Forty FAQs on Fluoridation

Fluoride is a naturally occurring mineral compound. It has been found to help prevent tooth decay.

The element Fluorine (F) is abundant in the earth’s crusts as fluoride in rocks and soil. Ground water moving through rocks and soil, dissolves these fluoride minerals; fluoride ions remain in the water.

Some natural wells and springs have naturally very high levels of fluoride: this can depend on the water depth and on the high quantity of fluoride minerals in the area.

Fluoride ions are also present in seas, lakes and rivers, as well as rainwater.

Water fluoridation is the adjusting or topping up the levels of naturally occurring fluoride in the water to strengthen teeth against tooth decay. Fluoridation is not really adding fluoride to water: it is already a natural component of water.

Fluoride from toothpaste and fluoridated water is taken up by tooth enamel and strengthens teeth against bacterial acid attacks that cause decay. 

It's important to note that almost all water supplies have naturally occurring fluoride at different levels.  Many towns in western Queensland already have fluoride at around ideal levels, but most regional towns and cities have around 0.1-0.2 ppm fluoride naturally present. 

Currently recommended levels in Queensland are around 0.6-0.8 ppm for SEQ, and up to 0.7 for hotter parts of Qld, where people are likely to drink more water. Naturally occurring fluoride levels are topped up to these levels. 

Seawater contains around 1.2-1.5 ppm fluoride, almost double the level in drinking water.        

Water fluoridation has been described as one of the "Ten Great Public Health Achievements of the 20^th Century" (US-based Centers for Disease Control and Prevention) and has been widely accepted and practiced in all Australian states and territories since the 1960s and 70s. 

Studies in Australia and overseas consistently report reduced tooth decay in children and adults who drink fluoridated water. The average from many studies is around 40% reduction in tooth decay experience.

Back in 2002 Australian Child Dental Health Survey examined more than 136,000 children across Australia, and specifically recorded whether they drank fluoridated water or not. The survey found that no matter which state or territory children came from, what age group they were, whether they were rich or poor or in between, whether they lived in the capital city or regionally or remotely, children who drank fluoridated water had significantly less tooth decay than children who didn't. 

Australian Child Dental Health Surveys are conducted every year or two, and invariably continue to show that Queensland children (until recently largely non-fluoridated) have significantly more tooth decay than children from other states (fluoridated for longer). 

Fluoride strengthens enamel at all ages and all stages of tooth formation.

We used to think that fluoride worked systemically, and was primarily beneficial for children i.e., fluoride from fluoridated water or fluoride tablets was ingested and absorbed, some of this fluoride ended up in developing tooth buds, and the erupting teeth contained more fluoride and were therefore more acid resistant. 

That process does occur, but more recent studies show that the protection against acid attack of this fluoride in the enamel is not as great as originally thought. 

The majority effect of fluoride is a topical effect i.e., fluoride coming into direct contact with teeth that have already erupted. 

Tooth enamel is subject to an endless cycle of demineralisation after acid attacks from food and drink, and remineralisation through saliva and fluoride vehicles. If the remineralisation also involves fluoride, the enamel becomes more resistant to acid attacks.

This is also the reason why dentists now encourage everyone to spit out after brushing, but don’t rinse out. This will help to maintain a small reservoir of fluoride and calcium in the mouth that will aid remineralisation for hours. Not rinsing after brushing is particularly important for those who are at high risk of caries.

The majority effect of fluoride is a topical post-eruptive effect; this is why dental associations and public health authorities no longer recommend fluoride tablets for children.  It is also the reason why adults of all ages who have natural teeth can continue to strengthen their teeth from drinking fluoridated water and using fluoride toothpaste.

Since 2006, fluoride supplements in drops or tablets to be chewed or swallowed are not routinely indicated because the beneficial effect of fluoride is mainly topical, not systemic, There are other reasons though: firstly, those who take fluoride supplements regularly are rarely in the high-risk groups. Secondly, compliance with this type of treatment in the higher needs groups is poor. Thirdly, a risk of fluorosis exists because of the availability of fluoride from other sources. ADA agrees that: “Fluoride supplements in the form of drops or tablets to be chewed and/or swallowed, should not be used”. There are better ways of reducing caries risk than fluoride tablets and drops. Optimally fluoridated drinking water is one.

