Oral Health›Everyday care

Water Fluoridation

What community water fluoridation is, the target levels in the UK, Australia and the US, how to find out if your water has fluoride, what the evidence shows, and how policy has changed in each country, with dates.

Updated September 2026·By the OHA editorial team·10 min read·How we write
Key takeaways
  • Community water fluoridation means adjusting the fluoride in public drinking water to a level that helps prevent tooth decay.
  • Target levels differ: 1.0 mg/L in England, 0.6 to 1.1 mg/L in Australia, and 0.7 mg/L recommended in the US.
  • Your water supplier can tell you whether your water is fluoridated.
  • Health bodies in all three countries support fluoridation. A 2024 Cochrane review found the benefit today may be smaller than in the past.
  • England is expanding fluoridation, while in the US two states have legislated against it and federal agencies are reviewing it.

Fluoride is a mineral found naturally in water, soil and some foods, and it strengthens tooth enamel against decay. This guide looks in depth at fluoride in drinking water; for toothpaste and varnish, see fluoride explained. Because policy is changing, statements below are dated.

What is community water fluoridation?

The CDC (US Centers for Disease Control and Prevention) explains that almost all water contains some natural fluoride, usually too little to prevent decay. Community water fluoridation means adding fluoride to a public water supply to reach a level that helps prevent decay. The 2024 Cochrane review says it is practised in about 25 countries.

Levels are given in milligrams per litre (mg/L), which is the same as parts per million (ppm). Australia's National Health and Medical Research Council (NHMRC) says there is no difference in a glass of water between natural and added fluoride, and that fluoridation does not change the water's taste or smell.

Target levels by country

  • England: water companies are asked to raise fluoride to 1.0 mg/L in fluoridated areas, within a legal limit of 1.5 mg/L (Department of Health and Social Care). About one in 10 people in England live in fluoridated areas (UK Health Security Agency, 2026).
  • Australia: the NHMRC supports states and territories fluoridating within 0.6 to 1.1 mg/L, with each state's health authority setting the exact level. In its 2017 statement it said around 89% of Australians had access to fluoridated water. The Better Health Channel says all Australian capital cities have fluoride added.
  • US: the recommended level is 0.7 mg/L. The CDC said that in 2022, 72.3% of people on public water supplies received fluoridated water. The Environmental Protection Agency (EPA) sets a legal maximum of 4.0 mg/L, and the CDC says the EPA recommends no more than 2.0 mg/L to help children avoid fluorosis.

How can you find out if your water is fluoridated?

  • UK: ask your local water supplier (Oral Health Foundation).
  • Australia: your local water authority can tell you (Better Health Channel).
  • US: the CDC says your local water provider is the best source. Its My Water's Fluoride website covers most states but is not updated in real time. Well water needs laboratory testing.

What does the evidence show?

Health bodies agree that fluoridation reduces decay, but estimates of how much differ.

  • NHMRC (Australia, 2017): fluoridation reduces decay by 26% to 44% in children and adolescents and by 27% in adults.
  • CDC (US): about 25% less decay in children and adults. The American Dental Association (ADA) says at least 25%, even with fluoride toothpaste widely used.
  • UK Health Security Agency (England, March 2026): children in fluoridated areas were less likely to have decay or need a tooth removed in hospital, with the largest benefit in more deprived areas.
  • Cochrane review (October 2024): this pools the results of many studies. Looking at studies since 1975, when fluoride toothpaste became widespread, it found adding fluoride to water may lead to slightly less decay in children's baby teeth, but could not be sure about adult teeth. It found a clear effect in studies from 1975 or earlier, but said that is unlikely to apply to all populations today.

The limits of the Cochrane review

The Cochrane authors say their confidence is limited: none of the studies were randomised trials, communities were deliberately selected, results varied, and only children's decay was measured. The review says the benefits may be smaller than before fluoride toothpaste, not that there are none. England's Department of Health and Social Care also says benefits may be smaller than in the 1970s, while still judging fluoridation worthwhile.

Fluorosis

Dental fluorosis is a change in how enamel looks, caused by taking in too much fluoride while teeth are forming. The CDC says this can only happen up to about age 8, and in the US is mostly mild and cosmetic. The NHMRC says almost all fluorosis in Australia is very mild or mild, and that moderate and severe forms are no more common in fluoridated than non-fluoridated areas. The Cochrane review, using older evidence current to 2015, estimated that at 0.7 mg/L about 40% of people may have some fluorosis and about 12% may have fluorosis that bothers them. See white spots on teeth.

For formula made up with fluoridated water, the CDC says there may be a higher chance of mild fluorosis and suggests low-fluoride bottled water some of the time; the NHMRC says formula made with Australian fluoridated water is safe.

Policy and debate, country by country

United Kingdom

The Health and Care Act 2022 gave the Secretary of State for Health power to start, vary and end schemes in England. In a 2021 statement, the UK's four Chief Medical Officers said there was strong scientific evidence that fluoridation is an effective public health measure. After a 2024 public consultation, the government decided in March 2025 to expand fluoridation across north east England, where over 1 million people already have it. Views were polarised: of 3,336 individual responses, 56% strongly disagreed, though a majority in the area itself agreed. A 2024 plan for NHS dentistry set a long-term ambition to bring fluoridation to more of the country, focusing on the most deprived areas. The March 2026 monitoring report found no evidence of an effect on children's cognitive ability (thinking skills) and no convincing evidence of an effect on hip fracture risk.

Australia

The NHMRC's 2017 statement strongly recommends fluoridation as safe, effective and ethical, and found reliable evidence that fluoridation at Australian levels is not associated with cancer, Down syndrome, lowered intelligence or hip fracture. Decisions are made by state or local governments, and the NHMRC's chief executive has written to local councils voting on the issue to explain how the evidence was reviewed.

