Water fluoridation is an effective public health intervention for preventing dental caries (tooth decay). There is a large body of evidence showing that community water fluoridation (CWF) can prevent dental caries, but much of this evidence is from older studies before the widespread use of fluoridated toothpaste.

Despite the evidence, only around 5% of the global population is covered by CWF schemes. Understanding the value and cost-effectiveness of CWF is crucial given the persistently high prevalence of dental caries and significant inequalities in oral health. Barriers to implementing new CWF schemes include a lack of water infrastructure, financial constraints, divergent public health priorities, legislative and procedural complexities, and a lack of political will.

Recently, there have been signs of increasing political interest in improving oral health, such as the UK's Health and Care Act 2022 and joint statements from UK Chief Medical Officers advocating for CWF. To increase political will, policymakers need to understand not only the burden of dental caries but also the value and long-term costs and benefits of CWF as a preventive intervention.

Economic evaluations can demonstrate the efficiency and value-for-money of CWF schemes. However, most studies to date have been cost-effectiveness analyses with limited ability to capture the full value of improved oral health. A comprehensive cost-benefit analysis incorporating societal valuation of health outcomes is needed to inform decisions about new CWF schemes.