Water Fluoridation Equity

$25 million for fluoridation projects in the Central Valley to bring parity and equity to community drinking water

Fits into the Governor’s proposal for water infrastructure, which includes $1.3 billion for drinking water and wastewater infrastructure with a focus on small and disadvantaged communities.

Aligns with both Senate and Assembly budget blueprints: Invest in water quality to help smaller, lower-income communities with drinking water, local water supply and water efficiency investments. Helps build a robust public health infrastructure, provide clean water and remediate air, water and ground pollution that impact our most disadvantaged communities.


Community water fluoridation, proclaimed by the CDC as one of 10 great public health achievements of the 20th century, ensures that, young or old, high income or low, every individual has equal access to one of the most evidenced-based preventions for dental disease.

Over the last 25 years, California has increased the percentage of residents with access to fluoridated water from 17% to over 60%. While this is a significant achievement, it falls far short of other states and the Healthy People 2020 goal that 79.6% of people served by community water systems have access to fluoridated water. Fluoridation expansions have stagnated, but this investment can fund new projects or restart fluoridation in areas that were previously fluoridated.

Tooth decay is the No. 1 chronic disease among children. It accounts for persistent pain, trouble eating and sleeping, missed school days and expensive emergency room visits for preventable dental problems. Children, low-income families and other underserved populations experience disproportionate levels of dental disease in large part because of difficulties accessing early preventive and routine dental care.

A just-released report by the California State Water Board highlights the need for significant investment in drinking water systems throughout California to ensure residents have access to safe, clean and affordable drinking water. Schools and communities in the San Joaquin Valley, Los Angeles Basin and the Central Coast were specifically cited as areas with the poorest water quality and highest need. Efforts to ensure these communities receive safe drinking water dovetails well with the need to increase their access to water fluoridation, as they have failed to benefit from the expansion of community water fluoridation in other parts of California.

Thanks in large part to community water fluoridation, half of all children in the U.S. ages 5 to 17 have never had a cavity in their permanent teeth. According to the 2000 Journal of Dental Research, the use of fluoride in the preceding 40 years had been the primary factor in saving some $40 billion in oral health care costs in the United States. Fluoride is nature’s cavity fighter and is naturally occurring in all water sources. Community water fluoridation has been around for over 75 years and is simply the process of adjusting the fluoride content of community water to the recommended level for optimal dental health.

In 1995, California advanced community fluoridation throughout the state by passing Assembly Bill 733, legislation that requires communities with 10,000 or more water connections to fluoridate when funding becomes available to do so. In 2000, the CDA Foundation was the recipient of a total of $15 million in grant funding from the California Endowment to advance water fluoridation in California. With the assistance of these funds, communities that benefitted from these efforts include Los Angeles, Sacramento, Mountain View, Pico Rivera, San Diego County and City, Escondido, Santa Maria, Daly City, Helix, Southern California Metropolitan Water District, San Francisco Public Utilities District, Watsonville and Santa Monica. With the exception of East San Jose/Santa Clara County, all of the largest city/urban areas in California are fluoridated to some level. However, the “hard to reach” communities in the San Joaquin Valley, Los Angeles Basin and the Central Coast have been more challenging to fluoridate. An investment in fluoridation efforts will open the door for these communities to begin exploring fluoridation.

How This Would Work

The state Dental Director, Dr. Jay Kumar, has calculated a need for $25 million in funds to support fully fluoridating remaining community water projects in the Central Valley. Local water operators who wish to install or upgrade water fluoridation may seek grant funds from this program to cover the costs of the engineering review/design or installation of the fluoridation system. The funds from this program shall not support operations and maintenance costs.

Draft Budget Bill Language

3940-101-3565 — For local assistance, the State Water Resources Control Board and Drinking Water Quality Fund


4265-001-4045010 — For state operations, the Department of Public Health and Office of Oral Health ............$25,000,000


The distribution of funds appropriated in this item shall be administered by the State Water Resources Control Board, in consultation with the Office of Oral Health or State Dental Director, and shall provide support for design, review or installation of community water fluoridation projects for water systems without optimal water fluoridation as of July 1, 2021. These funds may also be assisting in the modernization and support for fluoridation infrastructure in areas without adequate drinking water supplies.

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Paid for by the California Dental Association
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