Fluoridation by country

Fluoridation by country

Fluoridation of water, salt, and milk varies from country to country. Water fluoridation is most common in the English-speaking countries. Continental Europe largely does not fluoridate water,Ingram, Colin. (2006). "The Drinking Water Book". pp. 15-16] NCFPR. [http://www.fluoridationcenter.org/papers/2001/antifluoride.html Fluoridation Facts: Antifluoride Assertion - "Advanced Countries Shun Fluoridation"] . Drawn from the ADA [www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf Fluoridation Facts] document.] although some of its countries extensively fluoridate salt. China and Japan do not fluoridate water either. Developing nations may find it expensive to fluoridate water.


outh Africa

South Africa's Health Department recommends adding fluoridation chemicals to drinking water in some areas. It also advises removal of fluoride from drinking water (defluoridation) where the fluoride content is too high. [ [http://www.doh.gov.za/department/fluoridation.html "Water Fluoridation - The Facts"] , from South Africa's [http://www.doh.gov.za/department/ Department of Health] website, page accessed April 29, 2006.] [ [http://www.africanwater.org/randwater_fluoride.htm The Water Page - Rand Water and Fluoridation]



In China, water fluoridation began in 1964 in Guangzhou, and ceased in 1983. [http://www.fluoride-journal.com/02-35-1/351-01.pdf] The Chinese government considers any water supply containing over 1 ppm fluoride a risk for skeletal fluorosis. [Bo Z, et al. (2003). Distribution and risk assessment of fluoride in drinking water in the West Plainregion of Jilin Province, China. Environmental Geochemistry and Health 25: 421-431.]


Less than 1% of Japan practices water fluoridation.NCFPR. [http://www.fluoridationcenter.org/papers/2001/antifluoride.html Fluoridation Facts: Antifluoride Assertion - "Advanced Countries Shun Fluoridation"] . Drawn from the ADA [www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf Fluoridation Facts] document.]


Water fluoridation is not practiced in India. [ [http://www.windsofchange.eu.com/fluoride03.html Control of Fluorosis in India ] ] Fluorosis is endemic in at least 20 states, including Uttaranchal, Jharkhand and Chhattisgarh. [ [http://www.laleva.org/eng/2004/06/fluoridation_and_fluorosis_disaster_india_fluoride_in_water_takes_its_toll_in_assam.html Fluoridation and Fluorosis Disaster - India: Fluoride in water takes its toll in Assam - La Leva di Archimede (ENG)] ] The maximum permissible limit of fluoride in drinking water in India is 1.2mg/L. [http://www.who.int/water_sanitation_health/naturalhazards/en/index2.html WHO | Naturally occurring hazards] ]



In the Republic of Ireland the majority of drinking water is fluoridated. The fluoridation agent currently used in Ireland for addition to drinking water supplies is hydrofluorosilicic acid (HFSA; H2SiF6). [ [http://www.dohc.ie/publications/pdf/fluoridation_forum.pdf?direct=1 Report of the Forum on Fluoridation 2002] - [http://www.dohc.ie Dept of Health and Children] - Ireland] The original legal basis for fluoridation of water in the Republic of Ireland until 2007 was the Fluoridation of Water Supplies Regulations, 1965. Those regulations set the level of fluoride in drinking water to between 0.8 to 1.0 ppm. Since 1st July 2007, the legal basis for the fluoridation of drinking water in Ireland is the Fluoridation of Water Supplies Regulations, 2007. [ [http://www.dentalgain.org/SI%2042%20of%202007.doc Statutory Instrument No. 42 of 2007] - Fluoridation of Water Supplies Regulations 2007] These regulations set the level of fluoride in drinking water to between between 0.6 and 0.8 ppm, with a target value of 0.7 ppm.

The water supply in Northern Ireland has never been artificially fluoridated except in two small localities where fluoride was added to the water for about 30 years. By 1999, fluoridation ceased in those two areas, as well. Scotland's parliament rejected proposals to fluoridate public drinking water following a public consultation.


