Nebraska Water Fluoride: Updated Statistics

Nebraska’s approach to water fluoridation has evolved over decades, with diverse communities adopting varying practices regarding fluoride levels in drinking water. Below is an updated look at key statistics surrounding these efforts, focusing on coverage rates, naturally occurring concentrations, and measurable impacts on oral health.

From urban centers like Omaha and Lincoln to rural towns with distinct groundwater characteristics, Nebraska reflects the complexity of implementing and monitoring water fluoridation. The following data-driven overview highlights the most recent statistics on fluoridation coverage, concentrations, and resulting trends in dental outcomes—helping readers understand how fluoride fits into the state’s broader public health picture.

Despite historical mandates, community referenda, and ongoing monitoring, Nebraska’s coverage rates and compliance levels have shifted over time. Below are several noteworthy facts that illustrate the scope of fluoride use across the state.

• As of 2014, approximately 70% of Nebraska’s population was served by fluoridated water.
• By 2025, this figure stands at 62.9% statewide, reflecting changes in compliance and local decisions.
• In 2008, 49 of the 61 eligible communities voted to opt out of mandatory fluoridation requirements.
• Lincoln’s municipal water registered average fluoride levels of 0.88–0.90 ppm in 2023.

These basic figures introduce the broader patterns unfolding statewide, prompting a closer look at how Nebraska’s population interacts with fluoride in different ways. Below are deeper statistics on coverage rates, natural fluoride occurrence, and how neighboring states compare.

Coverage and Compliance Rates

Statewide coverage rates and community decisions play an essential role in fluoridation practices across Nebraska.

• Approximately 70% of Nebraskans had access to fluoridated water in 2014, slightly lower than the national average of 74.7% at that time.
• Following legislative actions in 2008, at least 49 communities rejected mandated fluoridation, including Grand Island and Hastings.
• As of 2025, 62.9% of the state’s population consistently receives fluoridated water.
• With opt-outs, only 12 communities meeting the population threshold mandated by law continued fluoridation measures in place.

These numbers reflect local decisions’ impact on overall coverage. Below is a table summarizing Nebraska’s approximate coverage percentage in selected years.

Community voting patterns, along with ongoing discussions around costs, have produced fluctuations in these coverage levels over the years.

Fluoride Levels in Municipal Systems

The concentration of fluoride in public water systems influences both dental outcomes and debates over recommended levels.

• Current federal recommendations set 0.7 ppm as the optimal fluoride level for preventing tooth decay.
• Nebraska’s state regulations allow levels from 0.8 ppm up to 1.5 ppm.
• Lincoln’s 2023 water supply tests measured fluoride levels between 0.88–0.90 ppm, exceeding the 0.7 ppm federal guideline but within state rules.
• A 2023 report identified 11 Nebraska communities exceeding the 1.5 ppm upper limit, including Verdel at 1.70 ppm and Winnebago at 1.60 ppm.

State-monitored data underscores ongoing questions about aligning municipal practices with federal recommendations. The following table highlights selected community levels in recent measurements.

Though many systems remain within state standards, some communities register higher levels in certain water sources, prompting ongoing monitoring.

Natural Fluoride in Groundwater

Beyond municipal adjustments, groundwater in certain regions of Nebraska naturally contains elevated fluoride levels.

• In the Dakota and Chadron formations, studies found fluoride concentrations up to 2.6 mg/L in domestic wells.
• Some areas require special treatment or dilution to bring naturally high levels to recommended ranges.
• Rural households relying on private wells often exceed 1.5 ppm, requiring additional filtration.
• Over 30% of Nebraska’s water supply systems source a portion of their water from groundwater, creating region-specific variations in fluoride content.

These findings reflect how geological characteristics can influence water quality. Below is a snapshot of high-fluoride groundwater zones:

In certain regions, residents must monitor and treat water independently to manage potential health risks while balancing caries-preventive benefits.

Comparison with Neighboring States

Analyzing Nebraska’s coverage and practices relative to bordering states provides useful context.

• Kansas, lacking a statewide fluoridation mandate, reports approximately 63.5% of its population served by fluoridated water.
• Iowa’s rate stands at 76.4%, partly due to proactive health department partnerships.
• Nebraska is ranked around 29th nationwide in water fluoridation rates.
• Kansas, with 35th in national rankings, is the only neighboring state significantly behind Nebraska’s coverage.

Below is a table highlighting recent fluoridation coverage percentages in selected neighboring states.

Although Nebraska trails states like Iowa and Colorado, local opt-outs explain the variation in coverage and rank.

Impact on Dental Caries

Fluoridated water has traditionally been linked to measurable decreases in tooth decay across age groups.

• Water fluoridation can reduce the incidence of tooth decay by roughly 25% in both children and adults.
• Omaha’s longstanding fluoridation since 1968 is associated with lower pediatric dental caries rates relative to rural areas.
• Recent data indicate that non-fluoridated parts of Saunders County experience 40% higher cavity rates compared to state averages.
• In Iowa, the 76.4% fluoridation coverage correlates with a 30% reduction in pediatric caries rates statewide, surpassing Nebraska’s 25% reduction.

Dental associations continue to document changes in oral health outcomes as some communities maintain, reduce, or increase fluoridation levels. Below is a table illustrating approximate decay reduction comparisons in selected regions.

These figures highlight how fluoride’s presence in drinking water can translate into tangible benefits for communities across different regions.

Key Statistics Summary

• 62.9% of Nebraskans were served by fluoridated water as of 2025.
• State regulations currently allow 0.8–1.5 ppm, with federal recommendations at 0.7 ppm.
• 11 communities in Nebraska report levels above 1.5 ppm in recent tests.
• Areas drawing from the Dakota formation can reach 2.6 mg/L in natural fluoride concentration.
• Fluoridation has reduced dental caries rates by around 25% statewide.

Nebraska’s water fluoridation metrics show meaningful but varied patterns, influenced by public referenda, natural geology, and neighboring states’ differing mandates. Although overall coverage stands below the national average, many communities continue to see reductions in dental caries correlated with fluoridated water. Regular monitoring and documentation of fluoride levels remain central to understanding both the benefits and challenges of this public health intervention.