1.   Alabama Department of Public Health: “The science and research behind community water fluoridation has proven that it is both safe and effective.”

2.  Alaska Department of Health and Social Services: “Strategies: 
a.  Maintain water fluoridation in communities with existing fluoridated community water systems.
b.  Provide information and resources that will help communities understand the value of water fluoridation in Alaska.
c.  Start community water fluoridation in communities that are not currently fluoridating their community water systems.
d.  Other Strategies:  Misinformation and Its Correction: Continued Influence and Successful Debiasing
e.  Specific Programs/Strategies: Counteract misinformation where opposition to water fluoridation is an issue.”

3.   Arizona Department of Health Services:  “Community water fluoridation is the process of adjusting the fluoride level that occurs naturally in a community's water to the optimal level for preventing tooth decay as proven by hundreds of studies conducted over fifty years throughout the world. Adults as well as children benefit from drinking fluoridated water throughout their lives.”

4.   Arkansas Department of Health:  “Fluoride added to public drinking water at a concentration of 1.7 parts per million (0.7mg/Liter) has been shown to be a safe, inexpensive, and extremely effective method of preventing tooth decay. Because public water fluoridation helps people in the community, no matter their age and status, fluoridation protects against tooth decay in areas with less access to dental services.”

5.   California Health and Human Services Agency:  "California Oral Health Plan 2018-2028: Individual-level interventions to encourage healthful habits such as tooth brushing,  drinking water containing fluoride, and regular dental visits are essential to maintaining  good oral health.”

6.  Colorado Department of Public Health and Environment:  “Scientific research shows that drinking optimally fluoridated water prevents approximately 25 percent of cavities. This is in addition to fluoridated toothpaste, mouth wash and other sources of fluoride.”  Colorado Fluoride Facts for additional information.

7.   Connecticut Department of Public Health:  “Thousands of research studies have shown that water fluoridation is safe, effective and the best way to improve oral health in a community. “

8.  Delaware Department of Health:  “The addition of fluoride significantly reduces the occurrence of tooth decay in the population served by public water systems.”  “There are effective preventive intervention strategies for dental caries.  The prevalence and severity of caries can be reduced through community water fluoridation, personal or professional topical fluoride applications, and using toothpaste with fluoride.”  2018 Fluoridation Awards

9.   Florida Department of Health:  “Adding fluoride to the public water supply is one of the most cost-effective method of preventing dental decay with positive effects for everyone of all ages.“

10.  Georgia Department of Public Health:  “Water fluoridation has been shown to reduce dental decay by 20-40% in fluoridated communities and results in a savings of $38 in future dental expenditures for each $1 invested in fluoridation.”

11.  Hawaii State Department of Health :  “Fluoride added to community drinking water sources at levels recommended by the federal government has  repeatedly been shown to be a safe, inexpensive, and extremely effective method of preventing tooth decay in  all age groups.”
“The results of Hawaii Smiles confirm that Hawaii’s children have the highest prevalence of tooth decay in the United States.   11% of Hawaii’s residents are served by a fluoridated community water system.  Community water fluoridation: Fluoridation has been shown to prevent tooth decay in both children and adults. 
Community-Based Prevention Programs:  Conduct ongoing educational campaigns to (1) encourage the first dental visit by age one, (2) increase oral health literacy and awareness, (3) promote the importance of oral health as part of general health and well-being, and (4) promote the benefits of water fluoridation and other fluorides for the reduction of dental disease.”

12.  Idaho Department of Health and Welfare:  “Oral health experts must take the lead in establishing and implementing programs to benefit the public. For example, the science and evidence shows communities with  adequate water fluoridation have a lower rate of tooth decay.”

13.  Illinois Department of Public Health:  “Illinois communities add small amounts of fluoride to their water supplies. This practice, called water fluoridation, ensures that the water contains the optimal level of fluoride. Drinking fluoridated water from birth can reduce decay by 40 percent to 65 percent.”

14.  Indiana State Department of Health:   “Fluoride prevents tooth decay in three ways.  It reduces the ability of plaque bacteria to produce acid.  It is absorbed into the crystalline structure of tooth enamel, thereby reducing the ability of acid to attack it.  Finally, fluoride remineralizes tooth enamel that has lost minerals due to the attack of acid producing bacteria.  In effect, fluoride stops, and can even reverse, the decay process in teeth.”

