Fluoride level of Alice Springs water called to account for heightened cases of child tooth decay
Alice Springs children are at double the risk of developing tooth decay in comparison to their Darwin counterparts, according to a dental expert involved in a comprehensive national survey.
Current fluoride level data provided by the Northern Territory’s Power and Water Corporation suggests that for the past 14 years, fluoride levels in the territory have been consistently below the World Health Organisation level of 0.6mg/L.
But the Alice Springs’ water supply has not had added fluoride since the late 1980s due to sufficiently and naturally occurring fluoridation, according to the NT Government.
Associate Professor Loc Do from the University of Adelaide’s School of Dentistry was involved in the 2016 National Child Oral Health Study, looking at the teeth of more than 30,000 children from 2012 to 2014.
During the study, 173 children under the age of 10 in the central Australia town were examined, with researchers identifying cavities, missing teeth, and fillings.
Professor Do said Alice Springs had been included in the study as a non-fluoridated area, despite the natural occurrence of fluoride in the town’s water.
“Comparing Darwin and Alice Springs children, Alice Springs children had about 5.5 surfaces with decay comparing to 1.7 in Darwin,” he said.
“The children in Alice Springs have more than twice the number of tooth surfaces affected by the dental caries than those in Darwin.”
However, the NT Department of Health has defended the current fluoride levels in the Alice Springs water supply.
“Alice Springs has naturally fluoridated ground water supplies,” it said in a statement.
“Levels are currently 0.6mg/L [and] previous levels above 0.5mg/L provided therapeutically beneficial amounts of fluoride to the community of Alice Springs, consistent with the position of the National Health and Medical Research Council and the World Health Organisation.”
Even lower levels in Yulara water
The community of Yulara, 446 kilometres south-west of Alice Springs, does not have access to a fluoridated water supply, and the naturally-occurring fluoride levels are well below the recommended levels.
Fluoride levels across the NT:
WHO recommended fluoride levels: 0.6 to 0.8 mg/L
Source: Northern Territory Power and Water Corporation
This is despite the NT’s own guidance which coincides with National Oral Health Plan 2015-2024 recommendations for the fluoridation of water supplies for communities of 1,000 or more people.
“Modelling carried out by the NT Department of Health suggested that the optimal cost-benefit balance in the Northern Territory would occur by adding additional fluoride to water supplies for communities of 600 or more people where the naturally occurring fluoride levels are less than 0.5mg/L,” a Northern Territory Department of Health spokesperson said.
Data from the Northern Territory Power and Water Corporation shows fluoridation levels in Yulara between 0.06 and 0.3mg/L across 12 years.
Dr John Boffa of the Central Australian Aboriginal Congress is calling for the NT Government to conduct an immediate review into the fluoride levels in Central Australian communities.
“I think in this day and age it is really important that every community has access to fluoride, including Yulara,” he said.
“I think this could be something that is considered by a review looking at which communities don’t have fluoridation and why.”
Fluoride level balancing act
In 1987, the decision was made by Dr Bruce Simmons, then general manager of the Central Australian Oral Health Service, to remove added fluoride from Alice Springs’ water supply.
There was no public consultation.
“The water authority said they were shifting the bore field further out of town,” Dr Simmons said.
“They were going to put new fluoridation and chlorination plants in, but before they invested in a fluoridation plant [the question was] ‘would they need to do it?’
“At that point we knew the natural occurring level was about 0.5mg/L, which was only 0.1mg/L less than the recommended level.
“The World Health Organisation (WHO) recommend a level of 0.6mg/L to 0.8mg/L [and] we had been adding fluoride to that 0.8mg/L level.”
Dr Simmons said he had also been concerned about the rates of children presenting with mild cases of fluorosis — white flecking on the surface of the teeth which, in mild cases, is not harmful.
“We used to be able to say ‘this is a good sign that your teeth have a lot of fluoride which makes them more resistant to tooth decay’,” he said.
“I used to examine schoolkids every two years and there was obviously quite a bit of mild or very mild fluorosis, and the therapists were concerned about it.”
Professor Do argues that fluorosis rates across Australia have declined steadily due to the removal of fluoride from baby formula, the discontinuation of oral fluoride tablets and drops, and the introduction of low fluoride toothpaste for children up to the age of six.
“Our data is showing that children in Alice Springs would benefit more from higher concentration of fluoride in the water,” he said.
Calls for immediate review
Dr Boffa said it was disappointing to hear “that the single most important public health dental measure that we can take is not effectively being implemented”.
Dr John Boffa says up to 50 per cent of children in Alice Springs have dental caries. (Supplied: Central Australian Aboriginal Congress)
“I think it’s up to the chief dentist to immediately conduct a review of the situation in Alice Springs including, I would suggest, some public consultation about the level of fluoride,” he said.
Dr Boffa is disappointed at any misinformation in regards to fluoride levels, and said many people were under the impression the town’s water supply was fluoridated and therefore within normal levels to prevent tooth decay.
“If you remember, when the NT National Emergency Response [“the intervention”] happened we were doing child health checks on very large numbers of children,” he said.
“Up to 50 per cent of children in the Alice Springs area had dental caries, which is the major health issue identified in the health checks.
“While a diet high in sugar is a contributing factor to tooth decay, having access to a fluoridated water supply would help mitigate the level of decay in children’s teeth.
“Even if we could prevent 25 per cent of dental caries, that would be a significant cost saving and an improvement in the health status of children in Alice Springs.”