A recent Cochrane review found that the effectiveness of adding fluoride to drinking water for dental health has declined compared to earlier times. Researchers analyzed 157 studies comparing communities with and without water fluoridation and concluded that the benefits of fluoridation have diminished since fluoride toothpaste became widely available in the 1970s. The current evidence suggests that water fluoridation might have a minimal effect on reducing tooth decay in children's baby teeth.

Studies conducted in high-income countries after 1975 show that fluoridation may reduce tooth decay by an average of 0.24 baby teeth per child, whereas earlier studies estimated a reduction of 2.1 decayed teeth per child. Furthermore, the review did not find strong evidence supporting the claim that water fluoridation helps reduce oral health inequalities.

Experts argue that while water fluoridation can have some benefits, it is not sufficient to tackle dental health issues alone. A comprehensive approach that includes reducing sugar consumption and improving oral hygiene practices is essential for preventing tooth decay. Fluoride is just one tool among many in promoting oral health, and more holistic strategies are needed.