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Fluoridation video transcripts

The videos for these transcripts are available on the Ministry of Health's water fluoridation YouTube channel.


Community Water Fluoridation: Effective, Safe, Affordable

Riana Clarke – National Clinical Director of Oral Health, Ministry of Health

Oral health is not just about having a nice smile. Oral health, it’s been shown, is very much related to your wellbeing and your quality of life.

Although oral health has really improved for New Zealanders over the last number of decades, dental decay is still the most common chronic disease for New Zealanders.

Jonathan Broadbent – Senior Lecturer Preventative Dentistry University of Otago

Even if you brush your teeth frequently, visit the dentist regularly, and have low sugar intake, water fluoridation provides an additional benefit. It's not a question of one or another. We need them all.

It’s effective

Riana Clarke – National Clinical Director of Oral Health, Ministry of Health

There’s a huge body of evidence both internationally and here in New Zealand that shows that water fluoridation significantly reduces decay levels for both adults and children.

In the most recent New Zealand Oral Health Survey in 2009, the figures showed that for those living in a community with water fluoridation that children and adolescents experienced 40 percent less decay than those who lived in a non-fluoridated area.

It’s safe

Sir Peter Gluckman – The Prime Minister’s Science Advisor

It's absolutely clear that the levels of fluoride that are put into New Zealand's water supply and are carefully regulated, are safe, they have real health benefits and there are no health risks.

Dr Don Mackie – Former Chief Medical Officer, Ministry of Health

Many of the studies have raised concerns about fluoridation come from overseas countries. Parts of the United States, India and China where they already have higher levels of fluoride in their water than we have in New Zealand. Many of these studies are flawed both in terms of their methodology and design and some of them simply repeat assertions from previous studies.

If there was a health effect from fluoride, we would see a difference between the fluoridated and non-fluoridated areas in New Zealand. We simply don't see that. There is no evidence of difference in health effect between fluoridated and non-fluoridated areas in New Zealand.

It’s affordable

Jonathan Broadbent – Senior Lecturer Preventative Dentistry University of Otago

Water fluoridation is a critical part of the mix. Because we know that more than half of New Zealand children don't brush their teeth frequently enough. And about half of New Zealand adults avoid going to the dentist because of the cost. Water fluoridation makes this preventive strategy affordable and accessible to all. It benefits everyone.

Community water fluoridation. Effective. safe. affordable.


Sir Peter Gluckman – Prime Minister's Science Advisor, on fluoridation

The discovery that the addition of fluoride to water at low concentrations in regions where natural concentration of fluoride are low was one of the great public health discoveries of the twentieth century.

It’s still very effective, it’s still very important, particularly for vulnerable members of our community.

There are no health risks and it’s something that really makes a difference to many people’s dental health.

Because fluoride like many other substances in high doses can be toxic, clearly public health and dental scientists have spent many decades looking carefully at the science of putting fluoride at low levels into water it is one of the most well studied questions in public health and the safety of fluoride at these very low concentrations, which are in fact much lower than in many natural water supplies around the world is certain.

While there are no health risks from fluoride in water, at the very low levels of fluoride we use, there can be some small and slight mottling of the teeth which is not disfiguring, can barely be seen by dentists under microscopes, and it’s certainly not the severe fluorosis that is shown on websites from those who oppose fluoride in water.

Community water fluoridation. Effective. safe. affordable.


Riana Clarke – National Clinical Director of Oral Health, Ministry of Health, on fluoridation

Although oral health has really improved for New Zealanders over the last number of decades, dental decay is still the most common chronic disease for New Zealanders.

Despite widespread use of fluoride toothpaste and having publicly provided dental services, we’re still seeing high levels of dental decay in our populations.

By the time children are starting school, 1 in 7 of them have already suffered from severe decay.

Dental Decay is a Serious Problem

Early childhood decay can cause extreme pain and the children who are suffering from early childhood decay, they can lose sleep, they may have to take time off school, some of them may even end up having to go to hospital and have a general anaesthetic to have dental treatment.

The results from the New Zealand Health Survey for the period 2014 to 2015 reported that an alarming number of children – 29,000 – had had one or more teeth removed in that time.

