Water fluoridation and infant formula policies
13 December 2006
New Zealand water fluoridation and infant formula policies appropriate
Recommendations published by the American Dental Association on fluoridation and infant formula cannot be used to argue against wider fluoridation of New Zealand drinking water, the Ministry of Health says.
In New Zealand, the evidence supporting fluoridation remains very strong.
"New Zealand children continue to experience higher than acceptable levels of dental decay and fluoridated water remains one of the best weapons we have in the fight against tooth decay,'' says the Ministry's chief advisor oral health Dr Robin Whyman.
The American Dental Association recently made recommendations around the use of infant formula and the use of fluoridated water. It recommended that if liquid concentrate or powdered infant formula was a baby's primary source of nutrition that it was mixed with water that was fluoride free or contained low levels of fluoride to reduce the risk of fluorosis.
Fluorosis is essentially marking to the enamel of the teeth, which most commonly appears as mild flecking or white spots.
Dr Whyman says in New Zealand levels of fluoride are well controlled in both water and infant formula, through the New Zealand Drinking Water Standards and the Australia New Zealand Food Standards Code. (see background below)
"In all our decisions we try to find the best balance between preventing tooth decay and ensuring people do not experience the teeth flecking that can occur with fluoriated water.''
"We will continue to monitor dietary fluoride intake and review the statements made in America but at the moment we believe we have things right,'' Dr Whyman says.
Dr Whyman says fluoride is not permitted to be added to infant formula in New Zealand and formula which contains a certain level of fluoride must be labelled as such.
"If parents are concerned they can check out the label and seek advice from a health professional. Alternatively they could choose a product with lower levels of fluoride in it.''
A Southland study of 9-year-old children published in 2005 found two thirds of children had experience of dental decay and about half the children had mild flecking or white spots. The study found the level of flecking among children who had lived their whole lives in a fluoridated area had not increased since earlier New Zealand studies in the 1980s.
Dr Whyman says the benefits of water fluoridation as a public health measure remain.
"Children continuously exposed to fluoridated water during their life experience half the number of dental caries of those who have not.''
In Northland, where fluoridated water is due to be introduced early next year, five-year-olds on average have twice the national average levels of dental decay.
The New Zealand Drinking Water Standards recommend that water supplies have 0.7 to 1.0 mg/litre of fluoride, which is the optimal level in New Zealand to maximise the prevention of dental caries and to minimise the risk of dental fluorosis.
Infant formula is regulated under Standard 2.9.1 of the Australia New Zealand Food Standards Code. Under this standard, fluoride is not permitted to be added to infant formula in New Zealand. When the Standard was developed, consideration was given to the fact that fluoridated tap water would be used in the reconstitution of powdered infant formula in New Zealand.
Companies manufacturing and selling infant formula in New Zealand must also comply with regulations under the Australia New Zealand Food Standard Code. An infant formula product must comply with this code where it contains -
- more than 17 micrograms of fluoride per 100
kilojoules prior to reconstitution, in the case of powdered
or concentrated infant formula product
- more than 0.15 micrograms of fluoride per 100 millilitres, in the case of 'ready to drink' formula.
Labels on packages of infant formula product that contain the above levels of fluoride must indicate that consumption of the formula has the potential to cause dental fluorosis and recommend that the risk of dental fluorosis should be discussed with a medical practitioner or other health professionals.
Other infant formula products for sale in New Zealand can be reconstitued with fluoridated water.