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Water Fluoridation

The Australian Dental Association Victorian Branch (ADAVB) believes that all Australians deserve access to the protective benefits of fluoride. Water fluoridation stands as a safe, effective, and ethical approach to significantly reduce tooth decay across various demographics.

Our ongoing efforts are dedicated to advocating for and supporting the expansion of water fluoridation initiatives. Water fluoridation is endorsed by numerous health and dental associations both in Australia and internationally. These organisations recognise water fluoridation as a critical public health measure aimed at preventing tooth decay and promoting oral health.

These Include:

We urge federal and state governments to support communities without fluoridated water, as this is essential for achieving the objectives outlined in both the National Oral Health Plan 2015–20241 and the Victorian Action Plan to Prevent Oral Disease 2020-2030.2

Fluoride is a naturally occurring mineral and is the key ingredient in toothpaste and other topical treatments used by dental practitioners in the prevention and treatment of dental caries. Its ionic form can be found in water supplies, in various rocks and soils, as well as in tea, vegetables and grains.3 In fact, the Victorian regions of Portland and Port Fairy naturally have the optimal amounts of fluoride in their water supplies! However, the majority of environmental fluoride is not found in sufficient quantities to benefit dental health, necessitating its addition to water supplies and various dental products.4 The addition of fluoride to drinking water offers an incredibly simple, cost-effective, efficient, and safe way to improve oral health for a large number of people without requiring any widespread behavioural change.5

 

Consistent fluoride exposure to the tooth surface not only reduces demineralisation (the dissolution of enamel) but also enhances remineralisation (the biochemical restoration of damaged enamel). Additionally, fluoride has been shown to slow the activity of bacteria that contribute to decay.3 Very little fluoride enters the body through swallowing, but even this small amount has been shown to have a pronounced beneficial effect.5

Benefits of Fluoridated Water on Dental Health6

  • Helps protect both children and adults against tooth decay.
  • Works to repair weak spots on the tooth surface that could develop into cavities.
  • Significantly reduces the amount of money individuals need to spend on dental treatment.
  • Saves the community both money and time, minimising absences from work and school.
  • Reduces discomfort and pain associated with tooth decay.
  • Offers significant benefits to all people, especially those from low socioeconomic backgrounds who have less access to other fluoride treatments.
  • Helps protect against surface decay in older adults and tooth decay in children.
  • Helps prevent the early loss of baby teeth due to decay, which is crucial as baby teeth guide the developing adult teeth into the correct position; losing them early may lead to the need for orthodontic treatment.
  • Helps prevent painful and costly dental complications, such as tooth abscesses or other permanent damage.

Victorian water is of exceptionally high quality and does not need to be filtered to remove any impurities.7 However, if you do choose to use a filter, please ensure that they are maintained and replaced regularly, certified to appropriate standards, and suitable for their intended use.7 We also strongly recommend using charcoal or carbon filters, which will not remove fluoride from the water.5

Fact 1: Impact of Water Fluoridation on Tooth Decay

Following the widespread introduction of water fluoridation programs throughout Australia in the 1970s, the rates of tooth decay among people born after 1970 are estimated to be half of what they were compared to older generations.8

Fact 2: Reduction in Tooth Decay

An evidence evaluation undertaken by the NHMRC found that water fluoridation is associated with a 26-44% reduction in tooth decay among children, teenagers and adults.8

Fact 3: Hospital Admissions

Promising preliminary evidence suggests that the rate of hospital admissions is lower in regions with access to a fluoridated water source.8

The process of water fluoridation in Australia is meticulously controlled and monitored, including checks at the tap to ensure compliance with federal drinking water guidelines, and each plant's fluoride management is integrated into its risk management plan in accordance with the Safe Drinking Water Act 2003.9 The National Health and Medical Research Council (NHMRC) determines the compounds suitable for water fluoridation, specifically sodium fluoride, sodium fluorosilicate, and fluorosilicic acid.9 These compounds are rigorously tested to establish safe consumption levels before their addition to drinking water.9

In Victoria, the fluoride concentration in drinking water is capped at 1 milligram per litre (mg/L), or 1 part per million (ppm), aligning with World Health Organisation (WHO) recommendations.9 For context, the fluoride content in children’s toothpaste ranges from 400-500 ppm, while regular adult toothpastes contain 1,000-1,500 ppm, according to Victorian government guidelines.9 All infant formula sold in Australia is below the threshold of 17 micrograms per 100 kilojoules (before reconstitution).4 Consequently, preparing infant formula with fluoridated tap water at levels typical in Australia (0.6-1.1 parts per million) is safe and does not increase the risk of dental fluorosis.4