It’s Effective

Community water fluoridation helps to protect our teeth over and above those other things we might do to protect our teeth. For example, we may brush out teeth with fluoride toothpaste, we might reduce the sugar levels in our diet, and we may drink lots of water - but community water fluoridation will help strengthen our teeth over and above this.

There is a huge body of evidence, both internationally and here in New Zealand, that shows that water fluoridation significantly reduces decay levels for both adults and children.

In the most recent New Zealand Oral Health Survey in 2009, the figures showed that for those living in a community with water fluoridation that children and adolescents experienced 40 percent less decay than those who lived in a non-fluoridated area.

Water fluoridation plays a role in protecting the teeth of the whole community and this has been recommended by the World Health Organization, our own Ministry of Health here in New Zealand, and by many respected health organisations throughout the world.

It’s Safe

Based on international and New Zealand evidence, we can say that at the levels we add fluoride to the water here in New Zealand, there is absolutely no health risk.

Community water fluoridation. Effective. safe. affordable.


Dr Lance O'Sullivan – a rural GP's perspective on water fluoridation

Yeah, I think there’s a need to take action on the appalling level of dental health that we – or dental disease – that we see in a community such as Kaitaia, the Far North, and in regions such as Northland.

I was shocked and appalled to see that none of the district councils in Northland have fluoride in their water – despite the fact that one of the top ten health problems in north – in the north id dental disease.

So, gum disease, tooth disease, decay.

So I’m really concerned that, you know, we aren’t doing anything to address this.

We certainly aren’t doing it at a – sort of a level of reducing the amount of soft drinks that people are – you know, kids are taking on a daily basis.

We are trying to do something around encouraging parents to get their kids to brush their teeth, but to be honest in a region, in a community such as the one I work in, where we have an epidemic of dental disease it’s negligent not to put fluoride – which we know works – into the water.

A really common scenario that I’m seeing in Kaitaia is adults presenting with absolutely terrible teeth and a real common comment they all make is that they just can’t afford – they can’t afford to maintain their teeth because it’s too expensive to go to the doctors on a regular – the dentists, sorry, on a regular occurrence, so they wait until things get so bad that they pull their teeth out.

Or they wait till things get to the point where they’re abscessed and they can – then they’ll have to go into hospital for intravenous antibiotics or you know have extractions because there’s no other option left.

I think that’s really poor. And I think that’s on the basis of not having had a strong preventative programme strategy in place.

You know, these people are making the option – generally they’re making the option of having their teeth extracted at the point that things are just too bad, they can’t tolerate the pain, they’re sick of having infections.

And that’s not giving people a fair chance at life and, I mean, we’re talking about adults there  we're seeing the same numbers of – children turn up with, you know, painful infections.

You know, how can a child learn in a class, if they're sitting in the back of the class and all they're thinking of is the throbbing pain that's going on in their head.

Or they're got a fever and swelling over their face because of an infection. You know, this is what we see.

It's costly.

It's costly to the family, it's costly to the patient, it's costly to us as a society when we take into account the downstream effects of poorer dental health.

There is a very vocal and active anti-fluoride lobby.

There's a very vocal and active anti-immunisation lobby.

And unfortunately for me as a Māori doctor working among Māori communities these res – their messages resonate with my community and it's very hard.

It's very hard.

But, you know, I often say to mums and dads who're sitting there and don't want to immunise their children, in the cases of fluoride, I'd say the same thing.

You know, they're the people that are bringing these messages come from such a different background to the people that they're promoting the message to.

You know, they're coming along to our communities and they come from backgrounds that don't include the poverty, the neglect, the significant health risks that they're born with – and they're saying that, you know, the benefit of – the risk of fluoride is far greater for you than the benefits but they're coming from their perspective. You know, a lot of the research that I've seen for anti-immunisation stuff is coming from communities that don't look like communities I serve.

And I – it's the same with the fluoride argument.

You know, I don't think we're comparing apples with apples and actually the people that are promoting anti-fluoride and anti-immunisation messages, I actually think are doing a massive disservice to the health needs of these people.

So if I was to talk to someone who – to give them my opinion on the importance of fluoride in the water, I'd be saying, look, we have overwhelming significant levels of dental disease in our community. We have problems with levels of education and economic you know, depression, if you like, up here.