United States

States and local governments decide whether to fluoridate (CDC). Since 2024 the position has changed quickly:

  • August 2024: a US National Toxicology Program report concluded with moderate confidence that fluoride above 1.5 mg/L, more than twice the US recommended level, is associated with lower IQ in children (EPA, ADA News).
  • September 2024: a federal judge ordered the EPA to respond to the risk of fluoride under chemical safety law; the ruling did not ban fluoridation (ADA News).
  • April 2025: the EPA announced a fast-tracked review of fluoride in drinking water, and news reports said the Health Secretary would tell the CDC to stop recommending fluoridation (ADA News). The Congressional Research Service said in May 2025 that no official statement on this had been released.
  • May 2025: a ban on adding fluoride to public water took effect in Utah, and Florida's governor signed a law to stop local governments "unilaterally" adding it (Utah legislature, Congressional Research Service).
  • October 2025: the Food and Drug Administration (FDA) moved to restrict the sale of unapproved prescription fluoride products that children swallow, for children under 3 and older children not at high risk of decay.
  • May 2026: the ADA reported that a federal appeals court had overturned the 2024 order.
  • August 2026: the EPA published the method for its review, which will look at effects on children's brain development and fluorosis. It had not concluded by September 2026.

In its August 2026 announcement, the EPA said the CDC's recommended level was still 0.7 mg/L. The ADA continues to support fluoridation, and in April 2026 said new US studies found no link between recommended levels and IQ.

Bottled and filtered water

The CDC says bottled water varies, and water labelled de-ionised, purified, demineralised or distilled contains little or none unless fluoride is listed. The NHMRC says most bottled water in Australia is not fluoridated. If you drink mostly bottled water, the CDC suggests telling your dental team.

Reverse osmosis and distillation remove fluoride, while carbon filters do not (ADA); the NHMRC adds filters containing ion-exchange resins or activated aluminium. The NHMRC says removing fluoride from fluoridated water is not necessary.

When to see a dentist
  • You mostly drink bottled, filtered, rain or well water.
  • Your water is not fluoridated and you want to know whether your child needs extra fluoride.
  • You notice white marks or streaks on your child's teeth.

Frequently asked questions

Is fluoridated water safe?

Health bodies in the UK, Australia and the US say fluoridation at recommended levels is safe. In the US, the EPA is re-examining possible risks, and its review had not concluded in September 2026.

Do I need fluoridated water if I use fluoride toothpaste?

The CDC says the two work together: water keeps a low level of fluoride in the mouth all day, while toothpaste gives a stronger dose at brushing times.

Does boiling water remove fluoride?

No. The Better Health Channel says boiling does not significantly change fluoride levels.

Sources

  1. Water fluoridation: health monitoring report for England 2026, short summary, UK Health Security Agency and Department of Health and Social Care, March 2026, accessed September 2026
  2. Consultation on community water fluoridation expansion in the north east of England: government response, Department of Health and Social Care, March 2025, accessed September 2026
  3. Community water fluoridation expansion in the north east of England, Department of Health and Social Care, accessed September 2026
  4. Statement on water fluoridation from the UK Chief Medical Officers, UK Chief Medical Officers, 2021, accessed September 2026
  5. Fluoride, Oral Health Foundation, accessed September 2026
  6. 2017 Public Statement: Water fluoridation and human health in Australia, National Health and Medical Research Council, accessed September 2026
  7. Water fluoridation and human health in Australia: questions and answers, National Health and Medical Research Council, accessed September 2026
  8. Health effects of water fluoridation, National Health and Medical Research Council, accessed September 2026
  9. Dental care: fluoride, Better Health Channel (Victoria), accessed September 2026
  10. About community water fluoridation, CDC, accessed September 2026
  11. CDC scientific statement on community water fluoridation, CDC, accessed September 2026
  12. Community water fluoridation frequently asked questions, CDC, accessed September 2026
  13. About dental fluorosis, CDC, accessed September 2026
  14. My Water's Fluoride, CDC, accessed September 2026
  15. Water fluoridation for the prevention of dental caries, Cochrane (Iheozor-Ejiofor and others, 2024), accessed September 2026
  16. Fluoride in drinking water, US Environmental Protection Agency, accessed September 2026
  17. EPA will expeditiously review new science on fluoride in drinking water, US Environmental Protection Agency, 7 April 2025, accessed September 2026
  18. EPA hits key milestone in expedited review of fluoride under Safe Drinking Water Act, US Environmental Protection Agency, August 2026, accessed September 2026
  19. Judge orders EPA to address impacts of fluoride in drinking water, ADA News, 26 September 2024, accessed September 2026
  20. RFK Jr. to tell CDC to change fluoride guidelines, ADA News, 9 April 2025, accessed September 2026
  21. H.B. 81 Fluoride Amendments (enrolled copy), Utah State Legislature, 2025, accessed September 2026
  22. The development of federal recommendations and regulations for fluoride in drinking water, Congressional Research Service, 16 May 2025, accessed September 2026
  23. FDA acts to protect children from unapproved fluoride drug products, US Food and Drug Administration, 31 October 2025, accessed September 2026
  24. Court of Appeals rules EPA case 'commandeered' by lower court, American Dental Association, 22 May 2026, accessed September 2026
  25. New studies reaffirm fluoride safety and benefits, find no link to cognitive outcomes, American Dental Association, 15 April 2026, accessed September 2026
  26. Fluoride in water, American Dental Association, accessed September 2026
  27. Fluoride: topical and systemic supplements, American Dental Association, accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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