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Experts call for more water fluoridation to fight tooth decay

For the first time, scientists have demonstrated the low environmental footprint of water fluoridation compared with other preventive measures for tooth decay, saying that renewed efforts should be made worldwide to provide this intervention.

Trinity College Dublin researchers, collaborating with University College London, said water fluoridation is regarded as one of the most significant public health interventions of the 20th century. But as the climate crisis worsens, the contribution of healthcare and the prevention of disease to the crisis must be considered.

Influenced by this urgency, they quantified the environmental impact of water fluoridation for an individual five-year-old child over a one-year period and compared this to the traditional use of fluoride varnish and toothbrushing programmes.

Today, more than 35% of the world’s population have access to water fluoridation, with studies showing significant reductions in dental caries. While data on the clinical effectiveness and cost analysis of water fluoridation are available, there have been no data regarding its environmental impact up to now.

To quantify this impact, the research team performed a Life Cycle Assessment (LCA) by carefully measuring the combined travel, the weight and amounts of all products and the processes involved in all three preventive programmes (toothbrushing, fluoride varnish programmes and water fluoridation). Data was inputted into a specific environmental programme (OpenLCA) and the team used the Ecoinvent database, enabling them to calculate environmental outputs, including the carbon footprint, the amount of water used for each product and the amount of land use.

The results of the study, led by Brett Duane, associate professor in Dental Public Health at Trinity College, concluded that water fluoridation had the lowest environmental impact in all categories studied, and had the lowest disability-adjusted life years impact when compared with all other community-level caries prevention programmes. The study also found that water fluoridation gives the greatest return on investment.

Considering the balance between clinical effectiveness, cost effectiveness and environmental sustainability, researchers believe that water fluoridation should be the preventive intervention of choice.

This research strengthens the case internationally for water fluoridation programmes to reduce dental decay, especially in the most vulnerable populations.

Duane said: “As the climate crisis starts to worsen, we need to find ways of preventing disease to reduce the environmental impact of our health systems. This research clearly demonstrates the low carbon impact of water fluoridation as an effective prevention tool.”

Professor Paul Ashley, Senior Clinical Lecturer (Honorary NHS Consultant), UCL Eastman Dental Institute added: “Renewed efforts should be made to increase access to this intervention.”

Study details

The environmental impact of community caries prevention – part 3: water fluoridation

Brett Duane, Alexandra Lyne, Ray Parle, Paul Ashley.

Published in the British Dental Journal on 26 August 2022.


Community-level interventions for the prevention of dental caries in children include fluoride varnish in schools, supervised toothbrushing in schools, the provision of toothbrushes and toothpaste and water fluoridation. The environmental impact of these interventions is an important factor to consider when commissioning these services.

Materials and methods
A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of fluoridation of the public water supply for a five-year-old child over a one-year period. These results were compared to LCA data for fluoride varnish in schools, supervised toothbrushing and the provision of toothbrushes and toothpaste.

When comparing community-level caries prevention programmes, water fluoridation had the lowest environmental impact in all 16 categories and had the lowest disability-adjusted life years impact.

All community-level caries prevention programmes have an associated environmental cost. Water fluoridation performed well in this LCA study in all measures of environmental sustainability. The results of this study could be used, along with cost and clinical effectiveness data, to inform public healthcare policy.


British Dental Journal article – The environmental impact of community caries prevention – part 3: water fluoridation (Open access)


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