There shouldn't be a scale issue with regards to fluoride in the water. It is either scientifically shown to be beneficial or it isn't, scale and geography likely have nothing to do with it.
Does it not depend on the chemical composition of local water? The US is vast, geologically diverse, and water quality varies hugely across it. Denmark can likely make a decision that's good for the entire country.
Actually, what most countries seem to do (according to other comments I’ve seen here), is just delegate to local bodies, so country size is a complete non-issue.