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Scientific evidence - Water Fluoridation

Evidence based articles addressing the safety and effectiveness of water fluoridation

Evidence of the safety of water fluoridation

  • The use of fluorides in Australia: guidelines Australian Research Centre for Population Oral Health, Dental School, The University of Adelaide, South Australia; Australian Dental Journal 2006;51:(2):195-199.
  • World Health Organization, 1994. Fluorides and oral health: report of a WHO expert committee on oral health status and fluoride use. Geneva: World Health Organization.
  • Evans W, Morgan M, Conn J. Dental fluorosis prevalence in Melbourne 12-yearolds is within expected limits. Presented at the IADR ANZ Division 38th Annual Scientific Meeting: Brisbane 27-29 September 1998.
  • World Health Organization, 2006. Fluoride in Drinking-water. London: IWA Publishing on behalf of the World Health Organization.
  • World Health Organization, World Dental Federation and International Association for Dental Research, 2006. Call to Action to promote dental health by using fluoride.
  • National Health and Medical Research Council. Dietary guidelines for all Australians. Canberra: Commonwealth of Australia; 2003.
  • Food Standards Australia New Zealand, 2007. Australia New Zealand Food Standards Code. Canberra: Food Standards Australia New Zealand.
  • Australia New Zealand Food Authority. Development of joint Australia New Zealand Food Standards as part of the process of review of the Food Standards Code. Infant formula. Preliminary inquiry report. Canberra: Australia New Zealand Food Authority; 1999.
  • Silva M, Reynolds EC. Fluoride content of infant formulae in Australia. Australian Dental Journal 1996; 41(1):37-42.
  • National Research Council Subcommittee on Health Effects of Ingested Fluoride. Health effects of ingested fluoride. Washington DC: National Research Council; 1993.
  • Centres for Disease Control and Prevention. Achievements in public health, 1990-1999: fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report 1999; 48 (41):933-940.
  • Sinclair MI, Kazda H, Cicuttini FM, Fairley CK. Public Health Effects of Water Fluoridation. Melbourne: Department of Epidemiology and Preventive Medicine, Monash University & Cooperative Research Centre for Water Quality and Treatment; 1998.
  • World Health Organization International Programme on Chemical Safety. Environmental health criteria 227: fluorides. Geneva: World Health Organization; 2002.
  • Medical Research Council Working Group. Water fluoridation and health. United Kingdom: Medical Research Council; 2002.
  • US Department of Health & Human Services. Fluorides, Hydrogen Fluoride and Fluorine. 2003 [accessed January 2005].
  • National Health and Medical Research Council, A Systematic Review of the Efficacy and Safety of Water Fluoridation, Australian Government 2007.
  • Choice Australia review: Fluoride: Is fluoride good for your teeth, or a slow poison? Choice, 2008.
  • McDonagh M, Whiting P, Wilson P et al. Systematic review of water fluoridation. Br Med J 2000; 321: 855-9.

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Technical aspects of fluoride

  • Ahokas J, Demos L, Donohue D, Killalea S, McNeil J, Rix C. Review of water fluoridation and fluoride intake from discretionary fluoride supplements: review for NHMRC. Melbourne: Royal Melbourne Institute of Technology and Monash University; 1999.
  • World Health Organization, 2002. World water day 2001: oral health.
  • Department of Human Services Victoria. Your private drinking water supply. Melbourne: Department of Human Services Victoria; Feb 2000.
  • 2004 Australian Drinking Water Guidelines (ADWG) developed by the National Health and Medical Research Council (NHMRC) in collaboration with the Natural Resource Management Ministerial Council (NRMMC).
  • National Health and Medical Research Council. The effectiveness of water fluoridation. Canberra: National Health and Medical Research Council; 1991.
  • National Health Service Centre for Reviews and Dissemination. A systematic review of public water fluoridation. York: University of York; 2000.
  • Committee of Inquiry into the Fluoridation of Victorian Water Supplies 1979-80. Report of the committee of inquiry into the fluoridation of Victorian water supplies 1979-80. Melbourne; 1980.
  • Government of Ireland. Forum on fluoridation. Dublin: Government of Ireland; 2002.
  • Public Health Commission Rangapu Hauora Tumatanui. Water fluoridation in New Zealand: analysis and monitoring report. Wellington: Public Health Commission Rangapu Hauora Tumatanui; 1994
  • National Health and Medical Research Council, A Systematic Review of the Efficacy and Safety of Water Fluoridation, Australian Government 2007.

