Successful implementation of community water fluoridation via the community diagnosis process

Objectives: This paper describes the community diagnosis process and how it was used to implement community water fluoridation in Tennessee. Methods: Public health dental staff developed a survey instrument to collect communi ty-specific data on the oral health status of schoolchildren. Key survey fi ndings were presented to county health councils who were determining and pr ioritizing the health needs of their communities. Results: Community-specif ic data showed higher caries levels in children without access to an optima lly fluoridated community water supply. Presentation of local survey findin gs to county health councils resulted in fluoridation being a high-priority health issue in several counties. With health council support, opposition to fluoridation by utility district officials was overcome when decision ma kers were challenged with local survey findings. The community diagnosis pr ocess resulted in the successful fluoridation of six community water system s serving a total of 33,000 residents. Conclusions: The community diagnosis approach was successful in implementing community wafer fluoridation in ge ographic areas historically opposed to this public health measure. The succ ess of these floridation initiatives was attributed to: (1) current, commun ity-specific assessments of children's oral health; (2) identification of c ommunities with disparate oral health needs, problems, and resources; and ( 3) effective presentation of community-specific oral health survey data to community leaders, stakeholders, and decision makers.