Fluoride: do we still need it?
Author: Dr Alexandra Jones, Co-Founder and Board Chair
A useful way to think about fluoride isn’t to start with chemistry, but with a simpler question: How are we going with tooth decay rates in Australia?
If tooth decay was no longer a problem, the fluoride conversation would look very different. But the data tells us we’re not there yet.
According to the Australian Institute of Health and Welfare, Australia made strong early gains in reducing tooth decay, particularly after water fluoridation and fluoride toothpaste became widespread.
But progress has slowed, and in some areas it has stalled altogether.
Here’s the reality:
Tooth decay remains one of the most common chronic diseases in the country
Fewer than 11 per cent of adults have never experienced tooth decay
More than 32 per cent of adults and 27 per cent of children age 5-10 currently have untreated decay
This is happening in one of the wealthiest countries in the world. Australia is consistently ranked among the world’s top economies by the Department of Foreign Affairs and Trade, yet thousands of Australians are hospitalised each year for preventable dental conditions.
So where does fluoride fit?
Tooth decay is a chronic, multifactorial disease. That can feel frustrating as there’s no single silver bullet, but it’s also good news, because it means we have options.
Fluoride is one of those options. A powerful one.
Fluoride works by strengthening tooth mineral and helping teeth repair themselves after everyday exposure to acid from food, drinks and bacteria. It doesn’t matter whether fluoride comes from toothpaste, professional treatments, or fluoridated water, the biological mechanisms are the same.
Think of fluoride as a protective support that helps teeth cope with real life.
Oral health risk isn’t static. It changes over time based on diet, stress, health conditions, medications, access to care, and life circumstances.
You might be at low risk right now, but teeth don’t regenerate, and damage accumulates. Once mineral is lost, it’s hard to get it back without intervention.
That’s why having ongoing, low-level fluoride exposure across our lifespans matters. It offers protection not just for today, but for future you.
The positive impact of fluoride is easiest to see across generations in Australia. Many of our grandparents lost all their teeth by mid-adulthood, and our parents kept their teeth but needed lots of fillings.
Those of us who are adults today tend to have far fewer restorations, and some children are growing up with no fillings at all.
That shift didn’t happen overnight. It took around 100 years, and fluoride played a big role in shifting the dial.
Some people worry that dental fluorosis (changes in tooth enamel) signals broader harm.
The key thing to know is this that the evidence of harm comes from very high fluoride exposures, seen in areas with naturally excessive fluoride levels, not from the carefully controlled levels used in public health prevention in Australia.
At current exposure levels, the benefits far outweigh the risks, particularly when weighed against the pain, infection, cost and lifelong burden of untreated dental disease.
Many Australians have limited access to oral health care and support. That means prevention matters even more.
Fluoride, especially through population-wide measures like community water fluoridation acts as a giant safety net. It protects people regardless of income, postcode, or whether they can afford regular dental visits. That’s why fluoride remains such an important part of preventive oral health.
Quick fluoride facts
Fluoride helps maintain and repair tooth mineral
It works the same way whether delivered via toothpaste, water or professional treatments
Safe use depends on carefully controlled exposure levels
Tooth decay has declined overall, but not for everyone
Progress has slowed, likely due to the influence of unhealthy systems across our lives
Fluoride supports prevention and treatment of tooth decay
It remains one of the most effective, low-cost public health tools we have
In short, Fluoride is a proven, effective part of a broader prevention toolkit that helps people keep their teeth for life.
And when it comes to teeth, while their surfaces can heal, they can’t regrow. That means as much as we love them, their strength hides a vulnerability, they are unforgiving when damaged. This means we need to care for our teeth across the course of our lives, and so does our health system.
The bottom line is we still need fluoride. It acts both individually and collectively to support oral health, especially for people who are most in need of it.