This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

The aim of this report is to assess the evidence on the positive and negative effects of population wide drinking water fluoridation strategies to prevent caries.

To achieve this aim five objectives were identified: 1: What are the effects of fluoridation of drinking water supplies on the incidence of caries? 2: If water fluoridation is shown to have beneficial effects, what is the effect over and above that offered by the use of alternative interventions and strategies? 3: Does water fluoridation result in a reduction of caries across social groups and between geographical locations, bringing equity? 4: Does water fluoridation have negative effects? 5: Are there differences in the effects of natural and artificial water fluoridation?

This review presents a summary of the best available and most reliable evidence on the safety and efficacy of water fluoridation.

Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken. As such, this review should provide both researchers and commissioners of research with an overview of the methodological limitations of previous research conducted in this area.

The evidence of a benefit of a reduction in caries should be considered together with the increased prevalence of dental fluorosis. The research evidence is of insufficient quality to allow confident statements about other potential harms or whether there is an impact on social inequalities. This evidence on benefits and harms needs to be considered along with the ethical, environmental, ecological, costs and legal issues that surround any decisions about water fluoridation. All of these issue fell outside the scope of this review.

Any future research into the safety and efficacy of water fluoridation should be carried out with appropriate methodology to improve the quality of the existing evidence base.

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