In this article, we list and discuss the 20 States with the Most Fluoridated Water in the US. If you would like to skip our detailed discussion of the fluoridation history and how it’s important today, you can go directly to the top 8 States with the Most Fluoridated Water in the US.
Fluoride, nicknamed nature's cavity fighter, is a naturally occurring mineral released by rocks and found in soil, water, and air. In the US, nearly 73% of Americans receive water from community water systems with adjusted levels of fluoride, which helps protect their teeth from decay. The process of adjusting fluoride in the water levels such that it does no harm and instead protects the teeth, is known as water fluoridation.
A Look Back At The Fluoridation History
Although the timeline for Community Water Fluoridation dates all the way back to 1901, it wasn’t until the 1930s that significant progress on the subject was made. In 1930, a chemist at Aluminum Company of America — now known as the Alcoa Corp (NYSE:AA) — used new technology to analyze water from an abandoned water well and found that it contained a concentration of fluoride many times higher than normal. The chemist, H. V. Churchill, was the chief chemist at Alcoa Corp (NYSE:AA) and had spent the past few years fighting claims that aluminum cookware was poisonous. The reason he looked into the water from this abandoned well was primarily that he did not want Alcoa’s reputation to be damaged further.
Spoiler: Churchill did in fact succeed in saving the company's reputation. Today, almost a century later, Alcoa Corp is still an industry leader. It is one of the largest producers of aluminum, and one of the world's largest bauxite miners too. In February 2024, the company made an offer to acquire the leading Australian mining corporation, Alumina Limited, in a $2.2 billion deal. In March 2024, this deal was finalized, and Alumina shareholders now have an ownership stake of 31.25% in the combined venture. Prior to this acquisition though, both companies already had a joint venture, Alcoa World Alumina and Chemicals (AWAC), that had been operating for decades.
Now, coming back to the history of fluoridation, it’s important to have a bit more context as to how Alcoa Corp (NYSE:AA) was linked to the ordeal, and why an abandoned water well mattered so much in this entire timeline.
At the time when all these events were unfolding, an increasingly significant number of the population in the United States, comprising both adults and children, was affected by the mottled enamel “disease.” The research on this, and fluoride, started back in 1901. However, in the years that preceded 1930, significant progress was made by Dr. McKay and Dr. Grover Kempf of the United States Public Health Service (PHS), when they traveled to Bauxite, Arkansas. Bauxite was a company town owned by ALCOA, and both the doctors had traveled here to investigate reports of the mottled enamel cases.
They soon found that the disease was common among the children in this town, but was absent in the children living in another town only five miles away. Dr. McKay and Dr. Kempf then analyzed the water supply, and although they found no clue if the water supply was causing this mottled enamel issue, they still published their findings. As a result of this publication, the community’s water well was abandoned, and ALCOA's reputation was put in danger.
Concerned, Churchill investigated the matter himself and soon found that it was the presence of fluoride in the community’s water supply that needed further investigation. From hereon, the journey was sped up. After some research, Churchill found out that the water supply in the town had fluorides in it, and contacted Dr. McKay to collaborate and look into this matter alongside him.
Within a year, in 1931, mottled enamel was renamed dental fluorosis, and it was concluded that the condition was caused by high levels of fluorides in the water. By 1945, the scientist who renamed mottled enamel, Dr. H. Trendley Dean, head of the Dental Hygiene Unit at the National Institute of Health (NIH), hypothesized that fluoride may help fight tooth decay if added to drinking water in a controlled quantity.
Following his hypothesis, in the same year, the city of Grand Rapids in the state of Michigan became the first city to add fluoride to its city water system, and the rest is history.
Now, community water fluoridation is a practice throughout the United States, alongside many other countries.
Fluoride Water Today
A study by the American Public Health Association in 2011 found that children with dental caries (tooth decay) were more likely to skip school due to dental pain than children with good oral health. Another study by the National Institute of Dental and Craniofacial Research (NIDCR) claimed that dental caries is one of the most common chronic diseases in America and one of the biggest threats to oral health. Despite this, children from low-income families are unable to access proper dental care due to the high costs. Consequently, tooth decay is more common among these children.
To address this concern, the United States has been working to make its fluoridated water accessible to all. By 2030, the country aims to provide at least 77% of Americans with fluoridated water. If successful, this initiative can help save tonnes of money on both ends and help thousands of individuals continue to function as productive extensions of society without succumbing to the growing pains of tooth decay.
Aside from government-level efforts to make oral health accessible to all, there are also some notable companies like Henry Schein, Inc. (NASDAQ:HSIC) and Procter & Gamble Co’s (NYSE:PG) working in the same domain, albeit through different initiatives.
Henry Schein, Inc. (NASDAQ:HSIC) aims to make healthcare, especially oral healthcare, accessible to all through its Global Product Donation program. Under this program, Henry Schein provides an array of healthcare products to community medical or dental organizations. However, organizations must apply and get selected to receive this donation from the company. With a market cap of $9.70 billion, Henry Schein is a leading American distributor of healthcare products and services, operating in 32 countries worldwide. In 2023, the company's total net sales stood at $12.3 billion, and it expects to see a total sales growth of around 8% to 12% in 2024. According to Henry Schein, its compound annual growth rate has been about 11.5% since 1995.
