Grew up where fluoride was the problem? Australia adds it to the water on purpose

For a parent who grew up in a part of India where fluoride was the problem and is now raising children in Australia, the new country can seem to have things the wrong way round. Here, fluoride goes into the tap water on purpose, a policy called water fluoridation. It is the same mineral at a different dose: a matter of milligrams.

In a 2017 public statement, Australia’s National Health and Medical Research Council (NHMRC) backed fluoridating drinking water within a range of 0.6 to 1.1 milligrams per litre, and put the share of Australians with access to fluoridated water at around 89 per cent.

Teeth that turn from white to black

India launched its National Programme for Prevention and Control of Fluorosis in 2008-09. By January 2020, according to a training module from the National Centre for Disease Control in Delhi, it covered 157 districts, among them 30 of Rajasthan’s 33. The module, dated February 2023 and produced with India’s health ministry, calls fluorosis “a crippling disease”, caused by taking in too much fluoride over a long period. Most of the excess comes through groundwater used for drinking, though food, black or rock salt in particular, and industrial pollutants add to it.

In children of school age, the module says, fluorosis discolours the teeth, “progressing from white, yellow, and brown to black”. It cannot be reversed. In adults, once skeletal fluorosis has set in, bone deformities cannot be corrected without surgery.

Citing Ministry of Jal Shakti data as at 1 April 2019, the module puts about 8,415 habitations in 19 states above the permissible limit of 1.5 mg/L, with about 60 lakh people, or six million, living in them at risk of fluorosis. The same ministry told the Lok Sabha in December 2024 that 255 fluoride-affected habitations remained and that safe drinking water had been made available in all of them, including through community water purification plants, which it describes as an interim measure until piped supply from a safe source is ready.

The case for water fluoridation at a smaller dose

NHMRC’s statement, released on 9 November 2017, rests on an evidence review published in 2016. It strongly recommends community water fluoridation as “a safe, effective and ethical way to help reduce tooth decay across the population”. NHMRC found that fluoridation cuts tooth decay by 26 to 44 per cent in children and adolescents, and by 27 per cent in adults. On harm, it says there is reliable evidence that fluoridation at current Australian levels is not associated with cancer, Down syndrome, cognitive dysfunction, lowered intelligence or hip fracture.

In a letter to councillors dated 8 March 2018, NHMRC’s then chief executive, Professor Anne Kelso, wrote: “Most of the evidence on possible harms to humans is from areas with higher levels of fluoride than we use in Australia.”

Dental fluorosis turns up here too, most often, the statement says, as white lines or areas on tooth surfaces. Almost all of it in Australia is very mild or mild and does not affect how the teeth work. Moderate cases are very uncommon, severe ones rare.

NHMRC’s page for the statement links to nothing newer. At its meeting on 23 January 2026, however, the NSW Fluoridation of Public Water Supplies Advisory Committee minuted: “The NHMRC will conduct an evidence review on the safety and efficacy of fluoridation.” Papers for its meeting on 21 August 2026 record that no timeline was available from NHMRC.

A ceiling both countries share

Australia’s drinking water guidelines, which NHMRC publishes, say fluoride should not exceed 1.5 mg/L, a value set to protect children from the risk of dental fluorosis. The module gives India’s permissible limit as the same 1.5 mg/L, with the rider that less is better, and the desirable limit as 1.0 mg/L, inside the range NHMRC supports for fluoridation.

Decay that differs by family background

A 2023 paper in Community Dental Health by Gustavo Hermes Soares and three co-authors profiled the oral health of Australian children from different immigrant backgrounds. “Three categories of immigrant status were created based on parents’ country of birth and language (non-immigrant, non-visible immigrant, and visible immigrant),” the abstract explains. It gives no breakdown by country, so none of its figures is specific to children of Indian-born parents.

In the study’s data, drawn from the National Child Oral Health Study of 2012 to 2014, untreated decay among children aged 5 to 9 was 38.8 per cent in the visible immigrant group, against 24.9 per cent among non-immigrant children and 21.0 per cent in the non-visible immigrant group. Children from non-visible immigrant families, though, did worse than both other groups on use of dental services and on self-rated oral health. The authors conclude that children from immigrant families in Australia are a highly varied group, with substantial differences in oral health outcomes.

A dental benefit nobody has to apply for

The Child Dental Benefits Schedule covers part or all of the cost of some basic dental services for children. According to Services Australia, a child qualifies if eligible for Medicare and aged 0 to 17 for at least one day of the calendar year, and if the child or their parent, carer, guardian or approved care organisation gets an eligible payment, such as Family Tax Benefit Part A, at least once that year. Nobody needs to apply or register; if the child is eligible, Services Australia sends a letter.

The agency’s page on what is covered, last updated on 1 January 2026, puts the cap at A$1,158 for each eligible child over two consecutive calendar years, indexed every 1 January. Check-ups, X-rays, cleaning, fissure sealing, fillings, root canals and extractions are covered. Orthodontic and cosmetic work, and any dental services in a hospital, are not.

Both countries draw the line at 1.5 milligrams per litre. For a parent who grew up drinking water above that line, the range NHMRC supports for their children’s tap water stops at 1.1.