Community water fluoridation, also known as artificial water fluoridation, is the addition of fluoride to drinking water with the aim of reducing tooth decay. This practice adjusts the natural fluoride concentration of water to that recommended for improving oral health. Good oral health is an integral part of good general health¹,  and allows people to eat, speak and socialise without discomfort or embarrassment. In Australia, dental health has improved since water fluoridation began in the 1950s and Australians born after 1970 have, on average, half the level of tooth decay of their parents’ generation².

In 2006, NHMRC undertook a systematic review of the evidence for the efficacy and safety of fluoride interventions. This review focused on sources that could be used to deliver fluoride to the Australian community including drinking water, milk, salt and topical fluoride treatments. The review, titled “A Systematic Review of the Efficacy and Safety of Fluoridation” (the 2007 Systematic Review) considered possible benefits and harms of these different sources of fluoride.

As a result of the 2007 Systematic Review, NHMRC released the NHMRC Public Statement: The Efficacy and Safety of Fluoridation (the 2007 Public Statement). This recommends that water be fluoridated in the target range of 0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries (tooth decay) and occurrence of dental fluorosis (mottling of teeth). It also states that fluoridation of drinking water is an effective way to ensure people across the community are exposed to fluoride and can benefit from its preventative role in tooth decay, regardless of age, gender or socioeconomic status.

• View more information on the 2007 Systematic Review and 2007 Public Statement

NHMRC’s evaluation of the evidence

At its meeting in November 2012, the Council of NHMRC (Council) advised that NHMRC consider options for investigating new evidence on the health effects of fluoridation. In response, on 20 June 2013, NHMRC hosted a meeting of experts in the field and state and territory government health representatives to consider NHMRC’s advice on water fluoridation. The main outcome of this meeting was that an update of the 2007 Systematic Review should be undertaken, subject to the availability of funding.

Following this meeting, Council reaffirmed its position on the 2007 Public Statement, and recommended that the Office of NHMRC update the body of evidence to include more recent studies and assess their relevance in the Australian context. An update of the evidence is now underway, and NHMRC has appointed a team from the University of Sydney to undertake an evaluation of the evidence on the health effects of water fluoridation.

Fluoride Reference Group

In May 2014, NHMRC established the Fluoride Reference Group to guide the evaluation of the evidence on the health effects of water fluoridation. The Fluoride Reference Group will consider the outcomes of the evidence evaluation and advise on how relevant these findings are for Australia, given that concerns regarding water fluoridation vary across international and geographic regions. The group will also use the findings to provide advice on a draft Information Paper, which will provide a summary of the evidence evaluation and its key findings.

• View more information about the Fluoride Reference Group

Public call for evidence and public consultation

The Australian community will be invited to submit published studies to be evaluated as part of the systematic review on the health effects of water fluoridation, a key component of the evidence evaluation. The public will also have an opportunity in 2015 to submit comments on the draft Information Paper during Public Consultation (see key milestones below).

Further information about the public call for evidence will be available by the end of July 2014.

Key milestones

Relevant resources

• A Systematic Review of the Efficacy and Safety of Fluoridation Part A
• A Systematic Review of the Efficacy and Safety of Fluoridation Part B
• NHMRC Public Statement: The Efficacy and Safety of Fluoridation 2007

Further information

For further information please contact NHMRC at fluoride@nhmrc.gov.au.

References

¹ Australian Institute of Health and Welfare 2012. Australia’s health 2012. Australia’s health series no.13. Cat. no. AUS 156. Canberra: AIHW

² Australian Institute of Health and Welfare 2012. Australia’s Health 2012: in brief. Cat. no. AUS 157. Canberra: AIHW

Website