Tennessee Water Fluoride: Updated Statistics

Community water fluoridation continues to play a central role in Tennessee’s efforts to reduce dental caries and improve oral health. In recent years, however, updated data reflects shifting trends in coverage levels, rural-urban disparities, and economic impacts on dental care costs.

This article compiles key statistical findings from the past two decades. It examines statewide adoption levels, highlights changing coverage rates, and explores how Tennessee compares with neighboring states in maintaining optimal fluoridation. The numbers below are presented to offer readers a comprehensive snapshot of the latest fluoride data available.

Noteworthy Statistics

• Statewide community water system (CWS) fluoridation coverage declined from 95.2% in 2004 to 88.3% by 2023
• Neighboring Kentucky maintains 99.9% fluoridation coverage
• Approximately 1.3 million fewer Tennessee residents now receive fluoridated water (after adjusting for population growth)
• Dental research suggests fluoridated communities see 21–25% lower caries rates on average

The following sections break down additional data surrounding the historical trends, geographic disparities, and health outcomes observed in Tennessee’s water fluoridation efforts. Tables and lists are included for clarity and citation value.

Historical Coverage Trends

These statistics illustrate coverage fluctuations over the past two decades, spotlighting the peak period and more recent declines.

• By 2004, 95.2% of CWS customers in Tennessee had access to optimally fluoridated water
• After reaching this early 2000s peak, the statewide rate dropped to 88.3% by 2023
• The reduction from 2006 to 2020 measured 5.3% (93.7% to 88.4%)
• This change included 40+ documented discontinuations of fluoridation in local water systems

The overall absolute decline from 2004 to the present indicates a noticeable shift in Tennessee’s fluoridation priorities among certain communities.

Coverage Over Two Decades (2004–2023)

Geographic and System Disparities

Differences in fluoridation rates can vary significantly across Tennessee’s urban centers and rural communities.

• Urban counties like Davidson (Nashville) report 100% coverage through their municipal systems
• Over 139,500 individuals are served by water systems not meeting optimal fluoride levels
• Approximately 26% of rural counties function below recommended standards
• Private wells in these regions are estimated to have a 43% fluoride deficiency rate

Such disparities underscore the importance of rural infrastructure and operator training in maintaining consistent fluoridation practices.

Current Status of Tennessee’s CWS

The chart above highlights the distribution of compliant systems and indicates that a small number of counties maintain no fluoridation at all.

Regional Comparisons

When viewed alongside neighboring states, Tennessee’s coverage still surpasses some parts of the Southeast but trails behind other states with mandatory fluoridation policies.

• Alabama reports 82.4% CWS fluoridation
• Georgia stands at 95.1%
• Kentucky reaches 99.9%, the highest in the region
• Mississippi registers 61.1%, lower than Tennessee’s 88.3%

Statewide requirements in Kentucky, Virginia, and Georgia generally help those states sustain their higher rates of coverage compared to Tennessee’s local-choice model.

State-by-State Water Fluoridation

Health and Economic Impacts

Multiple research findings highlight the direct benefits of community water fluoridation for oral health outcomes and economic savings.

• Fluoridated communities exhibit 21–25% lower incidence of dental caries
• Pioneering data in Milan, Tennessee, found a 57% childhood caries reduction within five years of fluoridation
• Residents in low-fluoride areas can experience 3x higher school absenteeism due to dental pain
• Every $1 spent on fluoridation translates to an estimated $38 saved in dental expenses

Economic advantages extend beyond individual treatments, reflecting both public health and reduced cost burdens on healthcare systems statewide.

Examples of Fluoridation Savings

By mitigating costly treatments and preventable dental emergencies, fluoridation remains a highly cited preventive measure among oral health experts.

Key Statistics Summary

• Tennessee’s fluoridation rates fell from 95.2% to 88.3% between 2004 and 2023
• About 40 CWS across Tennessee have discontinued fluoridation in recent years
• Rural areas see 26% of counties below recommended standards
• Fluoridated communities average 21–25% fewer caries than non-fluoridated ones
• Potential statewide savings surpass $100 million per year in reduced treatment costs

These statistics illustrate both the historical success and recent coverage declines of Tennessee’s community water fluoridation. Although current coverage levels remain relatively high compared to some southern states, considerable gaps exist in rural counties, and the overall downward trend underscores the importance of consistent fluoridation practices for optimal oral health.