There is a large body of evidence that showcases there is no association between any negative human health outcomes at the current fluoride levels in the Australian water supply.8

There is strong research indicating that humans do not develop allergies or sensitivities to fluoride.5 Water fluoridation also does not alter the water's taste or smell,9 or negatively impact ecosystems or natural environments.5

 

Dental fluorosis is a condition that affects the appearance, but not the health or function, of teeth.10 There is compelling evidence demonstrating an association between high fluoride intake from sources such as the water supply and dental fluorosis when teeth are developing in childhood.8 Despite the significant expansion of water fluoridation in Australia since the 1990s, the prevalence of dental fluorosis has declined by an estimated 23%, with moderate or severe cases remaining rare.4

Since its implementation in 1977, water fluoridation has been a significant public health initiative in Victoria.9 Today, approximately 90% of the Victorian population receives fluoridated water, a testament to the widespread adoption of this preventive measure.9 However, there are still remaining communities who live in areas that are either partially fluoridated—where some streets within a town might receive fluoridated water while others do not, due to the configuration of the local water supply system—or completely unfluoridated.9 Unfortunately, people who live in rural areas are disproportionately affected by a lack of access to fluoridated water.

ADAVB is actively engaging stakeholders, including the Victorian Oral Health Alliance(VOHA) to promote water fluoridation efforts in Victoria.

For individuals residing in areas without access to fluoridated water, the ADAVB strongly recommends following the oral health guidelines issued by the Victorian government.11

These Include:

  • Clean your teeth and along the gum line at least twice a day.
  • Use an age-appropriate fluoridated toothpaste as directed.
  • For infants from birth up to 18 months old, begin cleaning their teeth as soon as they emerge (around 6 months) using a soft toothbrush with a small head and water only; toothpaste is not necessary at this stage.
  • For children aged 18 months to 5 years, consult with a dental professional to determine whether to use a low-fluoride toothpaste or a standard fluoride toothpaste.
  • Individuals aged 6 years and older should seek advice from an oral health professional on whether to use a standard fluoride toothpaste or one with higher fluoride strength.
  • Drink plenty of water daily.
  • Reduce your consumption of sugary sodas, fruit juices, and alcoholic beverages.
  • Oral health needs vary from person to person. Consult with an oral health professional to determine how frequently you should schedule dental check-ups.

The ADAVB advises against the use of fluoride tablets or drops, even for those living in areas without water fluoridation, as substantial research indicates that these methods do not effectively reduce the risk of tooth decay and may increase the risk of developing dental fluorosis.12

  1. Australian Government Department of Health and Aged Care, “Healthy Mouths, Healthy Lives – Australia’s National Oral Health Plan 2015–2024,” May 8, 2023, source.
  2. Department of Health. Victoria, Australia. “Victorian Action Plan to Prevent Oral Disease 2020-30,” Department of Health. Victoria, Australia, November 15, 2021, source.
  3. ADA Policies - Fluoride Use. source.
  4. Hopcraft, Matt. Four myths about water fluoridation and why they’re wrong, July 12, 2017. source.
  5. Foley, Michael. “Forty FAQs on Fluoridation,” Fluoridation FAQs. source.
  6. Department of Health & Human Services, “Dental Care – Fluoride,” Better Health Channel, April 30, 2012. source.
  7. Australia Department of Health. Victoria, “Drinking Water and Public Health,” Department of Health. Victoria, Australia, December 5, 2022. source.
  8. National Health and Medical Research Council (NHMRC) 2017, Information paper – Water fluoridation: dental and other human health outcomes, report prepared by the Clinical Trials Centre at University of Sydney, NHMRC; Canberra. source.
  9. Australia Department of Health. Victoria, “Water Fluoridation in Victoria,” Department of Health. Victoria, Australia, November 29, 2023. source.
  10. Australian Dental Association. “Fluoride.” Teeth. 2017. source.
  11. Australia Department of Health. Victoria, “Unfluoridated Areas,” Department of Health. Victoria, Australia, November 29, 2023.source.
  12. Foley, Michael. Australian Dental Association, “I Cannot Access Fluoridated Water. Should I Add Fluoride to My Own Water?,” Teeth.source.