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Dental Public Health Activities: Descriptive Summaries

Arkansas Statewide Mandated Community Water Fluoridation

Practice Number: 05006
Submitted By: Office of Oral Health, Arkansas Department of Health
Submission Date: February 2015
Last Reviewed: February 2015
Last Updated: February 2015
Best Practice Approach Example Arkansas Statewide Mandated Community Water Fluoridation

For more than 65 years, community water fluoridation has been proven to be a safe and healthy way to effectively prevent tooth decay. CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.   With the hiring of Dr. Lynn Mouden in the year 2000 as Director of the Office of Oral Health, Arkansas Department of Health, the Department began a concerted effort to achieve fluoridation of all community water systems in the state. By the year 2010, Arkansas reported 65% of its population receiving the benefits of fluoridated water.  However, Dr. Mouden’s goal was 85%.  To achieve this goal, Dr. Mouden initiated an effort to rally collaborative support from the Arkansas Oral Health Coalition, identify a legislator who wanted to be an oral health champion, encourage the naming of “Oral Health” as a priority legislative issue for the Arkansas Department of Health, and to solicit help and support from the PEW foundation. 

During the 2011 Legislative Session, ACT 197 was passed by both the House and the Senate, realizing a 10 year goal of the Office of Oral Health.  ACT 197 requires all Arkansas water systems who service 5,000 or more customers to maintain a level of fluoride to prevent tooth decay.  To avert financial stress on community water systems, and as a compromise with fiscally concerned representatives, the act further stated: A water system required to fluoridate under this section is not required to comply with the requirements of this section until funds sufficient to pay capital start-up costs for fluoridation equipment for the system have become available from any source other than tax revenue or service revenue regularly collected by the company, corporation, municipality, county, or other government agency that owns or controls the water system.  Knowing this was a compromise that had the potential to thwart fluoridation efforts, the Delta Dental Foundation, an Arkansas Oral Health Coalition member, agreed to fund the capitol start-up costs needed to initiate water fluoridation for the 33 water systems affected by ACT 197. To date, Delta Dental has pledged over four million dollars to the effort.

Once all 33 water systems are online with fluoridation efforts, Arkansas should see 85% of its citizens receiving the scientifically proven, carries fighting benefits of fluoridated water.

Lessons Learned:

ACT 197 has worked well for Arkansas.   Many water systems were anxious to fluoridate their water and were only limited by lack of funding. However, several large water systems opposed ACT 197 and had voted down water fluoridation on the local level for many years.  In light of this opposition and personal prejudices of community leaders, it would have been beneficial to include an enforcement piece in ACT 197.  

Although Arkansas’ ACT 197 was passed in 2011, the anti-fluoride population does not take “no” for answer.  During the 2013 legislative session, a stiff battle was fought by the Arkansas Oral Health Coalition, Arkansas Health Department and other stakeholders to retain the law.  The most successful challenge was a “Freedom of Choice” bill, which would allow each water system to make an individual choice as to whether they desired to fluoridate or not. All attempts to repeal the law met with defeat. However, there is no doubt that ACT 197 will be challenged again during the next legislative session.

The Office of Oral Health is committed to long term sustainability of ACT 197 and community water fluoridation.  When writing grants, monies for sub-grants to water systems attempting to upgrade and maintain costly fluoridation equipment are now included when possible.

Contact Person(s) for Inquiries:

Carol Amerine, RDH, MSDH, Office of Oral Health, Arkansas Dept. of Health

4815 W. Markham, Slot 18, Little Rock, AR 72205, Telephone: 501-661-2051, Fax: 501-661-2240 Email: