Water fluoridation has been the centrepiece in dental caries (decay) prevention in Australia since its introduction in 1953 in Beaconsfield, Tasmania.1,2 Over the years, a growing number of Australian towns and communities have come to receive the benefits of this important public health initiative. Healthy mouths, healthy lives: Australia's National Oral Health Plan 2004–2013 had a goal of extending water fluoridation to communities across Australia with populations of 1,000 or more by end of 2006.3 As a letter published in this journal in 2006 noted, approximately 70% of the Australian population resided in areas with optimally fluoridated public water supplies.4 Since publication of that letter, a number of state and territory health departments have continued to implement water fluoridation extension programs. Given that four years have passed since the extent of water fluoridation coverage in Australia was last documented, it is timely to review the current status of water fluoridation in this country.
In mid-June 2010, contact was made with all state and territory health departments to ascertain the proportion of people in each jurisdiction who were exposed to optimally fluoridated drinking water supplies. That data is summarised in Table 1. The population data in the table represents Australia's population at end June quarter 2010.
|Jurisdiction||Population||% water fluoridation coverage||Number of people with water fluoridation|
|NSW||7.2388 m||94||6.8045 m|
|Victoria||5.5475 m||90||4.9928 m|
|Queensland||4.5164 m||80||3.6131 m|
|SA||1.6446 m||90||1.4801 m|
|WA||2.2964 m||92||2.1127 m|
|Tasmania||0.5076 m||83||0.4213 m|
|NT||0.2297 m||75||0.1723 m|
|ACT||0.3589 m||100||0.3589 m|
|Australia||22.3399 m||89.33||19.9557 m|
Table 1 shows that almost 90% of Australians now have the benefits of optimal water fluoridation – an increase from 70% in 2006. The vast bulk of this increase has come from the significant extension activity in Queensland, which began in 2008, and to a lesser degree from extension in Victoria, New South Wales and South Australia. This almost 90% coverage represents a significant increase from the 70% figure reported in 20064 and is a major public health achievement.
The extent to which additional water fluoridation coverage can be achieved will depend on the number of people in areas without water fluoridation who have reticulated water supplies and the funding available from state and territory health budgets to construct and commission new water fluoridation plants. Reticulated water supplies are required for fluoridation to be viable; people who do not have reticulated water supplies – such as farmers and others whose sole water supply is obtained from rain water tanks – cannot receive the benefits of a fluoridated water supply.
For example, in Victoria, approximately 10% of the population is now without optimally fluoridated water supplies. Of these people, approximately half are connected to water grids and receive reticulated water and could potentially receive fluoridated water. A study conducted in New Zealand has shown water fluoridation to be cost effective down to communities of approximately 1,000 people.5 A recent study from the Northern Territory, however, has found that extension of water fluoridation to communities of fewer than 1,000 people could be cost effective in some circumstances.6 Furthermore, for reasons of equity, there is a strong incentive to provide water fluoridation to communities of fewer than 1,000 people, as people in small rural communities tend to have lower socio-economic status and poorer health outcomes, including poorer oral health.7,8