title: Successful implementation of community water fluoridation via the community diagnosis process.
abstract: OBJECTIVE
  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 community-specific data on the oral health status of schoolchildren. Key survey findings were presented to county health councils who were determining and prioritizing the health needs of their communities.
  
  
  RESULTS
  Community-specific data showed higher caries levels in children without access to an optimally fluoridated community water supply. Presentation of local survey findings 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 makers were challenged with local survey findings. The community diagnosis process resulted in the successful fluoridation of six community water systems serving a total of 33,000 residents.
  
  
  CONCLUSIONS
  The community diagnosis approach was successful in implementing community water fluoridation in geographic areas historically opposed to this public health measure. The success of these fluoridation initiatives was attributed to: (1) current, community-specific assessments of children's oral health; (2) identification of communities 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.
authors.affiliation: Tennessee Department of Health, South Central Regional Health Office, 1216 Trotwood Avenue, Columbia, TN 38401-4899, USA. brumley@mail.state.tn.us
authors.forename: D E
authors.initials: DE
authors.lastname: Brumley
authors.forename: R W
authors.initials: RW
authors.lastname: Hawks
authors.forename: J A
authors.initials: JA
authors.lastname: Gillcrist
authors.forename: J U
authors.initials: JU
authors.lastname: Blackford
authors.forename: W W
authors.initials: WW
authors.lastname: Wells
mesh_terms: D001294:Attitude to Health; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D019058:Community Networks; D003256:Community Participation; D003159:Community-Institutional Relations; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology; D005457:Fluoridation; D006285:Health Planning; D006292:Health Priorities; D006304:Health Status; D006801:Humans; D020380:Needs Assessment; D009909:Oral Health; D011050:Policy Making; D011636:Public Health Dentistry; D012423:Rural Health / Q000706:statistics & numerical data; D012923:Social Class; D013714:Tennessee / Q000453:epidemiology