15.  Iowa Department of Public Health:  “Fluoride is a naturally-occurring mineral that can help prevent cavities in children and adults by making the tooth enamel (outer surface) more resistant to the acids that cause tooth decay. Fluoride is found in food, water, other drinks, toothpastes, and mouth rinses.   Community Water Fluoridation (CWF) is a safe and effective public health intervention that prevents 25% of tooth decay for all age groups.”

16.  Kansas Department of Health and Environment:  “Water fluoridation is safe and effective method to prevent tooth decay for all members of the community.  This aids the entire community and is not based on their age, income or if they visit a dentist.”  Fluoride in Kansas for additional information.

17.  Kentucky Cabinet for Health and Family Services:  “Fluoridation is a major effort of the Kentucky Oral Health Program (KOHP).”

18.  Louisiana Department of Health and Hospitals:  “Community water fluoridation is the adjusting of naturally occurring fluoride in public drinking water to a level that best offers maximum protection against tooth decay for all residents. It has been proven to be a safe, effective and inexpensive way to promote good oral health.”

19.  Maine Department of Health and Human Services:  “Maine Oral Health Program: Fluoride added to community drinking water has been shown to be a safe, inexpensive and extremely effective method of preventing tooth decay.”

20.  Maryland Department of Health:  “The Maryland Department of Health, Office of Oral Health (OOH) supports this recommendation [fluoridation] and applauds the continued evaluation of this cornerstone public health measure. OOH is committed to educating the public about proper use of fluorides for preventing tooth decay, including fluoride toothpaste and the benefits of community water fluoridation.”

21.  Massachusetts Department of Public Health:  “Because community water fluoridation benefits everyone in the community, regardless of age and socioeconomic status, fluoridation provides protection against tooth decay in populations.”

22.  Michigan Department of Community Health:  “Community Water Fluoridation is the adjustment of natural fluoride levels in a community water supply to achieve optimal benefits for reductions in dental decay.”

23.  Mississippi State Department of Health:  “Fluoride treatment is a proven way to prevent tooth decay and help maintain healthy teeth. Fluoride is safe and cost-effective when added to community water systems that may require it, and fluoride treatment provides early, long-lasting prevention for children against oral and dental disease.”

24.  Minnesota Department of Health:  “Fluoride is an efficient and equitable way to prevent one of the most common childhood diseases – dental decay. An estimated 51 million school hours in the United States are lost each year due to dental-related illness. … An overwhelming amount of scientific evidence indicates that fluoridation of community water supplies is safe.”

25.  Missouri Department of Health and Senior Services:  “Fluoridation is safe.  Fluoridation is the least expensive and most effective way to reduce tooth decay.”

26.  Montana Department of Public Health and Human Services:  “Exposure to systemic and topical fluoride inhibits the demineralization of tooth surfaces and reduces the effect of bacteria in the mouth, thereby reducing the risk for dental decay.”

27.  Nebraska Department of Health & Human Services:  “When planning community programs, it is essential that oral health program staff know and understand their state’s infrastructure. Especially important to oral health is community water fluoridation and programs that provide restorative and preventive dental care to those who might not be able to access care through private dentists.”  “Strong evidence supports fluoridation of water supplies in an effort to prevent tooth decay.”

28.  Nevada Department of Health and Human Services:  “The safety and benefits of fluoride are  well documented . For  70 years, people in the United States have benefited from drinking water with fluoride, leading to better dental health.   Drinking fluoridated water keeps the teeth strong and reduced tooth decay by approximately 25% in children and adults. By preventing tooth decay, community water fluoridation has been shown to save money, both for families and the health care system.”

29.  New Hampshire Department of Health & Human Services:  “The Oral Health Program promotes the benefits of community water fluoridation and protective dental sealants to prevent dental disease and improve the oral health of all NH residents.”

30.  New Jersey Department of Health and Senior Services:  “Fluoride is the most effective method of decay prevention.  Fluoride benefits are secured through systemic and topical methods.  Systemic fluoride is swallowed, such as in drinking fluoridated water.  Topical fluorides, such as fluoride found in toothpaste and mouth rinses, are not.  Topical and systemic fluorides can be used alone or in combination.”  “The ‘Save Our Smiles’ program is implemented in areas of the State where the public water supply is not optimally fluoridated.”

31.  New Mexico Department of Health:  “Community water fluoridation is the most effective way to deliver benefits of fluoride to a community.  Studies have shown that it prevents tooth decay by up to 18% to 40%.  Dental sealants and community water fluoridation programs are two evidence-based interventions to prevent tooth decay.”

