American medicine has advanced public health through the careful use of science and innovation. The Centers for Disease Control and Prevention (CDC) has identified smallpox eradication, polio elimination, and community water fluoridation as three of the greatest public health achievements of the 20th century. Yet tooth decay remains the most common chronic disease in children, even though it is largely preventable. Left untreated, it can cause pain, infection, and other serious health problems. It also drives up the cost of fillings, extractions, and emergency care while causing children and adults to miss school and work.
The good news is that tooth decay can be prevented, and community water fluoridation remains one of the most effective ways to do it. By keeping fluoride in public water at the recommended level, communities can strengthen teeth, reduce cavities, and lower future dental costs. Because fluoride is already a natural part of many water supplies, adjusting it when levels are too low is a simple, safe, and proven way to improve oral health. More than 65 years of national experience show that fluoridation works.
Fluoridation is also a strong financial investment. The Surgeon General has reported that nearly every American will experience tooth decay at some point in life, which means prevention can make a meaningful difference across the country. The American Dental Association says that a lifetime of fluoridated water costs less per person than a single dental filling, and the CDC estimates that every $1 invested saves about $38 in treatment costs. Fluoride is also found in products like toothpaste and mouthwash, yet studies still show that fluoridated water lowers tooth decay by about 25% over a lifetime. Because it reaches whole communities at once, it remains an efficient and practical public health strategy.
In Missouri, decisions about fluoridating public water are made locally. Water systems across the state already monitor naturally occurring fluoride and can adjust it to the recommended level of 0.7 milligrams per liter when needed. That amount is very small—about the same as one penny in $14,000—but it can make a real difference by helping prevent cavities before they begin and supporting better oral health across the community.
The financial case is just as strong in Missouri. Fluoridation costs about $1 per person each year and returns an estimated $22 for every dollar spent. Ending it, however, could lead to about $897 million in avoidable dental expenses over five years, with those costs passed on to families, taxpayers, and public programs. It could also leave thousands more children needing fillings or extractions, while increasing missed school, missed work, and Medicaid spending. These burdens would fall hardest on Missourians who already face barriers to dental care, including many seniors, veterans, rural residents, and people with disabilities.
For these reasons, the Missouri Coalition for Oral Health supports community water fluoridation as a practical way to prevent disease, reduce unnecessary pain, and keep health care costs lower for families. Backed by community leaders, medical and dental professionals, and policymakers, the coalition believes every Missouri community should have access to this proven public health protection.
Missouri cannot afford to lose a public health measure that prevents disease, reduces costs, and protects families. We urge local leaders, policymakers, and residents to speak up for community water fluoridation and take action to preserve access to this proven protection in every Missouri community.