Because it’s the easiest, cheapest, most effective and safest way to provide the dental health benefits of fluoridated water to the greatest number of people. No behaviour change is needed. Changing people’s behaviour, particularly those with the highest caries risk, is often very difficult.

Only a very small amount of swallowed fluoride will get into saliva systemically, but even this very low level has a beneficial effect. It may not contribute to remineralisation of the enamel, but will work to inhibit demineralisation, which is equally important to maintain healthy teeth throughout life.

The harms of smoking and the public health benefits of seat belts and parachutes have never been demonstrated through randomised controlled trials either, but we’re fairly certain of their impacts on public health!

Randomised controlled trials are the gold standard for individual treatments, but they are not appropriate to assess population health measures because they are usually impossible to conduct and/or unethical.

Water fluoridation requires large water treatment plants, and it is impossible to randomly allocate individuals to receive fluoridated water or non-fluoridated water. Moreover, “non”-fluoridated water will still contain lower levels of fluoride).

The 2017 NHMRC, National Health and Medical Research Council review found reductions of 26-44% in children and adolescents, and 27% in adults. Other international reviews have found similar reductions. This reduction in decay levels is above and beyond the reduction already achieved through the use of fluoride toothpastes.  

DMFT is the sum of the number of Decayed, Missing due to caries, and Filled Teeth in the permanent teeth. It's important to note that using DMFT score systems will underestimate the benefit of water fluoridation. 

If we prevent one permanent tooth cavity in a school child, we don't just prevent one filling. Dentists may prevent a whole lifetime of treatment on that tooth, with each successive treatment becoming larger, more complex and more expensive. Replacement fillings get bigger and bigger, then one or two cusps are snapped off and the tooth needs a crown. Then the nerve dies, and the tooth needs a root filling, plus another crown on the top. The DMFT score hasn’t changed, but the impact on the patient has been significant. 

Yes.  Fluoride is a natural substance already found in all rivers, lakes and oceans in varied quantities. It has been widely used in many countries since its introduction in America in 1945.  Water fluoridation is the most effective, cheapest and safest way of delivering the benefits of fluoride to the community, particularly to those with the greatest dental needs; elderly and infirm people, children, and residents of low socio-economic areas.

For many decades almost every city in Australia was fluoridated, and Brisbane and most regional Queensland cities weren't.  If fluoridation were dangerous, wouldn't we have started to see some evidence by now, that people in other states had more cancer, more kidney disease, more broken bones, lower IQs, than Queensland? There are no differences.

No, this is a myth. If fluoride levels in the water did delay eruption, we expect that caries experience in fluoridated areas would eventually catch up with that in non-fluoridated areas, but that’s not what we see. The difference in decay levels between fluoridated and non-fluoridated areas lasts a lifetime. 

The study “Does fluoride in drinking water delay tooth eruption?” was published in the Journal of Public Health Dentistry in 2014. It was the largest study of its type, and it counted the number of permanent teeth in over 13,000 American children aged 5-17 and recorded whether the children lived in areas with <0.3, 0.3-<0.7, or 0.7-1.2 ppm of fluoride. The study found almost no difference for any age and for any concentration of fluoride in the water.  

No, paediatricians agree that optimally fluoridated water poses no health risks to babies or young children.

Water fluoridation at around 1 part per million has been delivered around the world for more than 70 years. It is endorsed by the Australian Medical Association, World Health Organization, the American Academy of Paediatrics and Australian paediatricians, and poses no health risks for babies and young children. Water fluoridation gives babies and young children the best possible chance to grow up with healthy teeth. 

Yes. The chance of developing dental fluorosis from infant formula is low. Parents or caregivers should talk with their dentist about what's best for their child's health. If parents or caregivers remain concerned about the small risk of dental fluorosis, they can still choose non- fluoridated water for formula.

These claims have been analysed by health experts around the world and repeatedly rejected. Most of these studies investigated towns in remote parts of China with far higher levels of fluoride than used in community water fluoridation. None were conducted in artificially fluoridated towns and cities. The studies were poorly conducted, failed to control for other factors known to affect brain development, and were published in very poor-quality journals. Most demonstrated an appalling knowledge of public health research and were clearly biased. Interestingly, the towns in these comparison studies where children recorded the highest IQs tended to have fluoride levels much closer to those used in community water fluoridation.

