9. Fluoride
9. 1 What is fluoride
Fluoride is a naturally occurring mineral found:
- in plants, rocks, and at very low levels in almost all fresh water
- in virtually all foodstuffs, in trace amounts
- naturally at a beneficial level in the local water supplies of some Victorian communities and added to some community water supplies to achieve optimal levels, assisting in the prevention of dental caries.
9.2 The role of fluoride in oral health
Fluoride protects both developing and erupted teeth against caries, and therefore benefits people of all ages. The presence of fluoride in the pre-eruptive phase is incorporated into the developing tooth structure where it renders the tooth more resistant to later acid attack.
In the post-eruptive phase, fluoride acts as a constant ‘repair kit’ for teeth, after it is redistributed into saliva. Following acid attacks which remove calcium and phosphate from the tooth surface (demineralisation), the fluoride in saliva interacts with these minerals and salts at the tooth surface to remineralise the damaged enamel.
A constant supply of a low level of fluoride within the saliva is beneficial for replacement of lost minerals and therefore reduction of dental caries.
9.3 Fluoride in toothpaste
Fluoridated toothpaste is effective in the prevention of dental caries.
In countries where toothpaste use is widespread, fluoride toothpastes are probably the most important method for the topical application of fluoride
(Chu, Mei & Lo 2010).
The most common concentration of fluoride used in adult toothpaste is 1,000 ppm (parts per million). Low-fluoride concentration toothpastes typically contain 500–550 ppm and are designed for younger children aged from 18 months up to six years.
Toothpastes with a higher concentration of fluoride are available for use under the direction of a dental practitioner
If a family is concerned that their child’s access to fluoridated water, encourage them to book in with an dental practitioner, who can recommend children or adults use a higher strength fluoride toothpaste.
9.4 Fluoride supplements
Fluoride supplements are no longer recommended and have long been unavailable in Australia.
9.5 Water fluoridation
Water fluoridation is the most effective way to give everybody access to the benefits of fluoride regardless of age, income or education level, and because community water fluoridation reduces the prevalence of dental caries in both children and adults, it has been recognised as an important public health achievement (Department of Health 2023a).
Some water supplies naturally contain optimal levels of fluoride. Water fluoridation is the adjustment of the amount of fluoride in the community water supply to a level recommended for optimal dental health benefits.
Fluoride does not alter the taste or smell of water.
- Fluoride was first introduced in Australia over 70 years ago in 1953 in Beaconsfield, Tasmania.
- Today, approximately 90% of Australians can access fluoridated drinking water, including residents of all capital cities.
- More than 97% of Victorians drink water with either naturally occurring or added fluoride.
- Melbourne and some regional areas have enjoyed the benefits of fluoridated drinking water for nearly 50 years.
To see which Victorian suburbs are fluoridated visit:
Is my water fluoridated?
For more information on community water fluoridation Department of Health Water fluoridation in Victoria
Community action: Water Fluoridation in Cohuna
Visit the OHV 'Community water fluoridation' page to access our fact sheet and read a case study on how the Gannawarra community successfully secured water fluoridation for the rural town Cohuna.
9.5.1 Water filters
Some types of water filters may remove fluoride, including:
- reverse osmosis
- distillation
- ion exchange.
These types of filters are generally designed for specialised purposes and not commonly used in households that receive fluoridated tap water. Since fluoridated water in Australia, including Victoria, meets strict safety and quality standards, most people use simpler and more affordable filtration systems that do not remove fluoride.
Some families may seek them specifically to remove fluoride, but this is unnecessary and not advised. Fluoride in tap water is added at safe levels to help prevent tooth decay and improve oral health, particularly for children. Removing it can reduce these important health benefits.
What if the tap water tastes bad?
Normal membrane filters will not remove a small ion such as fluoride (Cameron & Widmer 2022). These include:
- carbon filters
- ceramic filters.
For families who find local tap water unpleasant tasting, filters can improve flavour while keeping the fluoride. Carbon filters, for example, reduce chlorine and other taste-affecting compounds and are widely available in filtered water jugs.
Families should ensure the filter does not remove fluoride. Regular tap water use for drinking and cooking supports hydration and good oral health.
9.5.2 Bottled water
Bottled water is generally not fluoridated, unlike most tap water in Victoria. While some bottled water brands may contain naturally occurring fluoride, it is typically at much lower levels than those added to tap water for dental health benefits. Families should be aware that relying on bottled water may mean missing out on the protective effects of fluoride in preventing tooth decay.
