Background For over 70 years the addition of fluoride to public
water with intent to prevent dental caries continues to be controversial
and risks are seldom included in monetary evaluations.
Objectives To estimate an economic cost-benefit-risk of
Community Water Fluoridation (CWF) using 2021 USA dollars Per Person Per
Year (PPPY), with the inclusion of two risks: dental fluorosis and lower
income resulting from developmental neurotoxicity as measured with lower
IQ. Methods Published operational costs and benefits of CWF are
used. Published and clinical experience treating dental fluorosis are
utilized to estimate treatment costs of patient perceived dental
fluorosis, and lost wages from lower IQ. Patients of record provided
consent for photographs. Results: Published estimated caries
averted, less operational costs, were calculated at $8 PPPY and
estimates of compensation for functional and cosmetic dental fluorosis
were $126 PPPY. Lower earnings from presumed harm of developmental
neurotoxicity $438 PPPY. Net loss from CWF is estimated at $556 PPPY.
Conclusions Previous economic evaluations of CWF have estimated
caries averted and costs of operations. Few evaluations include the
costs of treating harm. CWF is not cost effective if the cost of harm is
included. Policy Implications Alternatives for the prevention
of dental caries should be promoted and the cessation of CWF is
indicated.