Townsville and most Australian towns and cities outside Queensland have enjoyed the benefits of fluoridated water for around 70 years. All Australian capital cities apart from Brisbane were fluoridated in the period 1964-77. Townsville has been fluoridated since 1964.  Most American towns and cities have been fluoridated for 70 years. Has fluoridation affected everyone’s IQs there? 

Apart from poor quality studies, there has never been any suggestion from health, scientific or educational experts that residents of Townsville, Sydney, Melbourne, Canberra, Adelaide, Perth, Hobart, Darwin and the hundreds of other fluoridated towns and cities in Australia and elsewhere have lower IQs than residents of non-fluoridated towns and cities. Another example: children in Singapore, Hong Kong and South Korea record some of the top academic scores in the world, and their water has been fluoridated for decades.    

Water fluoridation has been practised around the world since 1945. It is well known in the scientific community that average IQ scores around the world have been steadily increasing since at least the middle of the 20^th century, a phenomenon known as the Flynn Effect. This has been found in all countries in which IQs have been measured, and the rise in average IQ has occurred equally in both fluoridated and non-fluoridated countries.

The Dunedin study, which follows over 1,000 children from their birth in 1972, has over the years found associations between socioeconomic status, breastfeeding, low birth weight and IQ, but no association between drinking of fluoridated water, use of fluoride toothpaste or fluoride tablets and IQ, both before and after adjusting for the other variables.

A very strong and particularly interesting Swedish study was published in 2017. Authors looked at 728,000 young adults (almost all those born in Sweden between 1985-92) and assessed their exposure to fluoride, their dental health, their IQs, and their incomes up to the age of about 30. 

Fluoride is almost always naturally found in water supplies, and in Sweden, the levels vary between 0-4 ppm F. These levels are regularly monitored, so authors could estimate people's lifetime fluoride intakes simply by finding out where they'd lived. Swedish children have IQ tests at around age 16. Until recently, military service was mandatory for young men, and they also had IQ tests on entry into the military.

The most interesting thing about the Swedish study is not the predictable finding of a positive correlation between fluoride levels in drinking water and dental health but that: fluoride improves later market outcomes, which indicates that good dental health is a positive factor on the labour market. The authors were economists, not dentists, with no axe to grind.

No.  Osteoporosis Australia endorses water fluoridation, as does Arthritis Australia.

The 2017 NHMRC fluoride reviews states that “The evidence shows that there is no association between water fluoridation at current Australian levels and hip fracture”, and there was insufficient evidence to assess the risk of any other fractures. 

The strongest ever study on this topic, “Estimated Drinking Water Fluoride Exposure and Risk of Hip Fracture: A Cohort Study” was published in the Journal of Dental Research in 2013. It was a Swedish study, and it examined almost 500,000 people born between 1900 and 1920. Swedish medical records are among the best in the world, and they recorded more than 50,000 hip fractures from 1900 to 2006, and recorded whether their town water had very low, low, optimal, or high levels of fluoride. The study found no increased risk of hip fractures due to the level of fluoride in the water. There is unlikely to ever be a stronger study on fluoride and hip fractures than this. It is the definitive study on the topic.

No. Kidney Health Australia supports the National Health and Medical Research Council which confirms no evidence has ever been found to confirm a link between fluoride in water at optimal levels and chronic kidney disease.

No. The AMA and Cancer Council endorse water fluoridation, as does the National Cancer Institute in the United States.

There is no association known between community water fluoridation as practiced in Australia, and any form of cancer, including osteosarcoma and Ewing sarcoma.

Skeletal fluorosis causes stiffness and pain in the joints due to increased bone density. It is occasionally seen in parts of the world with extremely high concentrations of naturally occurring fluoride in the water.

Skeletal fluorosis has never been recorded in Australia to our knowledge. Some rare cases reported in the American scientific literature have been in people with psychological or psychiatric conditions who ingest extremely high levels of fluorides e.g., adults eating large amounts of toothpaste or drinking incredible amounts of tea over many decades. 

Of course not. Fluoride is a nutrient, not a medicine.

In 2006, the National Health and Medical Research Council, Australian Department of Health and Ageing, and the New Zealand Ministry of Health described fluoride as a ‘nutrient’ in the Nutrient Reference Values for Australia and New Zealand document, adding that "Because of its role in the prevention of dental caries [decay], fluoride has been classified as essential to human health". 