32.  New York State Department of Health:  “The New York State Department of Health concurs with the current scientific evidence that fluoride added to water is safe and effective in controlling tooth decay. In New York State, approximately 12 million people drink water containing one milligram of fluoride per liter. The department considers this level as the appropriate amount to maximize tooth decay prevention and minimize the risk of enamel fluorosis.”

33.  North Carolina Department of Health and Human Services:  “Fluoride protects teeth from decay by strengthening tooth enamel and making it more resistant to the acids that are produced by bacteria that occur naturally in our mouths.  During childhood while teeth are forming, fluoride becomes a permanent part of the tooth enamel.  After the teeth are formed, fluoride strengthens and repairs the enamel on the surfaces of teeth.  Both children and adults of all ages benefit from fluoridation.   Fluoridation has been studied for over 60 years -- more thoroughly than any other public health measure.  The overwhelming weight of credible scientific evidence indicates that fluoridation of community water supplies is safe.”

34.   North Dakota Department of Health:  “Infants and toddlers who do not receive an adequate amount of fluoride may be at an increased risk for cavities since fluoride helps make teeth more resistant to cavities. It also helps repair weakened teeth. Bottled water may not contain fluoride; therefore, children who regularly drink bottled water or unfluoridated tap water may be missing the benefits of fluoride.”  Fluoride: “Before teeth break through the gums, the fluoride taken in from foods, beverages and dietary supplements makes tooth enamel (the hard surface of the tooth) stronger, making it easier to resist tooth decay. This provides what is called a "systemic" benefit.   After teeth erupt, fluoride helps rebuild (remineralize) weakened tooth enamel and reverses early signs of tooth decay. When you brush your teeth with fluoride toothpaste, or use other fluoride dental products, the fluoride is applied to the surface of your teeth. This provides what is called a "topical" benefit.   In addition, the fluoride you take in from foods and beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth with tiny amounts of fluoride that help rebuild weakened tooth enamel.   Community water fluoridation is like drinking milk fortified with Vitamin D or eating bread and cereals enriched with folic acid. Before water fluoridation, children had about three times as many cavities.”

35.  Ohio Department of Health:  “Our mission is to promote and improve the oral health of Ohioans. We do this by: Supporting programs that prevent oral diseases, such as community water fluoridation and school-based sealant programs...”  Preventing Oral Diseases: “Fluoride is naturally present in all water. Community water fluoridation is simply adjusting the natural fluoride level in public water systems to a level that is best to prevent tooth decay.”

36.  Oklahoma State Department of Health:  “The Oklahoma State Department of Health supports community water fluoridation and recognizes the practice as safe, cost-effective and beneficial to all who drink and use the water. For more than 70 years, fluoridated water has resulted in a remarkable decline in the prevalence and severity of dental decay. Studies prove that even today, the adjustment of fluoride in drinking water reduces dental decay by 18-40 percent.  It is the ideal public health measure because no compliance is required - just drink and use the water. Beverages and foods processed in fluoridated communities benefit all who consume these products. Widespread community water fluoridation prevents cavities and saves money, both for families and the health care system."

37.  Oregon Health Authority:  “Community water fluoridation is a proven, safe and low-cost way to protect children, adults and older adults from cavities. No matter if a person has insurance, access to a dentist or ability to pay, fluoride in water protects a person's oral health for their entire life. It is seen as one of the top ten greatest public health achievements of our time.  Community water fluoridation is an evidence-based practice recommended by the Community Preventative Services Task Force, Centers for Disease Control and Prevention (CDC), Association of State and Territorial Dental Directors (ASTDD), and Healthy People 2020 based on strong evidence of effectiveness in reducing dental cavities and disease across the entire population, regardless of age, race or ethnicity, insurance, access to a dentist, or the ability to pay for care.”

38.  Pennsylvania Department of Health:  “In celebrating the 75th anniversary of community water fluoridation, the Pennsylvania Department of Health Oral Health Program restates its strong endorsement for this proven public health measure.  Community water fluoridation remains the cornerstone of tooth decay prevention in the United States and worldwide.”

39.  Rhode Island Department of Health:  “Fluoride added to community drinking water (at a concentration of 0.7 parts per million) has been shown to be a safe, inexpensive, and extremely effective method of preventing tooth decay.  Community water fluoridation benefits everyone in the community, regardless of age and socioeconomic status.  Community water fluoridation provides protection against tooth decay in populations with limited access to prevention services.  Continued research has confirmed the safety of fluoridated water as an effective public health practice. The Rhode Island Department of Health has developed a document on the safety and effectiveness of community water.”

