Cost-savings of community water fluoridation program; Kerman, Iran, 2016

Document Type: Original Article(s)


1 Associate Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 PhD Student, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

3 Assistant Professor, Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran

4 Professor, Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

5 Assistant Professor, Modeling in Health Research Center, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

6 Associate Professor, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND AND AIM: Oral diseases are very important because they impose economic and social burden on societies. Given the resource scarcity, it is necessary to devise cost-effective and scientific strategies to prevent and control oral diseases. This study aimed to estimate the potential cost-savings for dental caries treatment associated with Community Water Fluoridation Program (CWFP) in Kerman, Iran.METHODS: An economic model to compare the costs of CWFP with treatment savings achieved through averted tooth decay was developed. Direct cost of prevented caries was taken equal to treatment savings. Implementation cost and the associated savings was estimated for Kerman in 2016. We obtained required data and parameters for costs and savings estimation through published documents and other sources.RESULTS: Annual cost-savings associated with implementing the water fluoridation in Kerman was estimated about $11160415.5 to $44350544.11. About $34.9 to $136 could be achieved per each dollar spent. Annual cost and benefit per capita was $0.66 and $23.4-$91.09 respectively. Net benefit per capita was $22.7 to $90.4.CONCLUSION: This study indicates significant annual savings from CWFP; additional savings could be achieved if this program is implemented in other regions. We could also receive even more if this program is integrated with other public oral health programs such as screening school children, community dentistry and oral health education.


  1. Yasamy MT, Shahmohammadi D, Bagheri Yazdi SA, Layeghi H, Bolhari J, Razzaghi EM, et al. Mental health in the Islamic Republic of Iran: achievements and areas of need. East Mediterr Health J 2001; 7(3): 381-91.
  2. Dehghani M. Determine of DMFT in 7-11 olds school children and its relation with level of water fluoride in 2008. Proceedings of the 12th National Conference of Iran Health; 2009 Nov 3-5; Tehran, Iran. [In Persian].
  3. Fluorides and oral health. Report of a WHO expert committee on oral health status and fluoride use. World Health Organ Tech Rep Ser 1994; 846: 1-37.
  4. O'Connell JM, Brunson D, Anselmo T, Sullivan PW. Costs and savings associated with community water fluoridation programs in Colorado. Prev Chronic Dis 2005; 2(Spec no): A06.
  5. Newbrun E. Effectiveness of water fluoridation. J Public Health Dent 1989; 49(5 Spec No): 279-89.
  6. Horowitz HS. The effectiveness of community water fluoridation in the United States. J Public Health Dent 1996; 56(5 Spec No): 253-8.
  7. Cochrane N, Poureslami H. Necessity of water fluoridation in Iran: A review on water fluoridation and prevention of dental caries. J Oral Health Oral Epidemiol 2014; 3(1): 1-7.
  8. Bayat-Movahed S, Samadzadeh H, Ziyarati L, Memary N, Khosravi R, Sadr-Eshkevari PS. Oral health of Iranian children in 2004: A national pathfinder survey of dental caries and treatment needs. East Mediterr Health J 2011; 17(3): 243-9.
  9. Ministry of Health and Medical Education. Oral Health Plan for children under 6 years. Journal of the Internal Management of Non-Communicable Diseases 2012; 12(Special Oral Health): 1-20. [In Persian].
  10. Jahani Y., Eshraghian MR, Foroushani A, Nourijelyani K, Mohammad K, Shahravan A, et al. Effect of socio-demographic status on dental caries in pupils by using a multilevel hurdle model. Health 2013; 5: 1110-6.
  11. Torabi M, Karimi Afshar SA, Sheykhzadeh A, Karimi Afshar M. Assessment of oral health indices in Kerman adults aged 35-44 years. J Isfahan Dent Sch 2009; 5(2): 93-5. [In Persian].
  12. Pooreslami H, Khazaeli P, Masoodpoor H. Fluoride content of drinking waters in Kerman/Iran. J Kerman Univ Med Sci 2008; 15(3): 235-42. [In Persian].
  13. Wikipedia the free encyclopedia. Demographics of Iran [Online]. [cited 2015]; Available from: URL:
  14. Najafipour H, Mirzazadeh A, Haghdoost A, Shadkam M, Afshari M, Moazenzadeh M, et al. Coronary Artery Disease Risk Factors in an Urban and Peri-urban Setting, Kerman, Southeastern Iran (KERCADR Study): Methodology and Preliminary Report. Iran J Public Health 2012; 41(9): 86-92.
  15. Griffin SO, Jones K, Tomar SL. An economic evaluation of community water fluoridation. J Public Health Dent 2001; 61(2): 78-86.
  16. Armfield JM. Community effectiveness of public water fluoridation in reducing children's dental disease. Public Health Rep 2010; 125(5): 655-64.
  17. American Dental Association. Statement commemorating the 60th anniversary of community water fluoridation [Online]. [cited 2005]; Available from: URL:
  18. Wright JC, Bates MN, Cutress T, Lee M. The cost-effectiveness of fluoridating water supplies in New Zealand. Aust N Z J Public Health 2001; 25(2): 170-8.
  19. Tchouaket E, Brousselle A, Fansi A, Dionne PA, Bertrand E, Fortin C. The economic value of Quebec's water fluoridation program. Z Gesundh Wiss 2013; 21(6): 523-33.