The fact is that we don’t know if fluoride is an essential element for humans or not, as it is almost impossible to construct a diet that does not contain fluoride. Fluoride is found in virtually all food and water. Even if we could construct a diet without fluoride, its proven benefits for dental health would prevent ethical approval of such a study.  If not essential in the strictest sense of the word, fluoride is still highly desirable for optimal public health.

All government decisions will inconvenience some people, but governments have a responsibility to make decisions for the greater public good.

Examples in public health include the chlorination of drinking water to prevent water-borne illnesses, the mandatory addition of folic acid, thiamine and iodized salt to bread in Australia since 2009 (only specialised organic bread is exempt from these requirements) to prevent spina bifida, neurological illnesses, goitre and the intellectual disability associated with iodine deficiency. 

Are these also mass medication? Of course not. The incidence of spina bifida and neural tube defects has decreased in Australia since this legislation was passed, particularly in teenage mothers (55% decrease) and Aboriginal and Torres Strait Islander women (74% decrease). 

Our communities readily accept these as simple, sensible, and highly effective public health measures. So is water fluoridation.  

Current Queensland legislation puts the responsibility on to local councils, but the Australian Dental Association strongly believes that decisions about fluoridation should be made at levels having significant public health expertise i.e., state or federal governments.

In 1968, the Tasmanian Royal Commission into Fluoridation in 1968 has already defined fluoridation decisions as a matter of public health: it is a matter for the decision of Parliament.

Anti-fluoridation groups are known for bombarding communities with scaremongering information with not a shred of truth, and many people will then vote against fluoridation because of those doubts.

However, as long as the decision remains with councils, Queensland Health and the Australian Dental Association will provide as much advice and help as needed.

There is no constitutional right to drink fluoride-free water, just as there is no constitutional right to drink chlorine-free water. Everyone is free to choose whether to drink fluoridated water or not, but governments have a responsibility to balance the best possible community health outcome with individual choice.

The vast majority of people in Australia have been drinking fluoridated water for decades.  It’s important to note that even ‘non-fluoridated’ water will still usually contain fluoride. Anyone who for whatever reason does not wish to drink optimally fluoridated water is probably already drinking tank water, filtered water, or bottled water.

They are perfectly entitled to continue doing this if they wish, but they shouldn't be able to prevent Australians who want to drink fluoridated water from doing so. Fluoride is a natural component of almost all water supplies and foods.

In many places the fluoride levels are sub-optimal for dental health, but some places e.g., many western Queensland towns, have higher natural levels of fluoride in their bore water. In these cases, state governments intervene to make available water that is safer to drink and better for oral health.

We all have a moral responsibility to help each other to lead healthier and happier lives, and water fluoridation is one small way of contributing to this.

We know that people who are well educated and well off are more likely to have good general and dental health. The reverse also applies - people who are not well educated and not well off tend to have poorer general and dental health. It's what we call the social determinants of health. It's very easy to say it's 'their' problem - they don't brush their teeth, or they eat and drink rubbish. That might sometimes be correct, but we now have plenty of research evidence showing that it's not as simple as that.

Low socio-economic status is associated with earlier bacterial colonisation on children's teeth and higher levels of the bacteria that cause decay. We have hundreds of species of bacteria in our mouth, but <1% of those bacterial species contribute to tooth decay. The isolation, boredom and depression often resulting from poverty are associated with less healthy behaviours. Less healthy, high-energy-density diets tend to be cheaper than healthier, nutrient-dense diets - important if you don't have much money.

Low socio-economic status, malnourishment and more life stresses in children are independently associated with weaker enamel, which in turn is associated with more tooth decay, particularly in children from low socio-economic backgrounds. Considerable research shows that less social support and higher stress levels are associated with tooth loss.

Moreover, there are many groups of people who often simply cannot maintain their dental health as well as they need to, for various reasons: people with mental health conditions, disabilities, dementia, frail elderly people, those taking medications that dry their mouth and greatly increase their risk of tooth decay, people in nursing homes and care facilities with limited access to dental care, people with drug dependencies. It's not just a case of saying that it's 'their' fault, and 'they' need to brush better or eat better. To some extent we are all each other’s keeper, and water fluoridation particularly helps those people who haven't had the advantages in life that most of us take for granted.

