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Dental Public Health Activities: Descriptive Summaries

Passage of the Fluoridation Bill in Nevada

Practice Number: 31002
Submitted By: Bureau of Family Health Services, Nevada State Health Division
Submission Date: May 2002
Last Reviewed: March 2013
Last Updated: March 2013
Best Practice Approach Example Passage of the Fluoridation Bill in Nevada


Prior to 2000, the Nevada statute specifically prohibited any water authority from implementing water fluoridation unless a majority of the citizens of the county had voted in favor of implementing fluoridation in that county.  In 1999, Assemblywoman Giunchigliani introduced a fluoridation bill which mandated fluoridation in counties with a population of 100,000 or more.  A statewide coalition, Citizens for Healthy Smiles was formed with the goal of passage of a fluoridation bill in the 1999 legislature and had a budget of $11,000.  Coalition members included the Nevada Dental and Dental Hygienist Associations, the Washoe and Clark County District Health Departments, the Clark County School District, Junior League of Las Vegas, Head Start, the Community College of Southern Nevada Dental Hygiene Program, Health Access Washoe County, and Saint Mary’s Hospital.  The final version of the bill passed by the Legislature mandated that fluoridation be implemented by March 1, 2000 in counties with a population of 400,000 or more (Clark County).  Counties with populations of <400,000 were still prohibited from implementing fluoridation unless a majority of the voters in the county had voted to do so.  The Governor was not comfortable signing the bill unless it was amended to require the residents of Clark County vote at the next general election on whether they wanted to continue fluoridation.  The amendment passed, the Governor signed the bill, and on March 1, 2000, the Las Vegas Water Authority and the City of Henderson implemented community water fluoridation, increasing the percentage of Nevada residents with access to optimally fluoridated community water supplies from less than 2% to 65%.  In November 2000, 56% of the voters in Clark County voted “No, fluoridation should not be ceased” and Clark County continues to enjoy the benefits of optimally fluoridated community water supplies today.

Nevada maintains three state of the art adjusted fluoridation water facilities all located in Clark County: the Alfred Merritt Smith Water Treatment Facility and River Mountains Water Treatment Facility  both of which are managed by the Southern Nevada Water Authority and the City of Henderson Water Authority Facility.  It should be noted that all three facilities have received the Centers for Disease Control and Prevention (CDC) “Water Fluoridation Quality Award” for 10 consecutive years. These three optimally fluoridated systems currently serve 1,851,098 of Nevada’s 2,700,551 residents, 72.88%   This percentage is significant, but it is well below the Healthy People 2020 objective OH-13:  “Increase proportion of the US population served by community water systems with optimally fluoridated water to 79.6%.” While Nevada was successful in passing legislation to provide optimal levels of fluoride in Clark County water systems (Nevada Revised Statute [NRS] 445A.055), the remaining counties still do not receive optimal levels of fluoride in their community water systems.  The biggest barrier to meeting the Healthy People 2020 objective was the population ceiling limitation stated in the original statute: “The State Board of Health shall adopt regulations requiring fluoridation of all water delivered for human consumption in a county whose population is 400,000 or more.” An amendment to NRS 445A.055 which passed during the 2011 Legislative Session made it even more difficult to mandate Washoe County or any county under a certain population ceiling receive optimal levels of fluoride in their community water systems.

Lessons Learned:

This amendment to NRS 445A.055 lifted the population ceiling requirement for implementation of community water fluoridation from 400,000 to 700,000.  This means that for a county to be required to implement community water fluoridation, other than via referendum, the population will need to be 700,000 or greater ( This poses a new challenge because Washoe County recently surpassed the 400,000 barrier. If Washoe County were mandated to provide optimal levels of fluoride in their community water systems, Nevada would surpass the Healthy People 2020 target of 79.6%.

The benefits of community water fluoridation have been documented in studies at the University of Las Vegas (UNLV) School of Dental Medicine (SDM). Marcia M. Ditmyer, PhD, MCHES,  Mildred A McCain, PhD, Christina Demopoulos, DDS, MPH, Connie Mobley, PhD, RD, authored and presented “Community Water Fluoridation and Oral Health” in the fall of 2011 at the annual  Nevada Public Health Association (NPHA) conference in Reno, Nevada.  It is a consolidated report on the numbers of decayed and treated teeth, gender, ethnicity, income, access, insurance, location, etc. in Nevada.  Although the focus is fluoridation, many oral health factors are addressed using the current demographic overview of Nevada.

Contact Person(s) for Inquiries:

Kimberly Fahey, Chronic Disease Prevention & Health Promotion Manager, Bureau of Child, Family and Community Wellness, Nevada State Health Division, 4150 Technology Way Suite 210, Carson City, NV 89706, Phone: 775-684-4253, Fax: 775-684-4245, Email: