Community Water Fluoridation

History of CWF in Tennessee

In 1951, dental health in Tennessee took an important step forward when Milan, in Gibson County, became the first city in the Volunteer State to fluoridate its water supply.The addition of fluoride, a naturally occurring mineral proven to reduce cavities, soon improved lives in the small West Tennessee community. From 1951 to 1956, there was a 57 percent reduction in tooth decay for six-year-old children served by the Milan water system. That decrease was noted by parents, doctors and dentists, and fluoridation of community water became accepted across the state and nation as a safe, effective way to reduce cavities.

Close to 80 years of intensive scientific research and experience with water fluoridation in the United States and 73 years in Tennessee have proven community water fluoridation is safe and effective and protects, promotes, and improves the health of its citizens. Comparisons of dental health before and after fluoridation in Tennessee showed a 75 percent decline in decay of children’s permanent teeth from the early 1950s to the late 1980s.

In 2023, 88.32 percent of Tennesseeans served by community water systems received fluoridated water. This is down from the 95.2 percent statewide rate achieved in 2004. Tennessee follows recommendations from the U.S. Department of Health and Human Services that the amount of fluoride in drinking water is 0.7 mg/l for prevention of tooth decay.   

The Basics of CWF

CWF is the most natural and cost-effective means of protecting residents in a community from tooth decay. Fluoride is naturally present in all water. CWF adjusts the amount of fluoride present in a community's water supply to a recommended level for preventing tooth decay. 

According to the Centers for Disease Control and Prevention, children not having access to fluoridated community water have a 20 to 40 percent higher chance of tooth decay, which can impact not just their dental and physical health, but also their social and economic health as they grow older. 

The CDC has cited fluoridated community water as one of the top 10 public health achievements of the last century. The current cost for CWF is approximately 50 cents per-person, per-year, which is a fraction of the cost for repairing one cavity. Click for additional facts and information about fluoride from the CDC.

Know the level of fluoride in your drinking water.
 My Water's Fluoride (MWF) allows consumers to learn about the fluoride level in their drinking water. Also, you can find out the number of people served by the system and the water source. Click to learn more. 

The Benefits of CWF

Tooth decay, or dental caries, is the most common infectious disease among children, and it is preventable. Good oral health can heighten self-esteem, affect social interactions, impact learning success, reduce medical costs, and enhance opportunities for employment. 

Water fluoridation is important for many reasons:

• Every dollar spent on community water fluoridation saves $38 in dental costs and helps to keep our children in school, learning, instead of sitting in a dentist’s chair with a toothache.
• We lose 51 million school hours each year in the U.S. due to dental-related childhood illnesses.
• Fluoride protects Tennessee’s most vulnerable children from dental pain and decay and gives them the healthy teeth needed for strong self-esteem and success in life.

A healthy smile is essential to an individual's overall health, and the continuation of this valuable public health service prioritizes the oral health of present and future generations. This is particularly true for the most vulnerable residents of a community—those who cannot afford regular dental care or who are not supported in good dental hygiene habits.

Tennessee surveys show underserved populations experience disproportionately higher levels of dental disease than the general population and the result is significant increases in dental treatment costs to the state.

Tennessee CWF Resources

The Division of Water Resources of the Tennessee Department of Environment and Conservation provides technical expertise, monitoring and surveillance of fluoridating communities to ensure that the fluoride content of the water supply is maintained at an optimal level.

Situated in the center of Tennessee, the Fleming Training Center (FTC) offers training, certification and technical assistance to water and wastewater systems and personnel throughout Tennessee.  FTC is located at 2022 Blanton Drive, Murfreesboro, TN 37219, (615) 898-8090, fax (615) 898-8064. Hours of operation are weekdays from 8 a.m. – 4:30 p.m., Central. Click for more on the Fleming Training Center.

More Links & Resources

• Fluoride Use in Caries Prevention in the Primary Care Setting | Pediatrics | American Academy of Pediatrics (aap.org)
• About Fluoride | Oral Health | CDC
• Fluoride: Topical and Systemic Supplements | American Dental Association (ada.org)
• The American Dental Association (ADA)
• The Centers for Disease Control and Prevention (CDC)
• The American Academy of Pediatrics (AAP)
• The American Fluoridation Society (AFS)