Around 10% of the population receives fluoridated water.Mullen, Joe. [http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html "History of Water Fluoridation"] , British Dental Journal, 2005, page accessed April 29, 2006.] [http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html] British Dental Journal (2005); 1-4. doi: 10.1038/sj.bdj.4812863Help History of Water Fluoridation by Dr Joe Mullen]

United Kingdom

Around 10% of the population of the United Kingdom receives fluoridated water. The All Party Parliamentary Group on Primary Care and Public Health recommended in April 2003 that fluoridation be introduced "as a legitimate and effective means of tackling dental health inequalities", laws were created allowing but not requiring fluoridation of water. The following UK utilities companies fluoridate their water: Anglian Water Services Ltd., Northumbrian Water Ltd., South Staffordshire Water plc, Severn Trent plc and United Utilities Water plc. Earlier schemes were undertaken in the Health Authority areas of Bedfordshire and Hertfordshire, Birmingham and the Black Country, Cheshire and Merseyside, County Durham and Tees Valley, Cumbria and Lancashire, North and East Yorkshire and Northern Lincolnshire, Northumberland, Tyne and Wear, Shropshire and Staffordshire, Trent, and West Midlands South whereby fluoridation was introduced progressively in the years between 1964 and 1988. [ [http://www.bma.org.uk/ap.nsf/Content/Water+fluoridation#Hansard British Medical Association] ]


In 1952, Norrköping in Sweden became one of the first cities in Europe to fluoridate its water supply.cite book | last = Larsson | first = Gerhard | coauthors = Bengt Bengtsson, Eva Hjelmström, Ove Karlsson, Maj-Inger Klingvall, Knut Wachtmeister, Karin Östergren | title = Fluor i kariesförebyggande syfte - Betänkande av fluorberedningen | publisher = Statens offentliga utredningar / Socialdepartementet | year = 1981 | month = May | language = Swedish | location = Stockholm | pages = 12
id = SOU 1981:32 | quote =
] It was declared illegal by the Swedish Supreme Administrative Court in 1961, re-legalized in 1962 [cite news | title = Fluoreringsfrågan avgjord | work = Västmanlands läns tidning | language = Swedish | date=1962-11-22 ] and finally prohibited by the parliament in 1971, [cite news | title = Stopp för fluor | work = Västmanlands läns tidning | pages = 1 | language = Swedish | date = 1971-11-19] after considerable debate. The parliament majority said that there were other and better ways of reducing tooth decay than water fluoridation. Four cities received permission to fluoridate tap water when it was legal.rp|56-57 An official commission was formed, which published its final report in 1981. They recommended other ways of reducing tooth decay (improving food and oral hygiene habits) instead of fluoridating tap water. They also found that many people found fluoridation to impinge upon personal liberty/freedom of choice, and that the long-term effects of fluoridation were not sufficiently known. They also lacked a good study on the effects of fluoridation on formula-fed infants.rp|29


In Switzerland since 1962 two fluoridation programmes had operated in tandem: water fluoridation in the City of Basel, and salt fluoridation in the rest of Switzerland (around 83% of domestic salt sold had fluoride added). However it became increasingly difficult to keep the two programmes separate. As a result some of the population of Basel were assumed to use both fluoridated salt and fluoridated water. In order to correct that situation, in April 2003 the State Parliament agreed to cease water fluoridation and officially expand salt fluoridation to Basel. [J. MEYER and P. Wiehl in Schweiz Monatsschr. Zahnmed 2003; 113: 702 (in French) and 728-729 (in German)]

North America


Approximately 40% of the Canadian population receives fluoridated water [ [http://www.hc-sc.gc.ca/iyh-vsv/environ/fluor_e.html "Fluorides and Human Health"] , from the [http://www.hc-sc.gc.ca/index_e.html Health Canada] website, page accessed March 25, 2006.]

