Tooth decay remains an endemic problem worldwide. Despite some modest decreases in tooth decay in the overall population, the incidence of decay remains high in specific subgroups. Cavity causing bacteria is passed on by caregivers (mothers) at a young age. By the first grade, 50% of all children in the USA have had tooth decay. Having cavities at an early age appears to predispose children for decay throughout their life. 95% of all adults experience decay on enamel or root surfaces. With age come risk factors which are essential in considering the need for additional fluoride, aside from toothpaste and drinking water. Whereas the implementation of water fluoridation has been extremely beneficial it is not without limitations. Fluoridation of the water does effect the fluoride content of enamel, the outer portion of the tooth, during tooth development. However, the benefit of water fluoridation is primarily topical as opposed to intrinsic fluoride incorporation during tooth development. Flouride does reduce tooth decay by assisting in the prevention of demineralization and by remineralizing early developing cavities. Tooth decay is a fluid process whereby demineralization, the mineral transfer from the tooth to the surrounding surface, is balanced or counteracted by remineralization. Consulting with your dentist is essential in assessing the need for fluoride. Reviewing your dental and familial history; assessing your diet; and examining your oral hygiene are essential in customizing a risk assessment and regiment specifically for you.