Compensatory discretionary fluoride use among children not consuming fluoridated water

Objectives: Water fluoridation is known to be efficacious in reducing dental caries in children and yet many of the world's children do not have access to this important preventive measure. This study aimed to explore whether children consuming non-fluoridated water in Australia, a predominantly fluoridated country, had an associated or compensatory increased exposure to other discretionary fluorides. Methods: Questionnaire data were collected on a random sample of 16,853 children attending the school dental services of four of Australia's eight states and territories. Children were aged between 5 and 17 years of age. Exposure to water fluoridation was categorised using information on child residence history, reported sources of water consumption, and estimated quantity of water consumed as a percentage of all fluid consumption. Results: There were few and only small differences between categories of fluoridated water consumption and age of first brushing with fluoridated tooth paste, tooth brushing frequency, amount of toothpaste used, and use of fluoride mouthrinse. Children with low exposure to fluoridated water were more likely to have used fluoride tablets or drops, but the percentages of children using these alternatives to water fluoridation were small and the time spent taking them was generally short. Conclusions: Discretionary fluoride use does not adequately compensate children for a lack of exposure to fluoridated water. Despite arguments that children living in non-fluoridated areas can effectively use fluoride tablets or drops to compensate for reduced fluoride exposure, the reality is that this measure has poor uptake and compliance, which further underlines the population-wide benefits of water fluoridation.