Implementation of fluoridation usually lies with provincial or city governments. Brantford, Ontario became the first city in Canada to fluoridate its water supplies in 1945. In 1955, Toronto approved water fluoridation, but delayed implementation of the program until 1963 due to a campaign against fluoridation by broadcaster Gordon Sinclair. [ [http://archives.cbc.ca/IDC-1-75-341-1816/science_technology/fluoride/clip4 "Gordon Sinclair's rant"] , from the [http://archives.cbc.ca/index.asp?IDLan=1 Canadian Broadcasting Corporation Archives] website, page accessed March 27, 2006.] The city continues to fluoridate its water today. [ [http://www.toronto.ca/water/supply/supply_facilities/rlclark/filtration_process.htm "Water supply - R. L. Clark Filtration Plant"] , from [http://www.toronto.ca/index.htm Toronto's] website, page accessed March 27, 2006.] There have been some recent decreases in the amount of fluoridation used, however, from 1 mg per litre to between 0.6 and 0.8 mg per litre. Historically, British Columbia has been the province with least percentage of its population receiving fluoridated water; [ [http://www.env.gov.bc.ca/wat/wq/BCguidelines/fluoride/fluoridetoo-03.html "Ambient Water Quality Criteria for Fluoride"] , from the [http://www.env.gov.bc.ca/epdiv/ Environmental Protection Division] of British Columbia's Ministry of Environment website, page accessed March 27, 2006.] Greater Vancouver Water District member municipalities within the Metro Vancouver region receive water supplies that do not have added fluoride. [http://www.gvrd.bc.ca/water/pdfs/DrinkingWaterFAQs.pdf Drinking Water FAQ] ]

On April 21, 2008, the town of Dryden, Ontario overwhelmingly rejected a water fluoridation proposal at the ballot box. [ [http://www.tbtv.com/NWNews-Story.aspx?cid=106869 TB Television ] ]

United States

As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation. [ [http://www.cdc.gov/fluoridation/fact_sheets/benefits.htm The Benefits of Fluoride] , from the [http://www.cdc.gov/ Centers for Disease Control and Prevention] website, accessed 19 March, 2006.] According to a 2002 study, [ [http://www2.cdc.gov/nohss/FluoridationV.asp Fluoridation Status: Percentage of U.S. Population on Public Water Supply Systems Receiving Fluoridated Water] , from the [http://www.cdc.gov Centers for Disease Control and Prevention] website, accessed 19 March, 2006.] 67% of U.S. residents were living in communities with fluoridated water at that time.

The United States Centers for Disease Control proclaims, "Community water fluoridation is safe and effective in preventing tooth decay, and has been identified by CDC as one of 10 great public health achievements of the 20th century." [ [http://www.cdc.gov/fluoridation/ Community Water Fluoridation - Oral Health ] ] The CDC states that water fluoridation is safe at a level of (0.7 mg/L-1.2 mg/L). The CDC also advises avoiding water with fluoride concentrations of 2mg/L or higher for children up to age 8. [http://www.cdc.gov/fluoridation/faqs.htm: Community Water Fluoridation :FAQ] There is a CDC database for researching the water fluoridation status of neighborhood water. [ [http://apps.nccd.cdc.gov/MWF/index.asp Oral Health - My Water's Fluoride ] ]

In 1998, 70% of people polled in a survey conducted by the American Dental Association (ADA) believed community water should be fluoridated, with 18% disagreeing and the rest undecided. [American Dental Association Survey Center. 1998 consumers' opinions regarding community water fluoridation. Chicago, Illinois: American Dental Association, 1998] In November of 2006, the ADA began recommending to parents that infants from 0 through 12 months of age should have their formula prepared with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis. [ What is the ADA’s interim guidance on infant formula and fluoride? American Dental Association Website accessed May 28, 2008 [http://www.ada.org/public/topics/fluoride/infantsformula_faq.asp#2] ]

The issue of whether or not to fluoridate water supplies frequently arises in local governments. For example, on November 8, 2005, citizens of Mt. Pleasant, Michigan voted 63% to 37% in favor of reinstating fluoridation in public drinking water after a 2004 ballot initiative ceased water fluoridation in the city. [Crozier, Stacie. [http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1684 "Michigan town votes to return fluoridation"] November 30, 2005.] At the same time, voters in Xenia, Ohio; Springfield, Ohio; Bellingham, Washington; and Tooele City, Utah all rejected water fluoridation. [ [http://www.noforcedfluoride.org No Forced Fluoride in Bellingham, Washington (Fluoride) ] ]