It's not well known, but many public health interventions (seat belts, motorbike helmets, screening for breast cancer, etc) cost the community more money than they return. That's not a problem - most of us think better health is worth paying a bit of money for. But water fluoridation is one of the very few public health initiatives that save far more money than what they cost to implement. Every dollar spent on water fluoridation will save many dollars in saved treatment costs, and that's even ignoring the reductions in pain and discomfort and time off school and work, and the benefits of a healthier smile. And in what is a complex scientific issue, who are you going to believe and take advice from - every reputable medical, dental, health and scientific authority and health department in the country, or a conspiracy theory fringe group?

No country in Europe has banned fluoridation. The EU allows water fluoridation in any European country. The Republic of Ireland is the only European country where most people drink fluoridated water, and England and Spain have much lower levels of fluoridation. Most European countries have elected not to fluoridate their water supplies for practical or political reasons or simply because of vocal opposition. Many European cities rely on multiple water sources that make water fluoridation less practical. Germany, France, Austria, Switzerland, Spain and the Czech and Slovak Republics use fluoridated salt (at around 250 ppm), and other countries have used fluoride supplements, or have comprehensive public dental services and programs in which fluorides continue to feature strongly.   

There is a site that purports to collate European authorities’ position against water fluoridation. The Fluoride Action Network has selected quotes, mostly from sources with no health or scientific expertise. Many are from water authorities, which tend to oppose fluoridation since they usually pay for it. Almost no health authorities are quoted, but some of the letters note fluoride’s beneficial effect on teeth. Connett does not include a copy of the original letter sent out and does not indicate how many authorities were approached or how many of the letters received were included on this site. As responses from health and scientific experts are limited, the strong impression is that letters were only sent to likely opponents of fluoridation or were only included if they contained quotes which could be misconstrued to indicate official opposition. 

In 2002, Queensland Health commissioned an independent report into the cost effectiveness of water fluoridation. This 2002 Impact Analysis of Water Fluoridation investigated many different scenarios and found that if most Queensland towns were to be fluoridated, the expected cost benefit to the state would be somewhere in the range of ~$400 million to over $1 billion (at 2002 figures). A similar investigation in Melbourne reported that the first 25 years of fluoridation in Melbourne saved more than a billion dollars in dental costs. 

A 2012 cost-effectiveness research study from the UQ School of Population Health (Cobiac & Vos, published in Community Dentistry and Oral Epidemiology) concluded that "Extending coverage of fluoridation to all communities of at least 1000 people will lead to improved population health, with a dominant cost-effectiveness ratio and 100% probability of cost-savings". 

Cost-effectiveness studies in the US show very similar results. Fluoridation is one of the few public health measures that not only improves health, but also saves money. A lot of it. 

Yes. A reverse osmosis filter will remove around 90% of the fluoride from water but will also remove other beneficial minerals.

Activated carbon filters with alumina will remove most fluoride from water but will leave a higher level of aluminium in the water.

The commonly used charcoal or carbon filters will not remove fluoride from the water.     

No. The American Academy of Allergy, Asthma, and Immunology and the Council of the British Society for Allergy and Clinical Immunology have both stated that “there is no evidence of allergy or intolerance to fluoride as used in the fluoridation of water supplies”.

The claim about 1% of people being allergic or sensitive to fluoride has been around for decades and is based on poor quality research.

Allergy specialists in the US and in Australia (they're all Fellows of the Australasian College of Physicians, which supports fluoridation) reputable medical groups around the world from the WHO down make no such claims. The AAAAI specifically considered the 'research' claimed to support the allergy claims, and they rejected it. Reading between the lines it's clear that they thought the research was rubbish. They were correct.  

People who claim allergic reactions when water fluoridation is introduced conveniently forget that almost all water sources already contain small amounts of fluoride. It's completely illogical to claim an allergy when water fluoridation simply represents a small increase in the level of fluoride already found naturally in the water. Has anyone ever claimed an allergy to the natural levels of fluoride in ‘non-fluoridated’ drinking water, including bore water that sometimes even contains fluoride at higher levels than used in community water fluoridation? Sea water contains around 1.2-1.5 parts per million fluorides, more than most drinking water. Has anyone ever claimed an allergy to fluoride from swimming at the beach? Anyone ever likely to?

