When it comes to fluoride, let’s do what’s best for children

State governments should take control of water fluoridation when the evidence of benefit is so strong. Picture: Getty Images

4 min read

3:31PMJanuary 21, 2025.

Updated 3:49PMJanuary 21, 2025

The debate over whether to fluoridate or not fluoridate local water supply in our towns and centres has become an issue once again, with anti-fluoride votes by a number of Queensland councils, and a political debate emerging in the United States.

In Queensland, several local councils have decided recently to remove fluoride from the water or continue to reject fluoridation, including Gympie, Cairns and Gladstone councils. They are joining about 50 of Queensland’s 77 counils that do not have fluoride in their water.

As a regional paediatric dental specialist, anecdotally I see much more tooth decay, and of greater severity, in children from non-fluoridated communities than their southeast Queensland counterparts.

Today a quarter of Queenslanders do not have access to a fluoridated drinking water supply, while 90 per cent of Australians do. Fluoride has been added to water supplies in Australia for seven decades, starting in 1953. The majority of Australian states and territories have laws requiring the fluoridation of public water supplies, with the exception of Queensland.

The results of this decision from an oral health perspective are not good.

Dentist Tim Keys is worried about the discrepancy between the health of children with and without access to fluoridated water.

Facts and fictions of water fluoridation in Queensland.

The removal of fluoride from regional water supplies in Queensland has been gaining pace since the decision to devolve decision-making responsibility to local councils in 2012. This is leaving the state’s most vulnerable children at an increased risk of pain, infection and preventable dental disease. With claims of potential harms, including lower IQ and cognitive impairment, now driving this debate, it’s time to reframe the discussion. Evidence, not fear, should guide public health policies, especially when the stakes involve children.

The proven benefits of fluoridation

Water fluoridation is one of the simplest, most efficient, equitable and cost-effective public health measures available to reduce dental decay. It works by adjusting fluoride levels in drinking water to strengthen tooth enamel and protect against cavities. This benefit is universal, regardless of income, location or access to dental care. However, it overwhelmingly benefits low socio-economic communities and regional and remote areas.

In Queensland, where children experience some of the nation’s highest rates of dental decay, fluoridation is not just beneficial – it is essential. Children in these regions face alarmingly high rates of dental disease. According to the Australian Institute of Health and Welfare, up to half of children in some Queensland regions have untreated decay before starting school. These children also have fewer dental services available.

Tap water provides fluoride to 90 per cent of Australians. Picture: Alastair Pike / AFP

Misguided claims: debunking the myths

Opposition to fluoridation, and fluoride, often hinges on claims that it poses health risks, including cognitive impairment or lower IQ. These claims have been amplified by figures such as Robert F. Kennedy Jr, the incoming secretary of health in the Trump administration. He recently called for the removal of fluoride from water supplies in the United States, citing concerns over neurotoxicity on the back of studies purporting to show a link to lower IQ or neuro-behavioural problems.

These claims of potentially harmful effects from fluoridation have garnered media attention but they do not stand up to scientific scrutiny. A recent University of Queensland study found no link between water fluoridation and cognitive impairment in Queensland children. People involved in the study who had a lifetime exposure to fluoridated water had an IQ score 1.07 points higher on average than those with no exposure. This is consistent with a long-term study from New Zealand following nearly 1000 people since their birth in 1972. There was no evidence that fluoride exposure was associated with lower IQ scores.

This local evidence aligns with global research. Organisations including the National Health and Medical Research Council, the World Health Organisation and the Centres for Disease Control agree that fluoridation at optimal levels is safe and effective, and poses no risk to cognitive development, cancer rates or other health conditions.

The cost of inaction

Despite the overwhelming evidence in favour of fluoridation, regional Queensland councils are opting out, often citing community pressure or cost concerns. However, the real cost of removing fluoride is borne by children and families. Without fluoridation, decay rates rise, leading to preventable pain, infection and expensive dental treatments.

Every dollar invested in fluoridation can save up to $18 in dental treatment costs, according to the National Health and Medical Research Council. With many families increasingly finding dental care unaffordable in the midst of a cost-of-living crisis, water fluoridation is critical to mitigating health inequities.

Cairns Regional Council voted to not introduce fluoride into Cairns’ drinking water at a meeting attended by dozens of anti-fluoride protesters. Picture: Brendan Radke

Where to from here?

It is vitally important that key health decisions are based on evidence, and not the influence of a vocal minority.

At its core, access to water fluoridation is about equity. It ensures that every child, regardless of where they live or their family’s income, has a chance to grow up with healthy teeth and without preventable pain. In Queensland, where children are already grappling with high rates of decay and insufficient dental services, fluoridation is not a luxury – it is a necessity.

By denying water fluoridation, we are not just ignoring the science – we are neglecting our children. The new Queensland government needs to take back control of this issue. It will save them more money in the long-term, with a lower burden of disease for Queenslanders. They need to stand up and mandate that water fluoridation occurs in all communities possible. Hopefully, all of our state and federal health policy decision makers take note.

Dr Tim Keys is a paediatric dental specialist in public and private practice. He is also the head of advocacy and policy for the Australasian Academy of Paediatric Dentistry.

Associate Professor Matt Hopcraft is a dental public health expert at the Melbourne Dental School.

REFERENCES

This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.