That means that we're getting a lot of kids that are coming from homes don't have a lot of things – they don't have a lot of money, they don't have a lot of education in the household.

And those two things combined are going to mean that you know, simple health messages aren't necessarily always going to be taken up – the importance of not, you know, not sending your child to school with the lolly water every day. Not, you know, making sure that your child's not eating lollies five, six, seven times a day.

Making sure that they're brushing their teeth twice a day. You know, in this community, if I was to say to a patient sitting in front of me I'd say the risks are incredibly high of dental disease and, you know, to address their we can do – we can do something that's safe, that will at least give some assurance to you and your family that there is a – there is something being put in place to try and reduce the level of dental decay that you and your family are going to be exposed to.

Community water fluoridation. Effective. safe. affordable.


Robin Whyman – New Zealand Dental Association, discusses fluoridation

So community water fluoridation offers an opportunity to provide fluorides to the population in a way that doesn't require the community to do anything particularly proactive or active about the use of fluorides.

We know that the information available through research shows that we've got a population protection of between 20 and 40 percent improvements in the levels of tooth decay. And it's highly cost-effective in terms of delivering fluorides to a population, community water fluoridation is one of the most cost-effective public health measures you can put in place.

So I work in two different areas of the country - one which has community water fluoridation in place and one which does not have community water fluoridation in place. What I see is a difference, is we do see lower levels of dental decay in the communities that have got community water fluoridation.

But at an individual practitioner level I also see decay that's more aggressive and harder to treat in the community that doesn't have water fluoridation in place. And what that means is that for the children often that I'm treating, I have to take more teeth out and I have fewer options about what I can do for their dental care.

So the confidence we have that community water fluoridation is an important part of keeping dental decay lower in New Zealand comes from different levels of information.

In 2009, the New Zealand Ministry of Health published their latest oral health survey, where they looked at children and adults across the country.

And for children who were living in a fluoridated area of the country, the dental decay levels were forty percent lower than for those children who were living in a non-fluoridated area.

You then weigh that up with information that's available from local studies in New Zealand over the last ten to twenty years and international studies, and both of those show overall that there are lower levels of dental decay for children and adults when they live in fluoridated water areas.

If you add that information together with what we see as individual practitioners when we're working in fluoridated areas - lower levels of dental decay decay that is easier to treat - overall you're left with an important impression that community fluoridation is an important part of reducing dental decay levels across the country.

If we remove water fluoridation I think we're going to see higher levels of dental decay across the community.

We're going to see harder-to-treat dental decay because as an individual practitioner I'm dealing with decay which is more aggressive, more difficult to manage.

And at a population level we're going to see a bigger level of the population having dental decay which needs to be managed both for children by the public system and for adolescents and adults by dentists in practice.

So severe levels of dental decay do still happen in New Zealand.

If we look children, around about half of five-year-old children and half of our 12- and 13-year-old children have had some level of dental decay.

Those children who have dental decay will have been to see the dental therapist and had fillings placed, will have had teeth removed, and in 2009, 6000 children were admitted to New Zealand hospitals to have dental treatment provided, mainly under general anaesthetic.

Those children will have had teeth removed and fillings placed during those operations.

We know that children who've had dental decay - that's one of the bigger risk factors for them developing future decay and so preventing decay early we want to try and reduce that ongoing risk.

The Dunedin multi-disciplinary study where they've been looking at children through into their adult years has shown us that for the children who had dental decay in their baby teeth, there's an increased risk of those permanent teeth coming through with some sort of defect on the tooth.

And so primary tooth decay has an ongoing effect into adult teeth, both in terms of risk of future dental decay and increasing the chances of having a developmental defect in the permanent teeth.

One of the challenges of our modern diets is the frequency with which we consume refined sugars.

Refined sugars around the teeth in combination with the bacteria that are on the teeth cause an acid and that acid draws the mineral out of the tooth and if that happens often enough eventually more mineral comes out and we form a hole in the tooth.

What water fluoridation - and fluorides in general - offer us is an ability to tip that balance back in favour of the tooth mineral returning to the tooth.