Yes. Here’s a list of some:

World Health Organisation

National Health and Medical Research Council

Australian Academy of Science

Australian Medical Association

Australian Dental Association

Royal Australian College of General Practitioners

Royal Australasian College of Physicians

Public Health Association of Australia

Queensland Health and every State and Federal Health Department in Australia

Centers for Disease Control

American Medical Association

U.S. Public Health Service

Royal College of Physicians

British Medical Association

UK Medical Research Council

UK National Health Service

and many others.

While we respect the right of those opposed to fluoridation to hold those views, the science and decades of experience are very clearly on the side of fluoridation.

Yes. There’s no need for the fluoride chemicals to undergo randomised clinical trials to determine their safety, because none of the chemical is left in the water for people to drink.  Only three chemicals can be used for water fluoridation in Australia; sodium fluoride, sodium fluorosilicate and fluorosilicic acid. More naturally occurring fluorides e.g. calcium fluoride are not used because they don't readily dissolve in water and don't release the fluoride ions essential for strengthening of teeth. The reason these three fluoride chemicals are chosen is that they all dissolve 100% in water and break down 100% into constituent parts. For example, sodium fluorosilicate (the most commonly used fluoridation chemical in Queensland, although I think Townsville still uses sodium fluoride) dissolves 100% in water and breaks down completely into sodium ions, fluoride ions, hydrogen ions, water, and silicon dioxide (molecules of silica or sand). Nothing more, nothing less. All those ions are already in the water; all the addition of the fluoride chemical will do is change their concentration slightly, with a particular focus obviously on the fluoride ions. “In water, the compound readily dissociates to sodium ions and hexafluoro silicate ions and then to hydrogen gas, fluoride ions, and hydrated silica. At the pH of drinking water (6.5-8.5) and at the concentration usually used for fluoridation (1 mg fluoride/L), the degree of hydrolysis is essentially 100%.”

https://ntp.niehs.nih.gov/ntp/htdocs/chem_background/exsumpdf/fluorosilicates_508.pdf

The ions added to the water are no different to the ions already in the water. Absolutely none of the original chemical is left in the water. The additional of these chemicals also does not increase the uptake of lead and other substances. Care obviously needs to be taken with the concentrated chemical, just as care needs to be taken with chlorine and all the other chemicals added to the water supply. Water treatment plant operators are trained in the safe handling of these chemicals.

Not true. Most fluoridation chemicals are by-products (not waste products) of fertiliser manufacture.  Many of the phosphate rocks from which fertiliser is made also contain high levels of fluoride. Some fertiliser plants also extract fluorides during the fertiliser manufacture, but many don't. If they don't, the fluorides remain in the fertiliser and go back into the ground where they came from. There are no "great costs" associated with their disposal.

"Industrial scrubbers" sounds terrible, with visions of dirt and filth and pollution, and that's why anti-fluoridationists use the term repeatedly. A scrubber is simply a chemical and engineering term for a purifier or filter, or cleansing device used to extract chemicals or remove impurities from a gas. The purity of the chemical is dealt with in the next question.

The fluoridating chemicals used around Australia are sourced from manufacturers who supply them for water fluoridation. Water treatment in Australia involves many chemicals e.g. aluminium chloride (coagulant to promote sedimentation), polyacrylamide (flocculant to enhance coagulation and filtration), potassium permanganate (helps to remove dissolved iron, manganese and hydrogen sulphide from water), chlorine (for disinfection), sodium hydroxide (to adjust the acidity), powdered activated carbon (to remove algae and improve taste and odour), fluoride (topping up natural fluoride levels in the water to strengthen teeth and prevent tooth decay) etc.

Councils obtain these chemicals from an industrial chemical supplier, who can source them from anywhere in the world, but all chemicals used in water treatment must meet similar strict purity standards. 

Only three chemicals can be used for water fluoridation in Australia; sodium fluoride (NaF), hydrofluosilicic acid or hexafluorosilicic acid (H2SiF6) and sodium silicofluoride (Na2SiF6).

More naturally occurring fluorides e.g., calcium fluoride are NOT used because they don't readily dissolve in water and don't release the fluoride ions essential for strengthening of teeth. The reason these three fluoride chemicals are chosen is that they all dissolve 100% in water and break down 100% into constituent parts. 

For example, sodium fluorosilicate (the most commonly used fluoridation chemical in Queensland) dissolves 100% in water and breaks down completely into sodium ions, fluoride ions, hydrogen ions, water, and silicon dioxide (molecules of silica or sand). Nothing more, nothing less.

