HJAR Jul/Aug 2025

66 JUL / AUG 2025 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH many families, the elderly, and certain ra- cial populations and ethnic minority groups. These special populations simply do not seek dental care due to a lack of healthcare pro- viders and/or lack of funds to receive ser- vices and, therefore, do not obtain preven- tive care. Since members of these special popula- tions often cannot afford fluoridated tooth- paste for at-home oral hygiene, regular den- tal visits, or necessary treatments, fluoridated tap water congruently delivers a tool to help fight against tooth decay. Despite socioeco- nomic status or access to care, water fluori- dation benefits all equally and serves as an essential public health intervention. Water fluoridation remains a key element, especially for those with limited access to oral hygiene products and regular dental care. Removing fluoride fromour water systems would burden those with lower incomes and preexisting dental conditions. These same people have fewer prevention options and already deal with socioeconomic barriers that make it difficult to maintain a healthy diet or to access dental care. In terms of reducing costs, there have been multiple studies surrounding the re- turn on investment. According to theAmeri- can Dental Association, for most cities, every $1 invested in water fluoridation yields $38 savings in dental treatment costs. 8 The CDC cited a study that included 172 public water systems, in which fluoridated water yielded an average savings of $60 per person when lifetime costs of maintaining a restoration were included. 9 Productivity time lost due to untreated dental disease costs the U.S. an estimated $45 billion each year. 10 Oral health status runs parallel in conse- quences and costs associated with the level of oral health achieved. Prevention is less DIALOGUE COLUMN ORAL HEALTH IN ARKANSAS, 86.8% of the population is served fluoridated tap water, helping our state rank well in national statistics in this category. 1 Water fluoridation has been a hot topic on the national level, as well as the state level here in Arkansas. Five key bills regard- ing water fluoridation in Arkansas were de- bated this legislative session of 2025. Each of these bills sought either to eliminate fluoride from public water systems or to give voters the chance to decide the issue. Ultimately, none of the bills passed. After 80 years of water fluoridation, why is this subject so controversial? Science-based evidence overwhelmingly supports commu- nity water fluoridation at the recommended level of 0.7 parts per million (ppm) for pre- venting tooth decay. It is the most cost-effec- tive, efficient, and reliable resource we have that distributes fluoride to our communities congruently to fight tooth decay. If this is the case, why do some refute it? There are multiple studies providing sta- tistics how fluoride is making a positive dif- ference for oral health. These efficacious outcomes can be grouped into four differ- ent categories: • Reducing decay in children and adults. • Addressing disparities. • Reducing costs for dental treatment. • Improves oral health, thereby im- proving overall health and well-being. In the last few years, several studies have determined reduction of tooth decay in chil- dren, as well as adults. A 2018 study of over 13,000 United States children concluded that for every 100 children who have access to flu- oridated water, there are 130 fewer decayed surfaces of primary teeth and 30 fewer de- cayed surfaces of permanent teeth. 2 In Canada, a 2021 study found that chil- dren residing in Calgary, which stopped What’s in theWater? Water Fluoridation and Its Effects on Oral Health and Communities fluoridation in 2011, had decay rates that were significantly above children residing in Edmonton, which had access to fluoridated water. This research led Calgary to fluoridate their city water again. 3 Another study found that adults who had access to fluoridated wa- ter as children were far less likely to lose their teeth due to decay when they were middle- aged adults. 4 One of the most telling studies from the CDC was completed in the second half of the 20th century. The mean number of decayed, missing, or filled tooth surfaces among per- sons aged 12 years in the U.S. declined 68%, from 4.0 in the years 1966-70 to 1.3 in the years 1988-94. 5 Although this study is older, the numbers still demonstrate the positive effects of water fluoridation. There is a health-wealth divide in dental health outcomes and access to care in Ar- kansas and in the nation. Arkansas is a very rural state in which 60% of dentists practice in only eight of the state’s 75 counties. 6 These eight counties represent 40% of the popula- tion, which are in the urban areas. There is also an overall shortage of dentists in our state. Even though the rate of den- tists per 100,000 population inArkansas has slightly increased from 44.3 in 2015 to 45.3 in 2023, the state has a dentist distribution problem, as most dentists practice in urban areas. 7 Higher education levels and higher in- come are associated with better access to care, regular dental visits, dental treatment, and products or services that straighten or whiten teeth. These services improve appear- ance, as well as opportunities for socioeco- nomic positions and job attainment. Oral health disparities are exacerbated in rural populations. Financial insecurity, lower education levels, and lower incomes affect