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Addressing claims of bans of Europe

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Addressing claims of side effects related to cancer, bone fractures, down syndrome, behavioural disturbances, thyroid problems or any other serious effects

  • Whiting P, McDonagh M, Kleijnen J. Association of Down's syndrome and water fluoride level: a systematic review of the evidence. In submission. 2001.
  • E. T. Treasure, I. G. Chestnutt, P. Whiting, M. McDonagh, P. Wilson  and J. Kleijnen "The York Review - A systematic review of public water fluoridation: a commentary", British Dental Journal Vol 192, No. 9, May 11 2002.
  • Ahokas J, Demos L, Donohue D, Killalea S, McNeil J, Rix C. Review of Water fluoridation and fluoride intake from discretionary fluoride supplements: review for NHMRC. Melbourne: Royal Melbourne Institute of Technology and MonashUniversity; 1999.
  • National Health and Medical Research Council, A Systematic Review of the Efficacy and Safety of Water Fluoridation, Australian Government 2007.
  • National Health Service Centre for Reviews and Dissemination. A systematic review of public water fluoridation. York: University of York; 2000.
  • Government of Ireland. Forum on fluoridation. Dublin: Government of Ireland; 2002.
  • Public Health Commission Rangapu Hauora Tumatanui. Water fluoridation in New Zealand: analysis and monitoring report. Wellington: Public Health Commission Rangapu Hauora Tumatanui; 1994.
  • The British Fluoridation Society, The UK Public Health Association, The British Dental Association and The Faculty of Public Health. One in a Million, The Facts about water fluoridation 2nd Edition. 2004.
  • Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. Morbidity and Mortality Weekly Report 2001;50(RR-14).
  • Bernard W. Stewart, Banding carcinogenic risks in developed countries: A procedural basis for qualitative assessment, Mutation Research -Review Jan-Feb 2008 Pages 124-151: article available from Science Direct.
  • The Irish Forum on Fluoridation in 2002 stated that "Studies from China claiming that children exposed to high levels of fluoride had lower IQs than children exposed to low levels were found to be deeply flawed and provided no credible evidence that fluoride obtained from water or industrial pollution affects the intellectual development of children".

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Fluoride tablets in comparison to water fluoridation

  • Ahokas J, Demos L, Donohue D, Killalea S, McNeil J, Rix C. Review of water fluoridation and fluoride intake from discretionary fluoride supplements: review for NHMRC. Melbourne: Royal Melbourne Institute of Technology and Monash University; 1999.
  • National Health Service Centre for Reviews and Dissemination. A systematic review of public water fluoridation. York: University of York; 2000.
  • World Health Organization, 1994. Fluorides and oral health: report of a WHO expert committee on oral health status and fluoride use. Geneva: World Health Organization.
  • Riordan P J. Fluoride supplements for young children: an analysis of the literature focusing on benefits and risks. Community Dentistry and Oral Epidemiology 1999;27:72-83.
  • Public Health Commission Rangapu Hauora Tumatanui. Water fluoridation in New Zealand: analysis and monitoring report. Wellington: Public Health Commission Rangapu Hauora Tumatanui; 1994
  • National Health and Medical Research Council, A Systematic Review of the Efficacy and Safety of Water Fluoridation, Australian Government 2007.

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Claims of accumulation in the body after drinking fluoridated water

  • Sinclair MI, Kazda H, Cicuttini FM, Fairley CK. Public Health Effects of Water Fluoridation. Melbourne: Department of Epidemiology and Preventive Medicine, Monash University & Cooperative Research Centre for Water Quality and Treatment; 1998.
  • Ahokas J, Demos L, Donohue D, Killalea S, McNeil J, Rix C. Review of water fluoridation and fluoride intake from discretionary fluoride supplements: review for NHMRC. Melbourne: Royal Melbourne Institute of Technology and Monash University; 1999.

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Harmful to babies because of content in infant formula



