Fluoride is one of the most talked about topics in dental health. It is found in many toothpastes and in the tap water of many Australian towns and cities. Some people are unsure whether it is safe or how much they actually need. The good news is that Australia’s peak health research body has looked at the evidence closely.
This article explains what the National Health and Medical Research Council says about water fluoridation. It also covers how fluoride toothpaste is used at different ages. The aim is to give you clear, plain information you can talk over with your dentist. It does not replace advice about your own teeth.
What community water fluoridation is
Community water fluoridation means adjusting the level of fluoride in public drinking water. The goal is to help protect teeth across a whole population. The fluoride level is kept within a range recommended by national health experts. Everyone who drinks the tap water gets the benefit without having to do anything extra.
The National Health and Medical Research Council, known as NHMRC, has supported community water fluoridation since 1952. It released its most recent public statement on 9 November 2017. That statement replaced an earlier 2007 version. The 2017 statement followed a review of the latest evidence, which NHMRC finished in 2016.
What the NHMRC found
The NHMRC 2017 public statement on water fluoridation says fluoridation safely and effectively reduces tooth decay across the population. NHMRC also describes it as safe, effective and ethical. The statement strongly recommends fluoridation within a range of 0.6 to 1.1 mg/L. This is the range NHMRC supports for Australian drinking water supplies.
The full NHMRC public statement gives figures for the benefit. It says water fluoridation reduces tooth decay by 26% to 44% in children and adolescents. In adults, the reduction is 27%. NHMRC also notes that Australians born after 1970 have about half the level of tooth decay of their parents’ generation.
Is water fluoridation safe?
Safety is the question many people ask first. NHMRC found no reliable evidence that water fluoridation at current Australian levels causes health problems. The statement says there is reliable evidence it is not associated with cancer, Down syndrome or cognitive dysfunction. It also says it is not associated with lowered intelligence or hip fracture.
Dental fluorosis is the one effect NHMRC discusses in detail. Fluorosis can change the look of tooth enamel when children take in more fluoride than they need. NHMRC says almost all dental fluorosis in Australia is very mild or mild and does not affect how teeth work. Moderate fluorosis is very uncommon and severe fluorosis is rare.
NHMRC links declining fluorosis to reduced fluoride from other sources such as toothpaste. That brings us to the way fluoride toothpaste is used at home. The amount a child uses, and whether they swallow it, makes a difference. Small changes in habit help keep fluoride at a sensible level.
Fluoride toothpaste at different ages
Australian dental health guidance says children under 18 months do not need toothpaste when brushing. Gently cleaning a baby’s first teeth is still a good habit. Our advice for parents of babies who are teething covers the early months. Your dentist or child health nurse can also help with questions.
From 18 months to 6 years, a children’s fluoride toothpaste with 500ppm of fluoride is recommended. This has less fluoride than adult toothpaste. Children under 6 should only use a smear of toothpaste on the brush. Parents usually need to help with brushing at this age.
From 6 years of age, adult toothpaste can be used. Adult toothpastes contain between 1000ppm and 1450ppm of fluoride. A pea sized amount is enough for older children and adults. NHMRC also advises using only a small pea sized amount and encouraging children not to swallow toothpaste.
Spit, do not rinse
One simple tip is easy to miss. After brushing, children are advised to spit out the extra toothpaste but not rinse with water. Leaving a little toothpaste on the teeth gives the fluoride more time to work. It is a small habit that many adults also find useful.
Some people like to try alternative products alongside their usual routine. Popular options include activated charcoal and miswak for teeth and gum health. If you use these, it is worth checking whether your routine still includes fluoride. Your dentist can help you decide what fits your mouth best.
Fluoride is one part of good oral health
Fluoride helps, but it works best as part of a wider routine. Regular brushing, cleaning between teeth and fewer sugary snacks and drinks all play a part. Regular dental checkups help catch problems early. Many people who lose teeth later in life end up looking at options like dental implants to restore your smile.
Fluoride intake can also come from foods, drinks and dental products. NHMRC notes this when it talks about the total amount people take in. That is one reason toothpaste amounts for young children are kept small. If you are unsure whether your tap water is fluoridated, your local water supplier is the best place to ask.
Frequently asked questions
What level of fluoride does NHMRC recommend in drinking water?
NHMRC strongly recommends community water fluoridation within the range of 0.6 to 1.1 mg/L. This is set out in its 2017 public statement. NHMRC says fluoridation at this level is safe and effective. It has supported fluoridation since 1952.
When should my child start using fluoride toothpaste?
Children under 18 months do not need toothpaste. From 18 months to 6 years, a smear of children’s toothpaste with 500ppm fluoride is recommended. From 6 years, a pea sized amount of adult toothpaste can be used. Ask your dentist if your child has special needs.
What is dental fluorosis?
Dental fluorosis is a change in the appearance of tooth enamel linked to fluoride intake in childhood. NHMRC says almost all fluorosis in Australia is very mild or mild. It does not affect how the teeth work. Severe fluorosis is rare in Australia.
Should my child rinse after brushing?
Children are advised to spit out the extra toothpaste rather than rinse with water. This leaves a little fluoride on the teeth. Encourage children not to swallow toothpaste. Supervising brushing helps younger children learn the habit.
This article is general information only and is not medical or dental advice. Speak with your dentist, doctor or a qualified health professional about your own or your child’s oral health.