North Carolina Water Fluoride: Updated Statistics

Community water fluoridation in North Carolina has a long history, dating back more than seven decades, with program participation rates that outpaced many neighboring states. However, changing local policies and evolving scientific conversations have shifted the landscape of fluoride in drinking water, prompting a close look at the data behind this public health measure.

This article presents recent statistics on North Carolina water fluoridation, contrasting coverage rates over time with those of surrounding states and detailing measurable impacts on oral health and infrastructure costs. The goal is to offer an accessible overview of the data for those seeking clear, quantifiable insights.

Key Statistics at a Glance

• 88% of North Carolinians on community water systems had fluoridated water as of 2022.
• Neighboring South Carolina reported just 30.03% coverage.
• Virginia maintained a near-universal fluoridation rate of approximately 97%.
• Aging infrastructure led Lincoln County to discontinue fluoridation in 2025, affecting over 400,000 residents statewide in tandem with other county opt-outs.

The following sections break down these figures more thoroughly. Each data point is drawn from state and local sources to help readers evaluate the scale and implications of water fluoridation statistics in North Carolina.

Coverage Over Time

Understanding how fluoridation rates evolved in North Carolina highlights both early success and recent shifts.

• In 2005, approximately 84.2% of residents in North Carolina on community water systems received fluoridated water.
• By 2012, the rate climbed to 92%, surpassing many other states during that period.
• The most recent statewide estimate indicates coverage ranges from 85% to 88% (down from the 2012 peak).
• Nationally, by comparison, coverage was 69.2% on community water systems in 2005, underscoring North Carolina’s historically higher rate.

The steady climb in the first decade of data was largely attributed to strong regulatory alignment with federal standards and advocacy from professional dental organizations. However, recent declines reveal how localized decisions can shift overall coverage.

Regional Comparisons

Examining North Carolina’s fluoridation rates within the broader regional context highlights varying approaches and coverage levels in neighboring states.

• Virginia consistently maintains around 97% coverage, bolstered by state-level mandates.
• South Carolina averages 30.03% coverage, with many rural systems facing funding or infrastructure barriers.
• Since 2024, at least two counties in North Carolina—Union and Lincoln—have opted out, each citing either cost constraints or concerns over “emerging science.”
• In contrast, Virginia reports few, if any, county-level opt-outs within the past decade.

Differences in state mandates and funding opportunities directly influence these varying coverage percentages. Although North Carolina historically surpasses the national average, localized actions can significantly impact overall rates.

Oral Health and Cost Implications

Numerous statistics illustrate the tangible oral health improvements and financial impacts associated with fluoridated water systems.

• Studies show an estimated 15–40% reduction in tooth decay within fluoridated communities.
• Statewide, North Carolina saves around $800 million annually in avoided dental treatments.
• Failing or aging fluoridation systems can require significant upgrades—Lincoln County faced a $1.25 million replacement cost in 2025.
• One analysis predicts that a 12% increase in caries risk may occur in non-fluoridated areas, potentially costing $950 million yearly in added dental care.

These figures underscore the role of fluoridation in reducing cavity prevalence and in alleviating financial burdens on both the healthcare system and individuals. However, even relatively modest infrastructure costs can disrupt local budgets, influencing county decisions to opt out.

Local Opt-Out Patterns

Patterns in which counties discontinue fluoridation reveal demographic and political factors influencing recent coverage declines.

• Union County discontinued fluoridation in 2024, followed by Lincoln County in 2025.
• These opt-outs, combined with a handful of other communities, affect over 400,000 North Carolinians.
• Data shows 78% of counties that ended fluoridation in North Carolina voted Republican in 2024, while 22% leaned Democratic.
• Rural systems appear most vulnerable due to higher per-capita costs and limited budgets.

These county-level departures mark a shift from widespread statewide consensus toward increased local autonomy. Reported political alignment and financial constraints are leading causes frequently cited for ending fluoridation programs.

Neurodevelopment Research Considerations

Some communities express concern about possible neurodevelopmental risks at higher fluoride exposures, referencing both national studies and local water quality measurements.

• Research indicates potential 3–5 IQ point reduction per 1 mg/L of fluoride in maternal urine above certain thresholds.
• North Carolina’s target level of 0.7 mg/L falls below the 1.5 mg/L threshold sometimes flagged in neurotoxicity studies.
• One major national review found no conclusive evidence of developmental harm below 1.5 mg/L.
• Still, state budget directives called for a 2023 review of these findings, prompting continued monitoring of both water chemistry and child development data.

Although average fluoride levels in North Carolina stay well under 1.0 mg/L, the ongoing spotlight on neurodevelopment fosters heightened public awareness and some policy skepticism in specific localities.

Key Statistics Summary

• Statewide fluoridation dropped from 92% coverage in 2012 to 85–88% in recent years.
• North Carolina saves an estimated $800 million each year due to reduced dental treatment needs.
• Less than 30.03% of South Carolina’s population has fluoridated water, compared to 97% in Virginia.
• Discontinuation in Union and Lincoln counties alone affected over 400,000 residents.
• Rural systems face higher fluoridation costs, with at least one replacement system topping $1.25 million.

Across these data points, North Carolina's story of fluoride usage illustrates substantial oral health and cost benefits, a historically strong coverage rate, and the complexity of localized decisions. While most communities maintain fluoridation, a small but notable number of opt-outs underscores the interplay between public health gains and varying budgetary or policy considerations.