  • A recent media article suggests that babies from six months to a year should only have 600ml of fluoridated water. NHMRC has three publications that refer to fluoride intake, none of which make this suggestion.
      - Australian Drinking Water Guidelines (2004)
      - Nutrient Reference Values for Australia and New Zealand (2006)
      - A Systematic Review of the Efficacy and Safety of Fluoridation (2007)
  • National Health and Medical Research Council. Dietary guidelines for children and adolescents in Australia incorporating the infant feeding guidelines for health workers. Canberra: Commonwealth of Australia; 2003. Available at  ww.nhmrc.gov.au/publications/pdf/n34.pdf
  • Food Standards Australia New Zealand, 2007. Australia New Zealand Food Standards Code. Canberra: Food Standards Australia New Zealand.
  • Food Standards Australia New Zealand, 2002. Review of infant formula. Canberra: Food Standards Australia New Zealand.
  • In the late 1990s, Australian and New Zealand infant formula manufacturers voluntarily began to use fluoride free water in the preparation of formula powder (Food Standards Australia New Zealand)
  • Unlike Australia, many US infant formulas contain fluoride, and the potential for fluorosis is obviously increased if the formula is subsequently made up with fluoridated water.
  • Silva M, Reynolds EC. Fluoride content of infant formulae in Australia. Australian Dental Journal 1996; 41(1):37-42.
  • Spencer A, Slade G, 2005. 'A rationale for the appropriate use of fluorides.' Paper presented at Workshop on the Use of Fluorides in Australia. Adelaide: The Australian Research Centre for Population Oral Health.
  • Do L and Spencer A, 2007. 'Decline in the prevalence of dental fluorosis among South Australian children.' Community Dentistry and Oral Epidemiology 35: 282-291.
  • Australian Research Centre for Population Oral Health, 2006. 'The Use of Fluorides in Australia: guidelines.' The Australian Dental Journal 51 (2): 195-199.

Addresses breast feeding:

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Osteosarcoma claims

  • International Agency for Research on Cancer, International Incidence of Childhood Cancer. Volume 2. 1998.
  • Victorian Cancer Registry, 1984-2003.
  • Queensland Cancer Registry, 1984-2003.
  • International Agency for Research on Cancer, International Incidence of Childhood Cancer. Volume 1. 1988.
  • International Agency for Research on Cancer, IARC Monographs on the Evaluation of Carcinogenic Risks of Chemicals to Humans, Volume 27. 1982.
  • San Francisco Department of Public Health, Current Scientific Evidence: Water Fluoridation is not associated with osteosarcoma. 2005.
  • Ahokas, J., et al., Review of water fluoridation and fluoride intake from discretionary fluoride supplements: review for NHMRC. 1999. Royal Melbourne Institute of Technology and Monash University: Melbourne.
  • McDonagh M S, et al., Systemic review of water fluoridation. BMJ, 2000. 321.
  • Medical Research Council Working Group, Water fluoridation and health. 2002, Medical Research Council: United Kingdom.
  • European Food Safety Authority, Opinion of the Scientific Panel on Dietetic products, Nutrition and Allergies on a request from the Commission related to the Tolerable Upper Intake Level of Fluoride. The EFSA Journal, 2005. 192: p. 1-65.

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Claims fluoride causes allergies

  • European Food Safety Authority, Opinion of the Scientific Panel on Dietetic products, Nutrition and Allergies on a request from the Commission related to the Tolerable Upper Intake Level of Fluoride. The EFSA Journal, 2005. 192: p. 1-65.
  • National Research Council Subcommittee on Health Effects of Ingested Fluoride. Health effects of ingested fluoride. Washington DC: National Research Council; 1993.
  • National Health Service Centre for Reviews and Dissemination. A systematic review of public water fluoridation. York: University of York; 2000.
  • The Council of the British Society for Allergy and Clinical Immunology has been asked for its view on the suggestion that some people are allergic to fluoridated water. The Council are unanimous in their view that there is no evidence of allergy or intolerance to fluoride as used in the fluoridation of water supplies". M.H. Lessor, MD, FRCP
  • National Health and Medical Research Council, A Systematic Review of the Efficacy and Safety of Water Fluoridation, Australian Government 2007.

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Improvements in dental health from water fluoridation

  • AIHW DSRU: Armfield JM, Slade GD & Spencer AJ 2007. Water fluoridation and children's dental health: The Child Dental Health Survey, Australia 2002. Cat. no. EN 170. Dental statistics and research series no. 36. Canberra: Australian Institute of Health and Welfare.
  • Centres for Disease Control and Prevention. Achievements in public health, 1990-1999: fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report 1999; 48 (41):933-940.
  • National Health Service Centre for Reviews and Dissemination. A systematic review of public water fluoridation. York: University of York; 2000.
  • World Health Organization Expert Committee on Oral Health Status and Fluoride Use. Fluorides and oral health: report of a WHO expert committee on oral health status and fluoride use. Geneva: World Health Organization; 1994.
  • Slade GD, Spencer AJ, Davies MJ, Stewart JF, Caries experience among children in fluoridated Townsville and unfluoridated Brisbane.  Australia and New Zealand Journal of Public Health. 1996.
  • National Health Service Centre for Reviews and Dissemination. A systematic review of public water fluoridation. York: University of York; 2000.

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Last updated: 31 August 2012