All those ions are already in the water; all the addition of the fluoride chemical will do is change their concentration slightly, with a focus obviously on the fluoride ions. The ions added to the water are no different to the sodium, fluoride, and hydrogen ions and silicon dioxide already in the water. Absolutely none of the original chemical is left in the water.

The additional of these chemicals also does not increase the uptake of lead and other substances. 

The chemicals used for water fluoridation are only a very small part of the total chemicals used in water treatment and have the same stringent safety requirements as the many other chemicals routinely used in water treatment.

The Water Fluoridation Code of Practice in Queensland also states that an addition of fluoride to the water can only result in an additional 10% to the maximum level of each impurity set by the Australian Drinking Water Guidelines. The addition of a fluoridation chemical to a water supply can only have a very minimal (and completely harmless) impact on the total level of any other substances in the water. 

Fluoride tablets are no longer sold in Australia. They are not as effective as fluoridated water (the benefit is primarily systemic, whereas the majority benefit of fluoride is topical), and may increase the risk of dental fluorosis through an immediate spike in blood fluoride levels. Also, fluoride tablets only provide a small benefit to young children taking them while their teeth are developing. Fluoridated water provides a much greater decay fighting effect, and strengthens everyone's teeth, from the very young to the very old.

Everything is a toxin at high enough concentrations – water, oxygen, salt, calcium, iron, fat-soluble vitamins A and D… Fluoride is no different. Common table salt, for example, is composed of sodium and chlorine, both highly dangerous at high concentrations. But at 1 ppm fluoridated water is very safe, just as chlorinated water is very safe and moderate amounts of table salt are also very safe.

If fluoride in the water at less than 1 part per million was dangerous, wouldn’t governments have banned fluoride toothpaste, which is at least a thousand times more concentrated? Conversely, if fluoride toothpaste is safe (and we're pretty sure it is – more than 90% of us having been using it for decades), is it likely that fluoridated water at less than one thousandth the concentration is killing us? Do opponents really think that every Australian state and territory and federal government since the 1960s has been trying to poison us?  When we visit Townsville (fluoridated since 1964) or any major city outside Queensland, do we notice people looking sicker, or with mottled teeth? Do the anti-fluoridation activists truly believe that all our governments have been trying to poison us for the past fifty years?

We also have to be realistic. Unlike fluoride, alcohol is both a proven neurotoxin and carcinogen, but we’ll happily have a beer containing 50,000 ppm alcohol or a wine containing more than 100,000 ppm alcohol because we know that within normal limits the risk of harm is extremely low. Is drinking water containing less than 1 ppm fluoride likely to cause us harm? Of course not.

I use the analogy of milk with added Vit D, available at all supermarkets. Vit D is one of the fat-soluble vitamins, and at high levels Vit D is toxic. Does anyone use the overdosing argument with milk and Vit D?  Of course not. It’s impossible to drink enough milk to overdose on Vit D, and fluoridated water is no different. Manual labourers, athletes etc in Townsville, Darwin, Singapore (right on the equator), California, Texas and Florida have been drinking fluoridated water for decades in perfect safety. They also have healthier teeth.

Water fluoridation will slightly increase the chance that teeth will develop dental fluorosis, but most dental fluorosis is invisible to the naked eye.  

When we visit Townsville, Sydney and the hundreds of other long fluoridated towns and cities in Australia, do we see lots of mottled teeth? Not really.

Anti-fluoridation web sites usually show photos of people with severe dental fluorosis, but these cases are not related to water fluoridation. They are invariably people from other countries: some parts of India, China and Africa with very high levels of fluorides naturally occurring in the water, or from inappropriate intake of fluoride supplements or fluoride toothpaste.  

It should be stressed that if it occurs, fluorosis is usually very mild, only detectable by a dentist, and does not damage the teeth. In mild fluorosis, at mirror or speaking distance, the very fine white striations can actually make the teeth appear whiter.

Tooth decay on the other hand is a destructive and disfiguring process, repair of which causes its own cosmetic problems, as well as pain, trauma, and significant financial cost.  The benefits of fluoridation far outweigh any negligible risks.