On the other hand, Procter & Gamble Co (NYSE:PG)’s oral health subsidiary company, Crest (subsidiary company), has a program named the “12 Days of Crest Smiles.” This is a holiday initiative, and through this program, Procter & Gamble grants “12 unforgettable Smile Wishes to children” to children across the country. The wishes can range anywhere from sponsoring treatments to supporting the dentistry dreams of deserving children, to providing free of cost check-ups. P&G Co is an American multinational consumer goods corporation, and a household name today, with a market cap of $381.78 billion as of the writing of this article. For Q2, 23/24 fiscal year, the company's revenue was $21.4 billion, which saw a 3% YoY increase.
In the years to come, alongside community water fluoridation, community efforts like those of Henry Schein, Inc. and Procter & Gamble Co., will play a significant role in making oral healthcare accessible to all the citizens of the United States.
20 States with the Most Fluoridated Water in the US
20 States with the Most Fluoridated Water in the US
Our Methodology
For our list of the states in the US with the most fluoridated water, we’ve considered the population percentage of each state that receives the most fluoridated water by the community water systems. To do so, we obtained our data from the Centers for Disease Control and Prevention, and ranked the list in ascending order of percentage of the state’s population served by the community water systems that have fluoridated water.
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20 States with the Most Fluoridated Water in the US
20. Rhode Island
Population served by CWS that have fluoridated water (%): 82.70%
Rhode Island is a state in the northeastern region of the USA, called the New England region. According to the US Census, the current population of the state is 1,095,962. Out of this, according to the CDC’s most recent data, the population receiving water from the community water systems stands at 979,110, whereas the number of Rhode Island residents receiving fluoridated water stood at 809,308.
19. Arkansas
Population served by CWS that have fluoridated water (%): 85.80%
A landlocked area in the south-central region of the USA, Arkansas is a beautiful state with lots of green areas. Out of 3,067,732 people who live in Arkansas, the total number of people receiving water from the community water systems stands at a little over 2,866,138. Out of these, according to 2020 data, 2,458,935 people in Arkansas were receiving fluoridated water.
18. Wisconsin
Population served by CWS that have fluoridated water (%): 86.70%
Eighteenth on the list of states with the most fluoridated water in the US, Wisconsin is located in its mid-western region of the States, bordering Illinois from the south. The US Census’s estimates for 2023 report the population of the state to be 5,910,955. Out of these, 4,260,757 Wisconsin residents are served by the community water systems, and 3,695,850 people receive fluoridated water.
17. North Carolina
Population served by CWS that have fluoridated water (%): 87.90%
A hub of higher education and research, North Carolina lies in the southern regions of the US, bordering the Atlantic Ocean. The current population of the state is around 10,835,491. 7,950,174 of these people are receiving water from community water systems, and out of these, 6,985,222 people are receiving fluoridated water.
16. Tennessee
Population served by CWS that have fluoridated water (%): 88.80%
A landlocked state of the US lying in its southern region, Tennessee is famous for its basketball sports teams in the NFL. According to the US Census, the population of Tennessee is around 7,126,489. Out of these, 6,296,831 people are supplied by the community water systems, and then among them, 5,592,155 people are receiving high-quality fluoridated water.
15. Michigan
Population served by CWS that have fluoridated water (%): 89.30%
Michigan is located in the Great Lakes region of the US, which lies in the western part of the country. It is famous for its medical schools and advanced education. Out of the 10,037,261 people living in the state according to the US Census, 7,432,372 are receiving water from the community water systems, while around 6,638,231 people receive fluoridated water.
14. Iowa
Population served by CWS that have fluoridated water (%): 89.80%
Ranked 14th, Iowa is another landlocked state of the US, lying in the western parts of the country. It's home to some of the major rivers of the country, like the Missouri River. Iowa is inhabited by 3,207,004 people and has a rich river system. Out of its total population, 2,684,404 people receive water from the community water systems, and 2,409,673 people receive fluoridated water.
13. Connecticut
Population served by CWS that have fluoridated water (%): 90.40%
The state of Connecticut lies in the extreme south of the New England region of the US. It is part of the tri-state area, along with New York and New Jersey. This state is home to 3,617,176 people, and if we talk about water services, 2,736,539 people are served by the community water systems, while 2,473,983 receive fluoridated water.
12. West Virginia
Population served by CWS that have fluoridated water (%): 90.90%
Located in the mid-Atlantic regions of the US, West Virginia is home to 1,770,071 people. Out of this huge population, around 1,409,744 are receiving water from the community water systems, and then out of these people, 1,277,174 are receiving fluoridated water.
11. South Carolina
Population served by CWS that have fluoridated water (%): 91.70%
Bordering North Carolina from its north, South Carolina is a state in the southern parts of the US. South Carolina is a media hub in the US, having 36 TV stations in total, broadcasting throughout the whole country. According to the US Census, 5,373,555 people live here, 3,891,342 receive water from the community water systems, and 3,567,836 people receive fluoridated water.
10. Indiana
Population served by CWS that have fluoridated water (%): 92.40%
10th on the list, Indiana is a state in the mid-west part of the US, bordering the River of Michigan. Having such a good water supply through the rivers, most of the people here benefit from good quality and clean water. CDC reports that approximately 5,066,252 people in the state receive water from the community water systems, and of these, 4,683,083 people receive fluoridated water.
9. Ohio
Population served by CWS that have fluoridated water (%): 92.70%
Having the 9th most fluoridated water in the US, Ohio is located in the midwest part of the US. It is ranked the 5th largest state in the US by area and is home to over 11,785,935 people. Out of these, 9,901,174 receive water supply from the community water systems, while 9,177,890 out of these are receiving fluoridated water.
