Background For over 70 years the addition of fluoride to public water with intent to prevent dental caries continues to be controversial and risks are seldom included in monetary evaluations. Objectives To estimate an economic cost-benefit-risk of Community Water Fluoridation (CWF) using 2021 USA dollars Per Person Per Year (PPPY), with the inclusion of two risks: dental fluorosis and lower income resulting from developmental neurotoxicity as measured with lower IQ. Methods Published operational costs and benefits of CWF are used. Published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient perceived dental fluorosis, and lost wages from lower IQ. Patients of record provided consent for photographs. Results: Published estimated caries averted, less operational costs, were calculated at $8 PPPY and estimates of compensation for functional and cosmetic dental fluorosis were $126 PPPY. Lower earnings from presumed harm of developmental neurotoxicity $438 PPPY. Net loss from CWF is estimated at $556 PPPY. Conclusions Previous economic evaluations of CWF have estimated caries averted and costs of operations. Few evaluations include the costs of treating harm. CWF is not cost effective if the cost of harm is included. Policy Implications Alternatives for the prevention of dental caries should be promoted and the cessation of CWF is indicated.