And so community water fluoridation offers an ability to have low levels of fluoride around the tooth surface throughout the day tipping the balance back in favour of repairing the tooth after acid challenges from sugary drinks and foods.

Community water fluoridation. Effective. safe. affordable.


Dr Don Mackie – former Ministry of Health Medical Officer, on fluoridation

We know from 60 years of experience that fluoridation of water is safe.

Fluoride already exists in water. We top it up to carefully controlled levels which are in line with recommendations of the World Health Organization and international public health organisations.

We know that at these levels fluoride is safe. Many of the studies that have raised concerns about water fluoridation come from overseas countries - parts of the United States, India and China, where they already have higher levels of fluoride in their water than we have in New Zealand. Many of these studies are flawed both in terms of their methodology and design.

And some of them simply repeat assertions from previous studies. If there was a health effect from fluoride we would see a difference between fluoridated and non-fluoridated areas in New Zealand.

We simply don't see that. There's no evidence of difference in health effect between fluoridated and non-fluoridated areas in New Zealand.

We know from sixty years of experience that fluoridation of water is safe.

Fluoride already exists in water. We top it up to carefully controlled levels which are in line with recommendations of the World Health Organization and international public health organisations.

We know that at these levels fluoride is safe. Many of the studies that have raised concerns about water fluoridation come from overseas countries - parts of the United States, India and China, where they already have higher levels of fluoride in their water than we have in New Zealand. Many of these studies are flawed both in terms of their methodology and design.

And some of them simply repeat assertions from previous studies. If there was a health effect from fluoride we would see a difference between fluoridated and non-fluoridated areas in New Zealand.

We simply don't see that. There's no evidence of difference in health effect between fluoridated and non-fluoridated areas in New Zealand.

Community water fluoridation. Effective. safe. affordable.


Dr Russell Wills, the Children’s Commissioner discusses fluoridation

So fluoridation is the single most cost-effective way we have of improving oral health outcomes for children. It makes the biggest difference to our poorest and most vulnerable children.

What fluoride does is it works mostly on the flat surfaces of teeth - the fronts that we see. Having missing, filled or holed teeth, particularly in the front, seriously impacts on children's future life chances, in particular, the chances of getting a high paying job. It also impacts on children's respiratory health and cardiac health, so we need to do everything we can, particularly for our poorest and most vulnerable children, to give them the best possible life chances. Fluoridation does that.

Most public health interventions involve a choice of rights. Often that’s between our right to choose or personal freedom versus a public good. So examples of that include having chlorine added to our water supply, requiring that children where cycle helmets or use booster seats in cars. And we all accept that these are public health goods and advantage our children and so we accept those. Fluoride in our water supply is like that.

We have a right to choose what's in our water, but children also have the right to the best possible health and as a country we have a responsibility to do the most that we can to improve their health outcomes, and to reduce inequalities.

Fluoride is the single most cost-effective way we have of reducing those inequalities for children's oral health. In my view, this small cost of not being able to choose what's in our water is worth the large benefit to those children.

You might see some debate about the science of fluoride. In fact, the science is settled. The World Health Organization, the US Centers for Disease Control, The New Zealand Medical Association, dental associations all around the world are all in universal agreement. The benefits of fluoride outweigh any tiny risks. There is no debate in scientific circles about the merits of fluoride.

Anti-fluoridationists will tell you there are risks to fluoride. They will sight fluoride as being a poison, for example. Any substance in excess is harmful - sugar, oxygen, water, are all dangerous in excess. In fluoridated water supplies the concentration is 0.7 parts per million. That is enough to protect our teeth,

it's not enough to do any harm to any part of our body. The science is quite clear at that concentration, fluoride benefits our health and it doesn't do harm.

Community water fluoridation. Effective. safe. affordable.


Dr Stephen Child – Chair of NZ Medical Association on fluoridation

One of the big issues in health at the moment now is health literacy, and we also talk about scientific literacy. And I know doctors always go on about evidence-based care. But the reason why we put our resources and our strength into evidence is because evidence allows us to have the informed decision making.

We’ve been fluoridating water as I understand it for more than 60 years around the world and we have extensive evidence – and the most medical associations including the World Medical Association have supported its introduction into the community water supply.

