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Overview

The Victorian Government is committed to extending water fluoridation to regional communities, in keeping with Australia’s National Oral Health Plan 2004–2013. The Plan Healthy Mouths Healthy Lives is endorsed by all Australian Health Ministers.

Some communities in regional and rural Victoria without optimal water fluoridation have recently started to receive fluoride in their drinking water as part of an important program to prevent tooth decay and improve the oral health of all Victorians.

Melbourne has had fluoridated water since 1977. Other parts of Australia have had fluoridated drinking water for more than 50 years.

The Government is committed to ensuring Victorians are not disadvantaged by where they live in terms of receiving the proven health benefits of water fluoridation. A program is underway to extend water fluoridation to those parts of Victoria which do not currently have access to this important and effective public health measure.

1. Water Fluoridation

Water fluoridation is the adjustment of fluoride in drinking water to a level that helps protect teeth against decay. Adding fl uoride does not alter the taste or smell of water.

In Victoria, the maximum level of fluoride in drinking water is 1mg/L or 1 part per million as recommended by the World Health Organization. As a comparison, the amount of fluoride in children’s toothpaste is 400–500 parts per million and in regular toothpaste is 1,000 parts per million.

2. Fluoride

Fluoride is a naturally occurring compound found in plants, rocks and at very low levels in almost all fresh water. It occurs naturally at a beneficial level in the local water supplies of some Victorian communities. Sea water has approximately the same fluoride level as that used in community fluoridation programs.

3. How fluoride works

Tooth decay occurs when acid destroys the outer surface of the tooth. The acid is produced by bacteria in the mouth from food and drinks containing sugar.

Fluoride acts like a constant repair kit by neutralising the effect of acids that cause decay as well as repairing damage before it becomes permanent.

Fluoride also works by helping to strengthen the mineral structure of developing teeth.

4. The benefits of fluoride

Water fluoridation helps protect teeth against decay in people of all ages, from the very young to the elderly.

Water fluoridation is a fair way of delivering the benefits of fluoride to the community, regardless of individual age, education, income or motivation.

5. Evidence that fluoride works

Numerous studies and reviews have confirmed the effectiveness of water fluoridation. Researchers from the Australian Research Centre for Population Oral Health (ARCPOH), recently presented results from a study which examined the effectiveness of water fluoridation on children’s dental health across four Australian states–– Queensland, Victoria, Tasmania and South Australia. The study found:

12–13 year old children who have lived for more than half their lives in areas with water fluoridation have 38 per cent less tooth decay in their adult teeth than children who have not lived in areas with water fluoridation.

6. Preventing tooth decay is still necessary

Tooth decay is still a significant problem in Victoria. In 2007–2008 more than 4,400 children under ten years of age, including 207 two year olds, required a general anaesthetic in hospital for treatment of tooth decay. Children under ten in non-optimally fluoridated areas are two times more likely to require a general anaesthetic for treatment of dental decay than children in optimally fluoridated areas.

In Victoria, 95 per cent of all preventable dental admissions to hospital for 0–9 year olds are due to dental decay.

7. The importance of preventing tooth decay

It is important to look after your teeth throughout life as good dental health has a direct impact on overall health.

Severe tooth decay can affect appearance, self-esteem, social interaction and the ability to eat and chew, which in turn can affect general health. In children, if baby teeth are lost too early because of decay their adult teeth may not develop in the correct position creating dental complications later in life.

A healthy diet, good oral hygiene, brushing with a fluoride toothpaste and regular dental check-ups will help to ensure your teeth and gums stay healthy. A fluoridated drinking water supply helps provide further protection against tooth decay.

8. Adding fluoride to drinking water

Fluoride is added to drinking water supplies at the water treatment plant via a carefully controlled and monitored process. Monitoring also occurs at the tap to ensure compliance with the

Australian Drinking Water Guidelines.

The fluoride plants must be incorporated within the water treatment plant’s risk management plan and are managed in accordance with the Safe Drinking Water Act, 2003.

For fluoridating drinking water, Australia’s peak health body, the National Health and Medical Research Council (NHMRC) specifies sodium fluoride, sodium fluorosilicate and fluorosilicic acid.

9. National and international support

Water fluoridation is supported by many national and international organisations including: the World Health Organization, World Health Assembly, World Dental Federation, Australia’s National Health and Medical Research Council, Australian Dental Association and Public Health Association of Australia.

The Centers for Disease Control and Prevention (CDC) in the United States of America includes water fluoridation in it’s list of the top ten health initiatives of the 20th Century, alongside immunisation, seatbelts and smoking bans.

