The following are the highlights of the Guidelines:
Dental fluorosis
Australia’s approach to the use of fluorides has given primacy to achieve a near maximal reduction in dental caries without an unacceptable level of dental fluorosis. Nearly 90% of Australians live in areas with fluoridated drinking water. In addition, most Australian children and adults brush with a fluoridated toothpaste. Water fluoridation, toothpaste use and other fluoride sources are associated with an increase in the prevalence of any fluorosis.12–15
… The National Child Oral Health Study 2012–14 provided the first ever national snapshot of the prevalence and severity of dental fluorosis in Australian children. Any level of fluorosis experience (a Thylstrup and Fejerskov (TF) score of 1+) was found in one in six Australian children. However, just under 1% of children had more definitive dental fluorosis (having a TF 3+ score). Very few children were observed with moderate to severe dental fluorosis (TF scores of 4 or 5)…
Dental caries in children
In the 2012–14 National Child Oral Health Survey, over 40% of children aged 5–10 years had caries in their primary teeth with a mean decayed, missing or filled teeth (dmft) of 1.5.11 Over a quarter of 5- to 10-year-old children had untreated dental caries in their primary dentition. Just under one-quarter of children aged 6–14 years had experienced caries in their permanent teeth with a mean decayed, missing or filled permanent teeth (DMFT) of 0.5. Furthermore, over one in ten with untreated dental caries in their permanent teeth…
Dental caries in adults
Dental caries affects a large majority of Australian adults.3 Dental caries experience is strongly age-related. Some three quarters of young adults aged 15–34 years had caries, whereas almost all adults of older ages had dental caries experience. People aged 15–34 years had on average 4.5 teeth affected by caries, but those 55+ years, born before the commencement of fluoride use in Australia had more than 20 teeth affected.
The 2019 Guidelines on water fluoridation
Therefore, the Workshop supported the continuation of water fluoridation at current Australian levels and recommended:
(1) Water fluoridation should be continued as an effective, efficient, socially equitable and safe population approach to the prevention of caries in Australia.
(2) Water fluoridation should be extended to as many non-fluoridated areas of Australia as possible, supported by all levels of Government.
(3) The level of fluoride in the water supply should be within the range 0.6–1.1 mg/L. Note to Recommendation # 3: Individual states and territories have set targets and tolerances for fluoride in their water supplies with all being within the range 0.6–1.1 mg/L.
(4) For people who choose to consume bottled or filtered water containing fluoride, manufacturers should be encouraged to market bottled water containing approximately 1.0 mg/L fluoride and water filters that do not remove fluoride. All bottled water and water filters should be clearly labelled to indicate the concentration of fluoride in water consumed or resulting from the use of such products.
(5) People in non-fluoridated areas should obtain the benefits of fluoride in drinking water using bottled water with fluoride at approximately 1 mg/L.
The 2019 Guidelines on fluoridated toothpaste
(6) From the time that teeth first erupt (about six months of age) to the age of 17 months, children’s teeth should be cleaned by a responsible adult, but not with toothpaste.
(7) For children aged from 18 months to five years (inclusive), the teeth should be cleaned twice a day with toothpaste containing 0.5–0.55 mg/g fluoride (500–550 ppm). Toothpaste should always be used under the supervision of a responsible adult. A small pea-sized amount should be applied to a child-sized soft toothbrush and children should spit out, not swallow, and not rinse. Young children should not be permitted to lick or eat toothpaste. Standard toothpaste is not recommended for children under 6 years of age unless on the advice of a dental professional or a trained health professional.
(8) For people aged 6 years or more, the teeth should be cleaned twice a day or more frequently with standard fluoride toothpaste containing 1–1.5 mg/g fluoride (1000–1500 ppm). People aged 6 years or more should spit out, not swallow, and not rinse.
(9) For people who do not consume fluoridated water or who are at elevated risk of developing caries for any other reason, guidelines about toothpaste usage should be varied, as needed, based on dental professional or trained health professional advice. Variations could include more frequent use of fluoridated toothpaste,
commencement of toothpaste use at a younger age, or earlier commencement of the use of standard toothpaste. This guideline might be applied particularly to preschool children at elevated risk of caries.
(10) For teenagers, adults and older adults who are at elevated risk of developing caries, dental professional or trained health professional advice should be sought to determine if they should use toothpaste containing a higher concentration (5 mg/g or 5000 ppm) of fluoride.
The 2019 Guidelines on fluoride supplements
(11) Fluoride supplements in the form of drops or tablets to be chewed and/or swallowed, should not be used.
The 2019 Guideline on fluoride mouth rinses
(12) Children below the age of 6 years should not use fluoride mouth rinse.
(13) Fluoride mouth rinse might be used by people aged 6 years or more who have an elevated risk of developing caries. Fluoride mouth rinse should be used at a time of day when toothpaste is not used, and it should not be a substitute for brushing with fluoridated toothpaste. After rinsing, mouth rinse should be spat out, not swallowed.
The 2019 Guideline on fluoride varnishes
(14) Fluoride varnish should be used for people who have an elevated risk of developing caries
Fluoride gel and foam
[Gels]… they are contra-indicated for use in children under the age of 10 because large amounts of fluoride can be ingested. …
[Foam] There is no evidence to support the use of foam.45
The 2019 Guideline on silver diamine fluoride
(16) Silver diamine fluoride or silver fluoride might be used for people with caries in situations where traditional treatment approaches to caries management might not be possible.
Safety of water fluoridation
The NHMRC Review searched the post-2006 literature for evidence of possible harmful effects of water fluoridation on human health.15 The NHMRC Review concluded that water fluoridation at current Australian levels is not associated with cognitive dysfunction, lowered IQ, cancer, hip fracture and Down syndrome. There was no reliable evidence of an association between water fluoridation at current Australian levels and other human health outcomes…
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