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Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.32 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. A 1994 World Health Organization expert committee suggested a level of fluoride from 0.5 to 1.0 mg/L (milligrams per liter), depending on climate. Dental cavities remain a major public health concern in most industrialized countries, affecting 60–90% of schoolchildren and the vast majority of adults, and costing society more to treat than any other disease. Water fluoridation prevents cavities in both children and adults, with studies estimating an 18–40% reduction in cavities when water fluoridation is used by children who already have access to toothpaste and other sources of fluoride. There is no clear evidence of adverse effects other than dental fluorosis. It is controversial, and opposition to it has been based on ethical, legal, safety, and efficacy grounds.