The most frequently asked questions about water fluoridation are answered below.
What is Water Fluoridation?
Water fluoridation is the topping up of the levels of naturally
occurring fluoride in the water to strengthen teeth against tooth decay.
Fluorides are minerals found very commonly in the earth's crust and in
all water supplies. American scientists in the 1930s found that people
living in towns with higher levels of fluoride in the water experienced
less tooth decay than people living in areas with much lower levels of
fluoride. Community water fluoridation began in America in 1945 and
spread rapidly once its effectiveness against tooth decay became
Most Australian towns and cities were fluoridated in the 1960s and 70s,
and today around 90% of Australians enjoy the decay fighting benefits of
water fluoridation. Fluoridated water means fewer fillings, fewer
extractions, and fewer visits to the dentist - resulting in healthier
teeth, better smiles, and less pain and suffering.
Health and scientific authorities around the world have endorsed
fluoridation for decades, and the number of people around the world
drinking fluoridated water continues to grow. Where water fluoridation
is impractical, many countries around the world use fluoridated salt or
other forms of fluorides as alternatives.
But most people already use fluoride toothpaste. Is water fluoridation still needed?
Yes. Dentists strongly recommend fluoride toothpastes to reduce tooth
decay, and water fluoridation provides an additional benefit.
How do we know that water fluoridation strengthens teeth?
Scientific studies in Australian and overseas consistently report
reduced tooth decay in children and adults who drink fluoridated water.
The 2002 Australian Child Dental Health Survey1 examined more than
136,000 children across Australia, and specifically recorded whether
they drank fluoridated water or not. The survey found that no matter
which state or territory children came from, what age group they were
from, whether they were rich or poor, or whether they lived in the
capital city or regionally or remotely, children who drank fluoridated
water had significantly less tooth decay than children who didn't.
A major 2012 Australian study2 analysed all studies published
worldwide from 1990-2010, in any language, which reported the effects of
water fluoridation. The authors found 59 studies from 10 countries,
yielding 83 separate evaluations into the effectiveness of water
fluoridation (30 for primary teeth and 53 for permanent teeth).
Thirteen of the studies were conducted in Australia. Every one of these
59 studies without exception showed a significant reduction in tooth
decay from water fluoridation, with most showing reductions of around
20-60%. It is important to note that fillings have a limited life span,
and are regularly replaced or repaired. Preventing one permanent tooth
cavity in a child may prevent not just one cavity, but a whole lifetime
of treatment on that tooth, with each successive treatment becoming
larger, more complex and more expensive.
More recent Australian
research based on the National Survey of Adult Oral Health 2004-06
confirmed that adults living in fluoridated areas also experience much
less tooth decay, even when they grew up without fluoridated water or
fluoride toothpaste3. Water fluoridation benefits all Australians.
Building and maintaining fluoridation plants is expensive. Is it worth it?
Yes. Directly or indirectly, we all pay for the cost of dental disease in our communities. Water fluoridation is an investment in public health that saves money for all Australians through fewer dental visits and reduced dental treatment costs. A 2012 study of the cost-effectiveness of water fluoridation in Australia concluded that "Extending coverage of fluoridation to all communities of at least 1000 people will lead to improved population health, with a dominant cost-effectiveness ratio and 100% probability of cost-savings"4.
What about chemicals used in fluoridating water supplies? Are they safe?
The only compounds which can be used for fluoridating water supplies are sodium fluoride, sodium fluorosilicate and fluorosilicic acid. These are chosen because they dissolve 100% in water and break down completely into harmless compounds, leaving none of the original chemical. Fluoride ions in artificially fluoridated water are identical to those already found naturally in the water.
Is water fluoridation mass "medication"?
