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The aim of this review is to describe the role of water fluoridation in preventing dental caries worldwide. Community water fluoridation began in 1945 and over the past 20 years has reached over 400 million people. In several countries, such as USA, Australia, New Zealand, Ireland, Singapore, Hong Kong, Brunei, Malaysia, Oman, Chile, Gabon and Brazil, a high proportion of the population receives fluoridated water. The clinical effectiveness is well established. Both water fluoridation and fluoride-containing toothpaste are effective and each adds to the effect of the other. Coverage of water fluoridation is equitable so that those at greatest risk of dental caries benefit most. Water fluoridation is cost-effective and has low environmental impact. Below the usual permitted concentration of 1.5 mgF/L, there is no risk to health. Prevalence of dental fluorosis is higher in fluoridated communities but severity is mild to very mild and of little aesthetic concern. In this regard, advice should focus on early use of fluoride-containing toothpaste to reduce fluoride ingestion during infancy and early childhood. The cost of water fluoridation is low. With increasing global urbanisation and improved equipment, the future of water fluoridation is promising. The WHO urges member states to consider implementing community water fluoridation.