ADA Guidelines for the Use of Fluoride
September 9, 2017 at 9:40 pm #84246yli46Participant
1.1. The use of fluorides in dentistry is one of the most important ways of preventing dental caries and has the
support of peak public health and dental authorities. International bodies such as the US-based Centres for
Disease Control and Prevention (CDC), the World Health Organisation (WHO) and the US Surgeon General
actively promote water fluoridation. The CDC placed water fluoridation in the top ten public health
achievements of the 20th Century. Similarly, scientific bodies in Australia, recognised public health groups and
professional organisations support water fluoridation.
1.2. Community water fluoridation continues to be the most cost-effective, equitable and safe means to provide
protection from tooth decay and has been successfully utilised in Australia for more than 50 years.
1.3. Community water fluoridation may be impractical in very small communities, particularly those in regional and
1.4. A significant number of households are not connected to mains water.
1.5. The effect of water fluoridation is predominantly topical.
1.6. Australian infant formula is manufactured to be safe and avoid causing fluorosis when used with fluoridated
1.7. Dental fluorosis occurs as a result of interference in the formation of the enamel. It varies from very thin, almost
invisible, white patches or lines over the tooth surface to significant areas of brown staining and/or pitted
enamel defects. Dental fluorosis can be a significant and unwanted effect on teeth if a child is exposed to high
levels of fluoride when the teeth are forming, although instances of severe dental fluorosis are now rare in
1.8. Dental fluorosis is only one of the numerous causes of hypo-mineralisation blemishes, or mottling, in teeth.
1.9. Studies have shown that most bottled water sold in Australia does not contain fluoride at sufficient levels to
protect teeth from caries.
1.10. Fluoride supplements in the form of drops and tablets are not widely available in Australia.
1.11. ADDITIONAL SOURCES OF FLUORIDE is an all-encompassing term to include all sources of fluoride other
than water fluoridation – fluoride drops, rinses, tablets, toothpastes, gels and fluoride in foods and beverages.
1.12. BOARD is the Dental Board of Australia.
1.13. DENTAL FLUOROSIS is the staining or mottling of the teeth as a result of greater than optimal fluoride
exposure while a child’s teeth are developing.
1.14. DENTAL PRACTITIONER is a person registered by the Board to provide dental care.
1.15. FLUORIDE SUPPLEMENTS are those products that seek to achieve a similar effect on the individual as
fluoridation of the water supply. The term is generally limited to fluoride tablets and drops.
1.16. WATER FLUORIDATION is the treatment of community water supplies for the purpose of adjusting the
concentration of the free fluoride ion to the optimum level for maximum caries prevention and minimal
occurrence of dental fluorosis.
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2.1. Water fluoridation is the most effective, equitable and efficient measure for achieving reduction in dental
caries incidence across a community.
2.2. All Australians should have equality of access to the benefits of fluoride, either by water fluoridation or
the use of fluoride supplements.
2.3. For children, there is a need to use fluorides to strive for optimal caries prevention while ensuring the
prevalence of dental fluorosis is minimised.
2.4. Whilst fluoridation of community water supplies is the preferred method of fluoride delivery, fluoride
supplements can be used to promote a reduction in dental caries in areas that are not optimally
2.5. Fluoridation of community water supplies benefits all age groups.
3.1. Fluoridation of community water supplies is preferred as a safe and effective means of reducing the
prevalence of dental caries in all age groups and should be implemented and maintained in those
communities where there is an insufficient natural fluoride content for this purpose.
3.2. The optimum level of fluoride to be achieved in a water supply should take into account climatic
conditions and water consumption.
3.3. Where fluoridation of water supplies is effected, there must be adequate control and supervision of the
3.4. Governments must adopt water fluoridation as part of Health Policy and actively promote its introduction,
where it is feasible, as a public health measure.
3.5. Manufacturers and producers of bottled water should be encouraged to ensure that their products
contain fluoride at approximately 1 milligram per litre (mg/L) and that the fluoride content is included in
3.6. Only water filters that do not remove fluorides should be recommended.
3.7. Manufacturers of water filters or water filtering systems should include information on their products as
to whether or not fluoride is removed.
Additional Sources of Fluoride
3.8. People living with non-fluoridated water supplies should use fluoride supplements by adding them to
their water to community water fluoridation levels.
3.9. Because of the variable presence of fluoride in foodstuffs, particularly processed foods and beverages,
supplementary fluoride must be used under the direction of a dentist and should take into account the
assessment, conducted by a dentist, of an individual’s caries risk.
3.10. Fluoride supplements must be readily available at a reasonable cost to those needing them.
3.11. Toothpastes containing fluoride should be used as an important method of further reducing dental caries
incidence, regardless of whether or not the area water supply is optimally fluoridated. Fluoride
toothpastes should be used as recommended by a dentist who should take into account the age of the
patient, the access to fluoridated water and an assessment of an individual’s caries risk. Special care
must be taken with very young children to limit the amount of toothpaste used and, thereby, the
ingestion of fluoride.
3.12. Professional topical application of fluorides must be selectively used on patients who, as a result of an
evaluation conducted by a dentist, are assessed as having a high caries risk.
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3.13. There is a need to support further studies that examine the impact of fluoride delivery mechanisms in the
Australian population including: studies of the epidemiology of dental caries and dental fluorosis;
investigations of the impact of both conditions on people’s well-being and quality of life; risk factors for
dental caries and dental fluorosis; use of fluoride vehicles in dental practice and the population; and the
efficacy, effectiveness and cost effectiveness of fluoride vehicles. Research is needed to develop new
preventive interventions including new vehicles for fluoride delivery as well as other preventive strategies
that are not based on fluoride. New interventions should be judged for their equivalency or superiority to
existing preventive approaches that have documented efficacy.
