Obstacles to extending fluoridation in the United States.

The purpose of this paper is two-fold: (1) to describe the current extent of water fluoridation in the United States; (2) to address the major obstacles to attaining 75 per cent fluoridation by the year 2000. While 62.1 per cent of the US population has access to fluoridated public water systems, more than 32 million people need to be added to the fluoridation census, primarily from the cities. The legal framework for implementing fluoridation is considered at the state level; a review of fluoridation actions at the local level is presented. The impact of forces affecting the extension of fluoridation in the United States is described: (1) demographic trends--urbanisation, race, ethnicity, language, immigration, age, education levels, housing, income and poverty levels; (2) external environmental forces/political climate; (3) media influence on public opinion and public policy; (4) voter apathy/lack of awareness of the benefits of fluoridation; (5) perceptions of risks vs. benefits; (6) lack of political campaign skills; and (7) legal issues.