You could just as well say that we shouldn't chlorinate the water, since only 1% of it is used for drinking. The simple answer is that we prepare all our water to the highest standards e.g., chlorination, removal of sediment, changing pH, changing taste etc, so that it can be safely used for all purposes, even though we know that most of it will not be used for drinking and cooking. But fluoridating the water is simply the cheapest, safest and most effective way to provide the benefits of fluoride to the greatest number of people.

No. Fluoride is naturally present in many ecosystems.

The addition of fluoride to drinking water will make no measurable difference to the level of fluoride in rivers or the ocean. The level of fluoride in sea water is already around 1.2-1.5 ppm, well above the level in our drinking water.

Fluoride does not affect organic farming and can be used in aquaponic systems.

Congratulations on looking after your teeth so well. However, directly or indirectly, we all pay for the levels of disease in our community, whether it's tooth decay, diabetes or dementia. Dental treatment, whether private or public, is expensive.

Why should we all continue to pay for the high level of dental disease in the community when we have a simple and proven preventive measure that has been used in the rest of Australia for 40-50 years? Australians pay almost as much for dental care as we do for heart and vascular disease, and more than we spend on all cancers combined, and all mental illness and dementia combined. Isn’t it in all our interests for Australians to be healthier? We already know that healthy teeth are associated with better general health.

Most opposition comes from a small number of very active people, most of whom aren't even from your local area. Some of the opposition even comes from overseas in a highly coordinated scare campaign. Many of the letters and e-mails will use the same emotive and anti-scientific arguments.

Large reputable fluoridation surveys taken in Queensland over the past 20 to 30  years show that a clear majority of Queenslanders want fluoridated water. It's just that the opponents are very vocal, and the silent majority stay silent because they don't want to be abused!

Local referenda and telephone polls show negative results because anti-fluoridation activists flood towns with scaremongering information immediately before the poll is taken. 

Because a controversy sells newspapers and attracts viewers.

The fluoride used in tap water is industrial grade fluorosilicic acid - toxic waste from industry chimney scrubbers. 

It is more poisonous than lead. 

It is also contaminated with arsenic and mercury etc.

It's not of pharmaceutical grade unlike that added to dental products.

All chemicals used in water treatment in Australia are subject to extremely strict purity standards, and the terms pharmaceutical grade and industrial grade never appear in those standards or the water fluoridation regulations or codes of conduct or the Australian Drinking Water Guidelines.    

Sometimes 99% purity is called pharmaceutical grade, but the term is rarely used in reputable scientific circles because it has no useful definition. When used, it usually refers to substances swallowed whole, applied to the skin etc. Whether a chemical is 99% pure or 95% pure or 99.9% pure is completely irrelevant in the case of water fluoridation where the chemical is diluted a few hundred thousand times when dissolved in water.

What's the problem with fluoridated water – the fluoride per se or the supposed contaminants?  If the fluoride just by itself is also toxic, what about fluoride toothpaste?  It's a thousand times more concentrated than fluoridated water! Anti-fluoridation activists ignore fluoride toothpaste because they know that almost everyone in the world considers fluoride in toothpaste to be safe and effective. It’s much easier to create a dishonest scaremongering exercise about water fluoridation than fluoride toothpaste.

If fluoride in the water at less than 1 part per million was dangerous, wouldn’t governments have banned fluoride toothpaste, which is at least a thousand times more concentrated?  Conversely, if fluoride toothpaste is safe (and we're pretty sure it is – more than 90% of us having been using it very safely for decades), is it likely that fluoridated water at less than one thousandth the concentration is killing us? No!

The precautionary principle is very important and sensible, and no doubt when the discovery of the role of fluoride was made seventy years ago, the scientists and decision-makers who had to roll out public fluoridation might have been mulling over it a bit!

Thankfully for us today, they must have also considered that most important flip side: if scientists never developed anything  because we weren’t 100% sure of long-term safety, we wouldn’t have invented the plane or the car, and we wouldn’t chlorinate water, perform open heart surgery, vaccinate children against polio, smallpox, measles, mumps and rubella, and we wouldn’t use x-rays or antibiotics.

Community water fluoridation has now been practised around the world for almost 70 years. We have seen only benefits, and huge benefits from this, in Australia and all other countries in which fluoridation has been practised. Reputable health and scientific authorities have no doubts about the effectiveness and safety of water fluoridation; only eccentric conspiracy theory fringe groups do.