Fluoridation is one of those things that actually has a bigger impact and a bigger benefit in the lower socioeconomic groups and would help with health equity. Often lower socioeconomic groups would have poorer oral health, poorer nutrition, poorer dental care and therefore it’s even more important that they have fluoridation, into oral health into their water supply.

Well, the evidence is irrefutable now, as I say we’ve had it for over 60 years that fluoridation in the community water supply reduces tooth decay and improves oral health. It reduces tooth decay by up to 40 percent. That’s not a minor amount. That’s not subtle.

Community water fluoridation. Effective. safe. affordable.


Warren Lindberg – Public Health Association, speaks on fluoridation

The Public Health Association is a voluntary organisation that brings together a cross-section of the wide range of occupations of people who work in the business of public health which is protecting and promoting people's health and preventing illness.

The Public Health Association supports community water fluoridation because it is a proven effective and efficient way of improving people's oral health.

This is a way of improving and protecting people's oral health that has been available for many years.

There's at least fifty years of its use in countries like ours – Australia, Canada, Britain, the United States, Ireland –and it has – there's ample evidence that it is both effective in improving oral health and efficient, particularly the small amount of mineral – that is a naturally occurring mineral in water but which in New Zealand is not quite enough to prevent tooth decay.

So what is done is done with – on the basis of good science and long experience of its effectiveness.

It's very easy to scare people off from a public health intervention like fluoridated water with science that people don't understand and with the labels that are put on it.

By calling it a medicine it sounds like it's a foreign substance that's being put in the water when actually it's a naturally occurring mineral that is all-- found in all water.

And that's what – it's a bit like the scare stories about immunisation that for a long time put people off getting immunisation.

And then we've had real scares about – of outbreaks of conditions like measles which we'd stopped worrying about but which suddenly became much more common and can have long-term consequences if they're not treated properly.

Community water fluoridation. Effective. safe. affordable.


Jonathan Broadbent – University of Otago lecturer, speaks on fluoridation

As senior lecturer in preventive and restructive dentistry I'm a strong believer that the best filling is the one you don't have to do.

Water fluoridation is a critical part of the mix because we know that more than half of New Zealand children don't brush their teeth frequently enough.

And about half of New Zealand adults avoid going to the dentist because of the cost.

Water fluoridation makes this preventive strategy affordable and accessible to all.

It benefits everyone.

Even if you brush your teeth frequently, visit the dentist regularly, and have low sugar intake water fluoridation provides an additional benefit.

It's not a question one or another.

We need them all.

Many of the claims by fluoridation opponents are, quite frankly, scaremongering.

They make inaccurate claims. They misquote real science.

Or they base their opinions on pseudo-science.

The fact is water fluoridation works and it's safe.

So some studies that fluoridation opponents base their opinions on are very badly methodologically flawed or they're based in areas where the water quality is so dreadful that in New Zealand we wouldn't even dream of drinking it ourselves where there are not only very high levels of fluoride, which is naturally in the water, but also very high levels of lead or arsenic which we simply don't have in New Zealand.

So it's not comparable to be comparing water in rural India with water in a – artificially fluoridated in New Zealand.

The children with bad teeth are the same people who grow up to be the adults with bad teeth and we know that bad teeth can affect your quality of life and day-to-day functioning.

So here we have something – water fluoridation – which can improve teeth through life.

It benefits you no matter what age you are.

It has a role while teeth are forming, to help make them stronger, and it has a role after teeth have erupted to protect them against the attack of acid on the teeth.

Community water fluoridation. Effective. safe. affordable.


Dr Kiki Maoate – Pacific Medical Association, talks about community water fluoridation

We are one of the most disadvantaged groups of people with high tooth decay rates in our children. Having fluoride in the water will improve the oral health of our children.

Our decisions on water fluoridation will have an impact on the future of our children's health. Fluoride in our water is such a simple method for improving health of our children with respect to their teeth. We should just get on with it.

If you look at fluoride – and fluoride is a normal element or mineral – in the water and so when we look at water we think it's just like air, there's nothing in it but in fact there are multiple other particles in water.

And fluoride is one of them.

And all these minerals have a part to play in how we function as a human being or how we do things around around the place.