In June 2006, ARCPOH published guidelines on the use of fluorides in Australia. ARCPOH supports continuation and extension of community water fluoridation, confirming it as: an effective, efficient, socially equitable and safe population approach to the prevention of caries [tooth decay] in Australia.

In November 2007, the NHMRC completed a review of the latest scientific evidence in relation to fluoride and health. Based on this the NHMRC recommends artificial fluoridation of water as the most effective community measure to protect the population from tooth decay.

10. Fluoride around the world

New Zealand, Hong Kong, Singapore, the United Kingdom, Ireland, Canada, the United States and Israel all have water fluoridation.

More than 350 million people benefit from community water fluoridation programs while more than 50 million people benefit from naturally fluoridated water at optimal levels to prevent tooth decay.

In February 2008, the United Kingdom’s Department of Health provided £42 million to extend water fluoridation over the next three years.

In 2006, in the United States almost 70 per cent of the population served by community water systems received optimally fl uoridated water, an increase from 62 per cent in 1992. This raised the number of people receiving water fluoridation to approximately 184 million. In September 2007, water fluoridation was extended to an additional 18 million people in southern California.

Due to differing technical, legal, financial or political environments some countries such as Switzerland supplement either salt or milk with fluoride.

11. Dental fluorosis

Dental fluorosis is a condition that can sometimes occur if young children get too much fluoride. It usually appears as very fine pearly white lines or flecks on the teeth and does not affect the function of teeth.

It is the only potential adverse effect of water fluoridation and cannot develop after teeth are fully formed. Since the mid 1990s in Australia, the prevalence of dental fluorosis has markedly reduced, mainly due to use of low-fluoride toothpaste in young children and awareness-raising of correct toothpaste use.

12. Infant formula

In Australia it is safe to reconstitute infant formula with fluoridated water. The Australian Research Centre for Population Oral Health guideline on infant formula states: Infant formula nowadays is safe for consumption by infants when using fl uoridated or non-fluoridated water.

13. Allergy

According to academic clinicians from the Department of Allergy, Immunology and Respiratory Medicine at Melbourne’s Alfred Hospital, no clinical or scientific evidence exists to confirm fluoridation causes allergies or affects immunity at the optimal 1mg/L. Specifically, they state: ... during the past 25 years, whether in Melbourne or in the UK, we have never seen a patient with any respiratory symptoms nor any allergy-like symptoms that could be attributed to fluoride 1ppm [1mg/L] as in our fluoridated water.

14. Kidney disease

Kidney Health Australia is Australia’s leading organisation promoting kidney health. The organisation recommends water as the fluid of choice to satisfy thirst and has stated: There is no evidence that consumption of optimally fluoridated water poses any health risks to people with chronic kidney disease, although only limited studies addressing this issue are available. It is important to note that Kidney Health Australia has not called for the cessation of water fluoridation.

15. Cancer

An Australian review in 2008 found there is a significant body of evidence demonstrating that the consumption of optimally fluoridated water is not associated with cancer risk.

16. Thyroid disease

Medical specialists confirm there is no credible evidence of a link between water fluoridation and thyroid disease, stating " ...there is no scientifically acceptable evidence that fluoridation increases the incidence of thyroid disease."

17. Education and choice

Governments and health professionals have a responsibility to make decisions that balance the best possible community health outcomes with individual choices.

Preventing problems before they occur is vital to good public health. Adding fluoride to water to prevent tooth decay can be compared to adding Vitamin D to margarine to maintain healthy bones; folic acid to breakfast cereals to reduce the risk of babies being born with neural tube defects or iodine into salt for thyroid health.

18. Water Fluoridation in Victoria

Currently 78 per cent of Victorians drink water with either naturally occurring or added fluoride. Melbourne and some regional centres have had fluoridated drinking water for more than 30 years.

In the last two years, the communities of Robinvale, Moe, Morwell, Sale, Warragul, Traralgon, Horsham, Wodonga, Wangaratta, Warrnambool and Castlemaine have had fluoride introduced to their drinking water supplies.

More recently, the decision has been made to commence water fluoridation in Hamilton, Yarrawonga, Ballarat, Geelong, Colac, Kerang, Swan Hill and Mildura.

Further information

Further fluoridation resources can be found at the following website

www.health.vic.gov.au/environment/water/fluoridation.htm or via the Department’s toll free information line on

1800 651 723.

Download documents

Young infants, infant formula and fluoride exposure (124kb, pdf)

Osteosarcoma and fluoride (104kb, pdf)

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