eng Science and Education Publishing American Journal of Public Health Research 2327-6703 2026-09-18 14 5 160 166 10.12691/ajphr-14-5-2 AJPHR20261452 article Dr. Santosh 1 Yaroslav Herin yaroslav.herin@gmail.com 2 Dr. Imran Idrees 3 Dr. Sree Rekha Movva 4 Sofia Olena Herin 5 Dr. Amanpreet Kaur 6 Dr. Ridhi Bhola 7 Dr. Sandeep Singh 7 BDS, Postgraduate Institute of Dental Sciences, Rohtak, India MPH, CUNY Graduate School of Public Health & Health Policy, New York, United States BDS, MPH, St.Francis College, Brooklyn Newyork, United States BDS, Kamineni Institute of Dental Sciences, Telangana, India Sophomore, Archbishop Molloy Highschool, Briarwood, NY, USA Baba Farid University of Health Sciences, Punjab, India MDS, Postgraduate Institute of Dental Sciences, Rohtak, India Community water fluoridation (CWF) has been recognized as one of the most effective population-based strategies for preventing dental caries and improving oral health equity. However, its continued relevance in developed countries has become a subject of debate due to declining caries rates, widespread use of fluoride-containing products, evolving preventive approaches, and concerns regarding safety and individual autonomy. This comprehensive review evaluates the current evidence on the mechanisms, effectiveness, safety, and global policy perspectives of CWF. Current data support the safety of optimally fluoridated water, with dental fluorosis being the only consistently documented adverse effect, predominantly mild and cosmetic. International experiences demonstrate varied approaches, with some countries continuing CWF as a key public health intervention while others rely on alternative strategies such as fluoride toothpaste, salt fluoridation, school-based programs, fluoride varnish, and silver diamine fluoride. Future caries prevention is likely to involve integration of population-based measures with precision public health, artificial intelligence, assisted risk prediction, and personalized preventive dentistry. Overall, CWF remains a relevant, evidence-based, and equitable public health strategy, particularly when incorporated within a comprehensive approach to oral disease prevention. https://pubs.sciepub.com/ajphr/14/5/2/ajphr-14-5-2.pdf Water fluoridation Fluorosis Dental Caries Salt fluoridation Milk fluoridation