3.14. The control of additional fluoride sources, rather than the reduction or removal of the optimum fluoride
level in drinking water, is the preferred strategy for maintaining the low incidence of dental fluorosis.
Policy Statement 2.2.1
Adopted by ADA Federal Council, November 15/16, 2001.
Revised version adopted by ADA Federal Council, November 11/12, 2004.
Amended by ADA Federal Council, April 7/8, 2005.
Revised version adopted by ADA Federal Council, November 15/16, 2007.
Amended by ADA Federal Council, November 18/19, 2010.
Amended by ADA Federal Council, April 12/13, 2012.
Amended by ADA Federal Council, April 10/14, 2014.
Amended by ADA Federal Council, November 13/14, 2014.
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Appendix to Policy Statement 2.2.1 – ADA guidelines for the
use of fluoride
1. Water Fluoridation
1.1. Water fluoridation is a proven method for reducing the prevalence of dental caries in communities.
1.2. Surveys of dental caries and dental fluorosis must be undertaken regularly, taking into account all
fluoride sources and patterns of consumption in a community, in order to confirm the most appropriate
water fluoridation concentration for that community or region.
1.3. The optimal fluoride concentration of community water supplies will normally be in the range of 0.6 to
milligram per litre (mg/Litre) of water (commonly known as parts per million or ppm).
1.4. The fluoride content of bottled water should be clearly stated on the label.
2. Fluoride Supplements
2.1. Fluoride drops or tablets should not be taken (swallowed) directly by an adult or child. They must be
added to drinking water to achieve a fluoride concentration of 1mg/L.
2.2. So people in non-fluoridated areas can obtain the benefits of fluoride in water it is recommended that
people buy bottled water with fluoride at approximately 1mg/L for drinking.
2.3. Support must be given to ongoing research into the epidemiology of dental caries and the use of fluoride
to ensure assessments of safety, effectiveness and efficiency of all methods of delivery of fluoride are up
2.4. All dental practitioners must maintain awareness of the latest science as it affects the use of all forms of
3. Fluoridated Toothpaste
3.1. From the time that teeth first erupt (about six months of age) to the age of 17 months, children’s teeth
should be cleaned by a responsible adult, but not with toothpaste.
3.2. For children aged 18 months to five years (inclusive), the teeth should be cleaned twice a day with
toothpaste containing 0.5–0.55mg/g of fluoride (500–550ppm). Toothpaste should always be used under
supervision of a responsible adult, a small pea-sized amount should be applied to a child-sized soft
toothbrush and children should spit out, not swallow, and not rinse. Young children should not be
permitted to lick or eat toothpaste.
3.3. For people aged six years or more, the teeth must be cleaned twice a day or more frequently with
standard fluoride toothpaste containing 1- 1.5mg/g fluoride (1000–1500ppm). People aged six years or
more should spit out, not swallow, and not rinse. Standard toothpaste is not recommended for children
under six years of age unless on the advice of a dental professional.
3.4. For children who do not consume fluoridated water or who are at elevated risk of developing caries for
any other reason, guidelines about toothpaste usage must be varied, as needed, based on dental
professional advice. Variations could include more frequent use of fluoridated toothpaste,
commencement of toothpaste use at a younger age, or earlier commencement of use of standard
toothpaste containing 1mg/g fluoride (1000ppm). This guideline may apply particularly to preschool
children at high risk of caries.
3.5. For teenagers, adults and older adults who are at elevated risk of developing caries, dental professional
advice should be sought to determine if they must use toothpaste containing a higher concentration of
fluoride (i.e. greater than 1000-1500 ppm up to 5000 ppm of fluoride).
3.6. Manufacturers must be encouraged to standardise and restrict the toothpaste tube orifice to allow a
more accurate and consistent amount of toothpaste to be dispensed.
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3.7. Manufacturers must be encouraged to avoid flavours that imitate too closely popular food tastes to avoid
accidental ingestion of large amounts of paste by very young children.
4. Application of Topical Fluoride
4.1. Concentrated forms of fluoride should only be applied by suitably-qualified dental practitioners and
should only be used after taking into account an assessment conducted by a dentist of an individual’s
4.2. Fluoride varnish should be used for people who have elevated risk of developing caries, including
children under the age of 10 years.
4.3. High concentration fluoride gels and foams (those containing more than 1.5mg/g fluoride ion) may be
used for people aged 10 years or more who are at an elevated risk of developing caries in situations
where other fluoride vehicles may be unavailable or impractical.
5. Fluoride Mouth Rinses
5.1. Fluoride mouth rinses must not be used by children under the age of six years due to the likelihood that
they will ingest large amounts and increase their risk of dental fluorosis.
5.2. Fluoride mouth rinses may be used by people over the age of six years under the direction of a dentist
where it is considered an appropriate choice for preventing caries in high risk individuals and where
there is certainty that the individual will understand that the product should be rinsed as directed and
spat out, not swallowed.
6. Fluoride, Diet, Cleaning Routines and Smoking
6.1. The beneficial effects of fluoride must be understood in conjunction with all the major risk factors for
6.2. A person’s inappropriate dietary and other habits have the potential to overcome the beneficial effect of
fluoride, with smoking, poor oral hygiene habits, and high frequency or prolonged exposure to dietary
sugars, starches and acidic foods and beverages, posing the highest risk.
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