Of course not. Fluoridation is simply the adjustment of the level of a substance already found naturally in all drinking water supplies to provide a major public health benefit. In 2006, the National Health and Medical Research Council, Department of Health and Ageing, and the New Zealand Ministry of Health described fluoride as a ‘nutrient’ in the Nutrient Reference Values for Australia and New Zealand document, adding that "Because of its role in the prevention of dental caries [decay], fluoride has been classified as essential to human health"5.
Governments have a responsibility to make decisions for the greater public good. Examples in public health include the chlorination of drinking water to prevent water-borne illnesses and the mandatory addition of folic acid, thiamine and iodized salt to bread in Australia to prevent spina bifida, neurological illnesses, goitre and the mental retardation associated with iodine deficiency. Our communities readily accept these and water fluoridation as simple, sensible, and highly effective public health measures.
Are there any adverse health effects associated with water fluoridation?
Drinking optimally fluoridated water is not harmful to human health. Water fluoridation is possibly the most widely studied public health measure of all time, and hundreds of studies over many decades have assessed possible associations between water fluoridation and a wide range of health conditions. Systematic reviews conducted in Australia and overseas consistently report that scientific evidence does not support an association between water fluoridation and any adverse health effect.
Water fluoridation will result in a slight increase in the incidence of dental fluorosis, seen as a slight mottling or flecking of tooth enamel. If it occurs, fluorosis is usually very mild, only detectable by a dentist, and does not damage the teeth. Tooth decay on the other hand is a destructive and disfiguring process, repair of which causes its own cosmetic problems, as well as pain, trauma, and significant financial cost. The benefits of fluoridation far outweigh any risks.
Could I be allergic or sensitive to fluoride in drinking water?
No. The American Academy of Allergy, Asthma, and Immunology and the Council of the British Society for Allergy and Clinical Immunology have both stated that "there is no evidence of allergy or intolerance to fluoride as used in the fluoridation of water supplies".
What do experts say about the safety and effectiveness of water fluoridation?
"Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride". National Health and Medical Research Council, 2007
"The benefits of fluoride for the prevention and control of dental caries have been known to the scientific and public health community for more than 60 years. Regrettably, particularly people living in developing countries and disadvantaged communities are deprived of fluoride for dental health". World Health Organization, 2007.
"…universal access to fluoride for dental health is a part of the basic human right to life". World Health Organization, 2006
"Fluoridation of drinking water…one of the ten great public health achievements of the 20th century". Centers for Disease Control, 2000
"There’s now solid scientific evidence that fluoride added to drinking water helps to protect your teeth from decay. The claims of those who oppose fluoridation are often based on outdated information, questionable research and selectively picking studies that support their case. There’s no convincing evidence for harmful effects from fluoride at the levels used in our water supply". Australian Consumers Association (Choice magazine), 2007
Water fluoridation is endorsed by the following Australian health and scientific authorities:
National Health and Medical Research Council
Australian Dental Association
Australian Medical Association
Royal Australian College of General Practitioners
Royal Australasian College of Physicians
Australian Academy of Science
Public Health Association of Australia
Australian Cancer Council
Kidney Health Australia
All Australian state and territory Departments of Health
1. Armfield JM, Slade GD, Spencer AJ. Water fluoridation and children's dental health: The Child Dental Health Survey, Australia 2002. Canberra: Australian Institute of Health and Welfare: AIHW Dental Statistics and Research Unit 2007.
2. Rugg-Gunn AJ, Do L. Effectiveness of water fluoridation in caries prevention. Community Dent Oral Epidemiol. 2012 Oct;40 Suppl 2:55-64.
3. Slade GD, Sanders AE, Do L, Roberts-Thomson K, Spencer AJ. Effects of fluoridated drinking water on dental caries in Australian adults. J Dent Res. 2013 Apr;92(4):376-82.
4. Cobiac LJ, Vos T. Cost-effectiveness of extending the coverage of water supply fluoridation for the prevention of dental caries in Australia. Community Dent Oral Epidemiol. 2012 Aug;40(4):369-76.
5. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. Canberra 2005; Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/n35.pdf.