And so that if we think of fluoride that's in the water normally, at the right levels everybody lives in harmony and it works and that's for all the elements and all the minerals in the water.

But clearly fluoride has a role to play in our teeth and supporting the teeth, make it stronger reducing decay, all those sort of things.

And at too low levels, which is what we know in New Zealand is one of the main issues, it's not useful. It doesn't contribute to improving the health care of our oral - of the teeth and particular in children.

And too high we know there's complications with excess fluoride that can come out of that.

And so if we can we can raise it to a level which is actually not that high but within a range, then that's what the ideal is.

Community water fluoridation. Effective. safe. affordable.


Dr Chris Kalderimis – General Practitioner, Wellington, on the quality of fluoridation information

As a family doctor, general practitioner, I look after people in a holistic way.

I care very much for their total wellbeing, not just bits of their care. And for me fluoridation provides a very safe and effective way of helping dental health.

We do realize now more and more that dental health is an integral part of your overall health. That if you have poor dental health your cardiac care, for example, may suffer and therefore it's so important to provide that sort of care and for our children, it is essential that we give them as good a start as we can.

Dental health does that for us.

Fluoridation is a safe, effective, cheap way of ensuring that.

I care very much that whatever prophylactic care we give children particularly it has to be safe and effective. And I believe fluoridation is both of those. I've seen and looked at very carefully all of the studies that have been presented to me and I did not find one peer-reviewed study that - as you said - that we cannot provide effective, safe dental care by fluoridation.

I'm concerned that we haven't had a good scientific discussion or debate about fluoridation. It is often emotive and people often with the loudest voices are the ones that are most listened to. That's not safe science. We should be looking at the proper scientific basis for the arguments - not what is being read on the internet. Because, unfortunately the internet's a very poor distiller of what is good quality information and what is just hype. And if people base their decision purely on that they're they're going to come up with some very strange responses really.

Fluoridation, it's had lots - lots and lots of study performed and there's not been one peer-reviewed study that I can find that has said that fluoridation is not safe. There have been lots and lots of studies that have said how safe and effective it is and that's what I want to provide for my patients.

There have been one or two studies that have been purported not to show fluoridation to be safe.

I think nobody - nobody has ever said it's not effective, the argument has been around the safety profile part of it. And I think if you look at those studies, they have not been peer reviewed, they have not been duplicated and I think we can have little credence to them still.

I am concerned about the fact that these studies have been the ones that have been put out and purported to be the ones that people should listen to and that's just the case of the matter at all.

And I fear that a lot of people who've perhaps look at these studies do not understand what we mean by scientifically valid study.

The media sometimes present the fluoridation debate as two equal arguments. They're non-equal arguments.

On one hand you get often quite well-informed people who've done lots of research and see this as - fluoridation as being a safe effective way and preserving dental health. Whereas other people who may be just one or two individuals or groups, who will present the other point of view, and the media will present these points of view as having equal status. They haven't got equal status. One is well researched, well informed and presents a lot of validity behind it whereas others are simply a point of view that hasn't got any of those qualities to it.

Community water fluoridation. Effective. safe. affordable.


Dr Rudi Johnson – NZ Māori Dental Association, a perspective on water fluoridation

Heaps of work to be done on our preschoolers from right up to five-year-olds right up to the seniors there's just so much work to be done.

Speaks to patient: "So these front ones, you've got a couple of holes on the front teeth here".

A lot of preschoolers we have to refer to hospital because they are so young we can't treat them in the clinic.

Speaks to patient: "Good girl. Well done. So we're going to go for a ride in the chair, OK?"

Their baby teeth that have just come through they're actually decayed before they even make it into the mouth.

I see kids that live in our rural areas with huge holes in their teeth lots and lots of decay, especially in their front teeth where it shouldn't be seen at all.

What we found is that fluoride in small quantities can be taken up into your teeth and it makes the surface really strong, it toughens them.

It's a normality. You see it every day. Everyone knows someone whose children or adults have have missing teeth, have tooth decay, you know, brown teeth in the front, black teeth in the front, missing teeth.

It's very common and shouldn't be.

Community water fluoridation. Effective. safe. affordable.

