By Dr. David Hicks | Jefferson County Health Officer
When public health works well, most people never notice. We expect our water to be safe, our food to be inspected, and our communities to support health — not illness. Community water fluoridation is one of those behind-the-scenes protections, and in Jefferson County, it remains an important part of keeping our families healthy.
Tooth decay is often dismissed as minor, but it is one of the most common chronic conditions affecting children and adults. In Alabama, recent school-based screenings show that more than one in five kindergarteners and nearly one in four third graders have untreated tooth decay, rates that exceed national averages.
Untreated cavities cause pain, infection, missed school days, and costly emergency care — problems that disproportionately affect families with limited access to dental services.
Fluoridated water helps prevent these outcomes. By maintaining a low level of fluoride in the mouth throughout the day, it strengthens tooth enamel and reduces the risk of cavities across the lifespan. Decades of research show that communities with fluoridated water experience lower rates of tooth decay than those without it, even in the modern era of fluoride toothpaste.
In Alabama, about 77% of people served by public water systems receive fluoridated water, slightly above the national average but still leaving large gaps. Jefferson County performs better than many counties, with nearly all residents on public water systems receiving fluoridated water. That matters, because counties with lower fluoridation coverage tend to see higher rates of untreated tooth decay in children.
Some have asked whether fluoridation is still needed now that fluoride toothpaste is widely available. Toothpaste is important, but it requires regular access, proper use, and consistent habits. Fluoridated water provides continuous, passive protection, benefiting everyone who drinks it — regardless of income, insurance status, or ability to see a dentist. When communities discontinue fluoridation, cavity rates reliably rise, particularly among children and low-income families.
Safety is another common concern. Fluoride is one of the most studied public health interventions in history. In the United States, water systems target 0.7 milligrams per liter, a level chosen to maximize dental benefits while minimizing risks. Extensive reviews by national scientific bodies find no credible evidence of serious health harm at this level.
Fluoridation is a highly cost-effective choice for communities. For every dollar invested, several dollars are saved on dental treatments — benefiting families, schools, and taxpayers. Supplying optimally fluoridated water across US communities for a year saves $6.5 billion in dental expenses and achieves an average return of $20 for every dollar spent. On average, communities with fluoridated water see 25% fewer cavities, saving $32 per person each year by avoiding dental costs and reducing missed work and school days.
In Jefferson County and across Alabama, we face real challenges in access to dental care. Water fluoridation is not a cure-all, but it is a proven and affordable tool that protects everyone, especially children. Preserving it is a practical step toward a healthier community.
Dr. David Hicks is a board-certified family medicine physician and serves as Health Officer at the Jefferson County Department of Health (JCDH).
