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There are two ways to prevent tooth decay. First is the easy way which is to put fluoride in the drinking water. It's easy and protects everyone, but particularly the poorer segments of the population that might struggle with things like preventative dentist appointments.
The second way is the hard way which is to modify your diet to avoid foods high in sugars and carbs and to prefer more proteins and fiber. This is the approach some European countries take.
If you do neither you will get significantly increased rates of tooth decay.
Most European countries do not fluoridate their water. Our solution is brushing our teeth and public healtcare that also includes dental care (albeit it can still be fairly expensive and many prefer private due to long queues in public (Private is like 100-250 per visit in Finland and generally its recommended to do 1-2 visits a year but many visit much less frequently)