 


David Moore – Managing Director, Sapere Research Group, on the benefits and cost of water fluoridation

My name is David Moore. I’m from Sapere Research Group. We’re a firm of independent economists and we were commissioned by the Ministry of Health to look at the economics of adding fluoride to New Zealand’s water supplies.

There’s a great deal of evidence, you know, stretching over decades. Quite a bit of it is international. Some of it’s Australian and some of it’s New Zealand.

There is some variation between studies about just how much tooth decay is reduced by fluoridation:

The York Report of 2000 showed a 38 percent reduction (figure calculated by Sapere Research Group),

Gunn and Do (2012) showed a 30-59 percent reduction; and

The Cochrane (2015) Review showed a 35 percent reduction.

The New Zealand Oral Health Survey shows, for children, that there is 40 percent less tooth decay in areas which are fluoridated.

The Australian National Oral Health Survey shows, again, a material and consistent reduction between 20 and 30 percent.

But consistently over time, there is a large body of evidence showing that fluoridating water makes a significant difference, a positive difference in reducing tooth decay.

There are several studies in New Zealand, two of which, the Southland study which showed that you got basically half as much tooth decay with fluoridated water - and a very good comparison of Christchurch and Wellington.

Where Wellington is fluoridated, Christchurch is not - it’s only about 5 percent fluoridated. And there was 40 percent benefit in terms of the reduction in tooth decay.

The cost of running a water fluoridation programme is relatively minor and the savings are very considerable. 

We estimate that approximately 8 million fewer teeth will suffer decay, which is a decrease of about 22 percent. And that’s a lot of teeth.

Water fluoridation costs around $2.60 per person per year versus the cost of an average filling which is around $250.

We save $1.4 billion over 20 years and that’s a pay back of about $9 for every $1 that you put into water fluoridation.

Adding fluoride to water supplies improves things for everybody, whether Māori, Pacific Islanders, whether they’re socially advantaged or socially disadvantaged. What’s particularly important is, you know, for those populations that we know have relatively poor oral health – they get benefit which is quite material and that includes Māori, and the socially disadvantaged.

Community Water Fluoridation: Effective. Safe. Affordable.


Dr Stewart Jessamine – Director of Protection, Regulation and Assurance, Ministry of Health

I’m Dr Stewart Jessamine and I’m the Director of Protection, Regulation and Assurance.

Over the last 15 years there’s been multiple studies examining the effects of water fluoridation across regions in New Zealand.

While the results of these studies vary from region to region they consistently show significantly less decay in communities that use water fluoridation.

The most recent New Zealand Oral Health Survey showed that children living in areas with fluoridated water had 40 percent less tooth decay.

A recent Australian survey showed that adults living in areas with fluoridated water had 20-30 percent less tooth decay.

This significant difference is consistent with international evidence where water is fluoridated at similar levels as in New Zealand.

There have been numerous studies and ongoing analysis over the last 60 years about the safety of water fluoridation.

We can confidently say from a medical and from a public health perspective that water fluoridation at the levels recommended in New Zealand pose no health risk whatsoever.

There’s no impact on IQ, there’s no impact on bone cancer, there’s no other major health consequences associated with consumption of fluoridated water at all.

The only known side-effect of drinking fluoridated water in New Zealand is mild dental fluorosis. This is a kind of mottling of the teeth that can only really be seen by dentists. There’s been no cases of severe dental fluorosis reported in New Zealand associated with drinking fluoridated water.

One of the advantages of having lots of research in this area is that you can do economic analysis, you can work out how much it costs to fluoridate the water supply and what are the health benefits.

Water fluoridation is likely to save more in dental costs than actually it costs to administer the fluoridation programme.

A recent study by the Sapere Research Group for New Zealand demonstrated that water fluoridation by preventing dental decay saves us about $1.4billion over the next 20 years.

That’s mostly through decreasing the need for dental treatment. At a personal level, this will mean less fillings, less extractions, less kids having to go into hospital to get dental therapy. So this is going to save money both nationally and personally out of your own pocket.

Sapere has reported that the average cost per person per year for water fluoridation is about $2.60. This is an incredibly small amount of money when you compare it against the average cost to an individual adult of one filling which is about $250.

Community Water Fluoridation: Effective. Safe. Affordable.