40.  South Carolina Department of Health and Environmental Control:  “Community leaders have come to realize that fluoridation benefits their entire community—children, adults, and senior citizens. Community water fluoridation does not discriminate against anyone on the basis of income, education, or race. Simply by drinking fluoridated water, everyone in a community benefits. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25 percent over a person's lifetime.”

41.  South Dakota Department of Health:  “Fluoride For Oral Health:  Fluoride helps make teeth stronger and helps prevent cavities. One way to get fluoride is through drinking water. However, bottled water or water that has been treated by reverse osmosis, distillation or deionization has have very little or no fluoride.  Strategic Goal 4: Objective One: By 2020, advocate support of water fluoridation for all community water systems.  Strategies:  1. Develop talking points available for dissemination to all Coalition partners by November 2015.  2. Coalition members will respond to anti-fluoridation activity by engaging with other partners.”

42.  Tennessee Department of Health:  “Community Water Fluoridation is a health measure that allows the state to observe the conditions supporting oral health in a community. Fluoride prevents tooth decay by 25%, saving money for families’ and the US health care system while also leading to better future physical health.”

43.  Texas Department of State Health Services:  “The Texas Fluoridation Program (TFP) works to improve the health of Texans by preventing tooth decay through community water fluoridation. TFP assists public water systems in the engineering design, installation, and maintenance of water fluoridation systems; monitors the adjusted fluoride level in the drinking water; and maintains the US Centers for Disease Control and Prevention (CDC) fluoridation database for the State of Texas.  Community water fluoridation is safe and the most cost-effective way to deliver fluoride to everyone. On average, it costs only $0.64 per person to fluoridate water for a year. For most cities, every $1 invested in water fluoridation yields $38 savings in dental treatment costs (Fluoridation Facts American Dental Association [ADA]). Community water fluoridation is recommended by nearly all public health, medical, and dental organizations.”

44.  Utah Department of Health:  “Safe, effective prevention of tooth decay for people of all ages; know if your water is optimally fluoridated. The Centers for Disease Control and Prevention has recognized water fluoridation as one of 10 great public health achievements of the 20th century. For 65 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay. The current recommendation is .7 milligrams of fluoride per liter water.”

45.  Vermont Department of Health:  “For more than 60 years, community water fluoridation has been a major factor in the decline of tooth decay in Vermont. Optimally fluoridated water is the single most cost-effective strategy that a community can use to improve the oral health of its residents. Fluoridation benefits everyone – it has been shown to save money for families and the health care system.”

46.  Virginia Department of Health:  “Since 1945, communities have been combating tooth decay by fluoridating public water supplies. According to the Centers for Disease Control and Prevention (CDC), children living in communities with fluoridated water have about 25 percent fewer cavities than children in communities without fluoridation. With rising health care costs, community water fluoridation is a cost-effective intervention to prevent oral health complications for people of all backgrounds, regardless of age, education, or income levels.”

47.  Washington State Department of Health:  “Fluoride is a naturally occurring mineral that protects teeth from tooth decay. Almost all water contains some naturally occurring fluoride, but usually not enough to prevent tooth decay. Many communities adjust the amount of fluoride in the water supply to a level known to reduce tooth decay and promote good oral health.”  Spokane Regional Health District

48.  West Virginia Department of Health and Human Resources:  “Water fluoridation is a safe and cost-effective way to prevent tooth decay.” 

49.  Wisconsin Department of Health Services:  “Fluoride added to community drinking water has repeatedly been shown to be a safe, inexpensive, and extremely effective method of preventing tooth decay.   Because community water fluoridation benefits everyone in the community, regardless of age and socioeconomic status, fluoridation provides protection against tooth decay in populations with limited access to prevention services.”

50.  Wyoming Department of Health: “Strategies to Improve Wyoming’s Oral Health –Expand the most cost effective oral disease prevention measure by educating local communities about the importance of community water fluoridation, better ascertaining the level of fluoridation in their water currently, and demonstrate a linkage to the oral health of their children.”
Dr. Alexia Harrist, state health officer and epidemiologist in the Wyoming Department of Health’s Public Health Division, said “The levels of fluoride that are in public water have been very well studied.  The (recommended level) is safe and is not associated with any serious health effects. Public water fluoridation is a very effective and safe public health intervention to prevent dental caries, or cavities, among both children and adults.”