Clinical context
Water fluoridation is a safe, effective and ethical way to help reduce tooth decay across the population and has long standing support of peak public health and dental authorities.
Water fluoridation
Water fluoridation is a proven method for reducing the prevalence of tooth decay in communities.
Surveys of tooth decay and dental fluorosis must be undertaken regularly, taking into account all fluoride sources and patterns of consumption in a community, in order to confirm the most appropriate water fluoridation concentration for that community or region.
The optimal fluoride concentration of community water supplies will normally be in the range of 0.6 to 1 milligram per litre (mg/Litre) of water (commonly known as parts per million or ppm).
The fluoride content of bottled water should be clearly stated on the label.
Fluoride supplements
Fluoride drops or tablets should only be taken (swallowed) under the direction of a dentist.
Fluoridated toothpaste
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 unless the tooth decay risk is deemed to be high, as assessed by a dentist.
For children aged 18 months to five years (inclusive), the teeth should be cleaned twice a day with toothpaste containing 0.5–0.55 mg/g of fluoride (500–550 ppm). Toothpaste should always be used under 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. If risk of tooth decay is increased, concentrations of fluoride greater than 550 ppm may be used as recommended by a dentist.
For people aged six years or more, the teeth must be cleaned twice a day or more frequently with standard fluoride toothpaste containing 1 - 1.5 mg/g fluoride (1000–1500 ppm). People aged six years or more should spit out, not swallow, and not rinse. Standard toothpaste is not recommended for children under six years of age unless on the advice of a dentist.
For children who do not consume fluoridated water or who are at elevated risk of developing tooth decay for any other reason, guidelines about toothpaste usage must be varied, as needed, based on dental professional advice. Variations could include more frequent use of fluoridated toothpaste, commencement of toothpaste use at a younger age, or earlier commencement of use of standard toothpaste containing 1mg/g fluoride (1000ppm). This guideline may apply particularly to preschool children at high risk of tooth decay.
For teenagers, adults and older adults who are at elevated risk of developing tooth decay, dental professional advice should be sought to determine if they should use toothpaste containing a higher concentration of fluoride (i.e. greater than 1000- 1500 ppm up to 5000 ppm of fluoride).
Manufacturers must avoid flavours that imitate too closely popular food tastes to avoid accidental ingestion of large amounts of paste by very young children.
Application of topical fluoride
Concentrated forms of fluoride should only be routinely applied by suitably qualified dental practitioners and should only be used after taking into account an assessment of an individual’s tooth decay risk conducted by a dentist.
Fluoride varnish should be used for people who have elevated risk of tooth decay.
High concentration fluoride gels and foams (those containing more than 1.5 mg/g fluoride ion) may be used for patients who have an increased risk of tooth decay.
Fluoride mouth rinses
Fluoride mouth rinses must not be used by children under the age of six years due to the possibility that they will ingest some of the product and increase their risk of dental fluorosis.
Fluoride mouth rinses may be used by people over the age of six years under the direction of a dentist where it is considered an appropriate choice for preventing tooth decay in high risk individuals and where there is certainty that the individual will understand that the product should be rinsed as directed and spat out, not swallowed.
Fluoride, diet and cleaning routines
The beneficial effects of fluorides must be understood in conjunction with all the major risk factors for tooth decay.
A person’s inappropriate dietary and other habits have the potential to overcome the beneficial effect of fluoride, with poor oral hygiene habits, and high frequency or prolonged exposure to dietary sugars and acidic foods and beverages, posing the highest risk.