9.5.3 Tank water
Tank water is likely to have suboptimal fluoride levels. Families using tank water should not supplement their fluoride intake independently. Encourage families using tank water to consult an oral health professional, who can assess whether fluoride treatments or higher-strength toothpaste may be appropriate.
9.5.4 Boiling water for infants under 12 months
9.6 Fluoride varnish
Fluoride varnish is a high concentration fluoride product that can prevent tooth decay from starting. It can also slow or stop the progression of already established decay and support the remineralisation teeth. The varnish is quick and easy to apply to all surfaces of both deciduous and permanent teeth with a small brush or cotton bud.
Only certain health professionals can apply fluoride varnish onto teeth, these include oral health professionals, Certificate IV dental assistants and specially certified Aboriginal health practitioners.
The varnish can stick to the teeth for hours, and can be seen on the teeth, until it dissolves away. Fluoride varnish works best if applied at least twice a year. Individuals at the highest risk of dental caries benefit the most from fluoride varnish applications.
Aboriginal Health Practitioner Fluoride Varnish (AHP FV) Program Amendments to Victorian Fluoride Regulations in 2022 now enable Aboriginal Health Practitioners (AHP) to Aboriginal Community Controlled Health Organisations employ AHPs who work closely with their communities If you work with an AHP who is interested in becoming accredited to apply fluoride varnish, |
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9.7 Safety of fluoride
Studies have confirmed that fluoride effectively prevents and reduces tooth decay without negatively effecting health, when used in the modalities and quantities recommended.
There is no credible evidence to suggest that fluoride, at the levels typically encountered by the Australian public, is linked to anything beyond mild, and occasionally moderate, dental fluorosis (see 9.8 Dental Fluorosis).
As a trusted health professional, it is appropriate for you to reassure curious families that fluoride is safe. Maternal and Child Health Nurses and other non-oral health professionals are not expected to engage in deep or detailed discussions with families about fluoride. Rather, encourage them to seek information from an oral health professional directly.
9.8 Dental Fluorosis
Dental fluorosis is the defective formation of tooth enamel or dentine as a result of excessive fluoride ingestion during the period of tooth development, such as when young children swallow excessive amounts of toothpaste. It has been reported that the risk of fluorosis in Melbourne has not increased since the introduction of community water fluoridation in 1977, and that the degree of fluorosis in Melbourne is mild and within expected limits of an optimally fluoridated community.
In its mildest (and most common) form, fluorosis may manifest as barely noticeable whitish striations on the teeth, while more severe forms involve confluent pitting and staining of the dental enamel. Determining the exact level of fluorosis within the community is difficult, as there are numerous other causes of enamel defects that may resemble fluorosis. The mild fluorosis also comes with the added bonus of protecting those same teeth against decay.
The risk of fluorosis can be minimised by:
- not letting children to lick, suck or swallow toothpaste
- brushing a child’s teeth using only water until they are 18 months of age, unless otherwise recommended by a dental professional
- using only a pea-sized amount of low-fluoride toothpaste
- Helping children learn the and practice the skill of spitting out toothpaste
9.9 Fluoride and infant formula
Historically, infant formula powder was manufactured with relatively high fluoride content, and when reconstituted with fluoridated water, there was potential for exposure to high levels of fluoride in relation to body weight (ARCPOH 206). This is no longer a concern: ‘Infant formula nowadays is safe for consumption by infants when reconstituted using fluoridated or non-fluoridated water’ (ARCPOH 2006, p. 196). In order to limit the amount of fluoride in formula, infant formula manufacturers use non-fluoridated or de-fluoridated water in processing (NHMRC 2003). Australian research demonstrates that regardless of the type of water used to reconstitute infant formula, no significant association exists between use of formula and dental fluorosis.
Food Standards Australia New Zealand is an independent statutory authority that develops food standards to protect the health and safety of the public. Standard 2.9.1 of the 2024 revised Australia New Zealand Food Standards Code relates to infant formula products.
Clause 5 sates that the powdered or concentrated infant formula and follow-on formula must not exceed 17 μg/100 kJ, and ready-to-drink forms must not exceed 24 μg/100 kJ. These same limits are applicable to special medical purpose product for infants under clause 29.
For further information see, Department of Health -Fluoride and infants
For more information about fluoride use in Australia read:
Research Centre for Population Oral Health Guidelines for use of fluorides in Australia: update 2019