In Skagit County, in Washington, the county commissioners have voted 2 to 1 to order the local public utility district to begin fluoridating the public water supply by Jan. 2009. $1.2 million could be provided by the privately funded Washington Dental Service Foundation to begin building the equipment needed to add fluoride chemicals to the Judy Reservoir, which supplies the majority of Skagit Valley's water customers. The source and type of fluoride to be added to the drinking water of more than 70,000 citizens has not been disclosed. [ [http://www.goskagit.com/home/article/state_attorney_general_says_board_can_require_fluoridation/ goskagit.com ] ]

The cost of adding fluoridation chemicals to the water of 44 Florida communities has been researched by the State Health Office in Tallahassee.Ringelberg, M. L., S. J. Allen, L. J. Brown. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1564695&dopt=Citation "Cost of fluoridation: 44 Florida communities."] , abstract from [http://www.pubmed.gov PubMed] website, page accessed 19 March, 2006.] In communities with a population of over 50,000 people, fluoridation costs were estimated at 31 cents per person per year. The estimated cost rises to $2.12 per person in areas with a population below 10,000. Unintended consequences, such as equipment malfunction, can substantially raise the financial burden, as well as the health risks, to the consumer.Flanders, R. A.; Marques, L. (May-June 1993). "Fluoride overfeeds in public water supplies". Illinois dental journal 62 (3): 165-169.] ^ Gessner, B. D.; Beller, M.; Middaugh, J. P.; Whitford, G. M. (January 1994). "Acute fluoride poisoning from a public water system". New England journal of medicine 330 (2): 95-99.] [http://www.ncbi.nlm.nih.gov/pubmed/12369244?dopt=Abstract Fluoride overfeed at a well site near an elementar... [J Environ Health. 2002 - PubMed Result ] ] [ [http://www.nofluoride.com/Dublin_overdose.htm Fluoride suspected as 23 in Dublin California grow ill ] ] [http://www.ncbi.nlm.nih.gov/pubmed/9323392?dopt=Abstract Outbreak of acute fluoride poisoning caused by a f... [Public Health Rep. 1997 Sep-Oct - PubMed Result ] ] CHICAGO SUN-TIMES, July 31, 1993, Fluoride Blamed in 3 Deaths: Traces found in Blood of U. of C. Dialysis Patients Gary Wieby] EVENING CAPITAL (Annapolis, Maryland), November 29, 1979, Fluoride Linked to Death, Mary Ann Kryzankowicz] [ [http://www.fluoridealert.org/health/accidents/fluoridation.html Examples of Acute Poisoning from Water Fluoridation ] ]



Australia has fluoridation in all but one state, Queensland, in which water fluoridation is under local government control. However, on 5 December 2007 Queensland Premier Anna Bligh announced fluoridation of most of Queensland's water supply will begin in 2008. [ [http://www.abc.net.au/news/stories/2007/12/05/2110402.htm Qld to get fluoridated water - ABC News (Australian Broadcasting Corporation) ] ] The city of Geelong, west of Melbourne, does not fluoridate its water supplies. This is despite the fact that all of Melbourne's water is fluoridated. The first town to fluoridate the water supply in Australia was Beaconsfield, Tasmania in 1953. [cite book | editor = Editors: Graham Aplin, S.G. Foster and Michael McKernan | title = Australians:Events and Places | year = 1987 | publisher = Fairfax, Syme & Weldon Associates | location = Sydney, NSW, Australia | id = ISBN 0-521-34073-X | pages = page 366 | chapter = Tasmania ] Fluoridation commenced January 7th, 2008 in the City of Gosford, New South Wales. [ [http://www.gosford.nsw.gov.au/water_and_sewer/fluoride Gosford City Council Water Information Centre] ]

New Zealand

New Zealand has fluoridated nearly all water-supplies except those in remote areas. The use of water fluoridation first began in New Zealand in Hastings in 1954. A Commission of Inquiry was held in 1957 and then its use rapidly expanded in the mid 1960s. [ [http://www.moh.govt.nz/moh.nsf/0/AB32B58A8D61D9DACC256F47007C32BB New Zealand Ministry of Health] ]

outh America


In Chile 70.5% of the population receive fluoridated water (10.1 million added by chemical means, 604,000 naturally occurring). [Information from the Oral Health Department of the Chilean Ministry of Health. December 2004.]


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