The summer after my first year of medical school, I spent time working with a community dentist who was the first to teach me the association between oral health and systemic disease.

For instance, severe dental decay among children appears to impair growth and development. Some studies have also shown an association between periodontal (gum) disease and adult diseases such as coronary heart disease, diabetes, certain types of cancer and rheumatoid arthritis.

Certainly, problems with oral health can contribute to psychosocial factors, ranging from self-image to school and work absence.

There are a variety of factors that influence oral health, ranging from genetic to environmental influences. Most of us are familiar with the various modifiable behaviors necessary for good dental hygiene, and we may practice them with varying degrees of adherence to the recommendations of our dental health provider. They merit mention and include frequent and thorough brushing of the teeth and use of dental floss to remove debris from between the teeth. Regular visits to the dentist’s office, twice yearly for cleaning, aids removal of plaque. Also, avoidance of tobacco products and sugar, especially juices and sugar-sweetened beverages, reduces the risk of gum disease and dental decay.

Community water fluoridation is another important component in the battle against dental decay. Following efforts spearheaded by the U.S. Public Health Service, community water fluoridation has been recognized as one of the 10 great public health achievements of the 20th century, owing to the significant decline in cavities in the U.S. since the 1960s.

Fluoride is a naturally occurring mineral found to varying degrees in natural water sources. This mineral has been found to strengthen the enamel on the surface of the teeth, which reduces the risk of decay. Community water fluoridation is the process of adjusting the amount of fluoride found in water to achieve optimal prevention of tooth decay. It has been shown to be independently responsible for reducing rates of decay in children and adults by 25 percent.

Community water fluoridation began in the U.S. in 1945. In 2012, nearly 75 percent of the country was served by community water systems with fluoridated water, according to the Centers for Disease Control and Prevention.

Some have raised concerns about community water fluoridation. These concerns range across questions about the benefits, cost effectiveness and potential toxicity of fluoride. While the concerns have been raised since the initiation of community water fluoridation in 1945, evidence continues to favor the safety and effectiveness of the practice.

Community water fluoridation is a safe and effective public health practice that has substantially contributed to the reduction of tooth decay in the U.S. and other developed countries.

Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.