key":"B154","article-title":"The extent of water fluoridation","year":""},{"key":"B155","doi-asserted-by":"publisher","first-page":"e054","DOI":"10.1590\/1807-3107bor-2021.vol35.0054","article-title":"Community interventions and strategies for caries control in Latin American and Caribbean countries","volume":"35","author":"Ricomini Filho","year":"2021","journal-title":"Braz Oral Res"}],"container-title":["Frontiers in Oral Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2026.1745916\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:49:42Z","timestamp":1774421382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/froh.2026.1745916\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":155,"alternative-id":["10.3389\/froh.2026.1745916"],"URL":"https:\/\/doi.org\/10.3389\/froh.2026.1745916","relation":{},"ISSN":["2673-4842"],"issn-type":[{"value":"2673-4842","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]},"article-number":"1745916"}}