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Oral health impacts general health and well-being throughout the lifespan. Recent trends in the United States towards cessation of community water fluoridation (CWF) may increase disparities in oral health. The purpose of this quantitative retrospective cohort study was to analyze Medicaid dental claims records for caries related procedures among 0 to18-year-old patients during an optimal CWF year 2003 (n = 854) and compare them to claims records from 2012 (n = 1,053), 5 years after CWF was ceased. The theoretical framework of this study was the diffusion of innovations theory. Statistically significant results included higher mean number of caries related procedures among 0 to18 year and < 7-year aged patients in the suboptimal CWF group (2.57 vs. 2.43, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). Mean caries related treatment costs per patient was also higher in the 0 to18 year and < 7-year suboptimal CWF groups compared to the optimal CWF group (583.70 vs 344.34 $, p < 0.0001; 692.87 vs. 350.13 $, p < 0.0001, respectively). Binary logistic regression analysis results indicated a protective effect from optimal CWF for the 0 to18 and < 7 year age groups ([OR] 0.75, 95% CI [0.62, 0.90], p = 0.002); OR = 0.70, 95% CI [0.52, 0.95], p = 0.02, respectively). The results confirm optimal CWF exposure prevents dental decay, expand the evidence base of caries epidemiology under CWF cessation, and indicate patients without early childhood CWF exposure experience more dental caries procedures and treatment costs. These findings may create opportunities for social change by supplying evidence that can be used to improve equity oriented oral health public policies that protect population health.