Singapore started fluoridating its water in 1956, at a time when Singapore was making the decision to make a great economic leap forward and become prosperous. Water fluoridation was viewed as modern and good for all.

Singapore has succeeded fabulously in becoming a place where all live well. However, it residents are not rich in dental health. Children there have a significant level of dental fluorosis. In 1996

the community fluorosis index was at 1.96; 9.2% of children had severe fluorosis and 26.2% had moderate fluorosis.

There are more and more dentists today who are taking the position that they favor fluoride applied topically – as in toothpaste – but oppose putting it in drinking water.

When fluoride is in drinking water there is no way to control the dose. Certain sub-populations are especially sensitive, fetuses, infants, diabetics, and those with kidney disease.


The best way to have cavity free teeth is to eat a lot of vegetables, quit eating sugar and starch, and brush and floss your teeth whenever you eat. Chew Xylitol chewing gum. Xylitol kills decay causing bacteria. There are better ways to strengthen teeth than to consume fluoride.

I have relatives in Singapore, so I will take a special look at fluoridation there.

Ann Acad Med Singapore. 1984 Apr;13(2):247-51.

Fluoridation of public water supplies in Singapore.


Fluoridation of public water supplies as a means of reducing the prevalence of dental caries was introduced in Singapore in 1956. This paper will describe the fluoridation programme, and discuss its role in the prevention of dental decay. Water fluoridation has been advocated by the World Health Organisation in 1958 when the first report by an expert committee concluded that drinking water containing about 1 ppm. fluoride had a marked caries preventive action, and that controlled fluoridation of drinking water was a practicable and effective public health measure. Today, more than 60 countries serving over 330 million people have drinking water which is fluoridated. In Singapore, public water supplies contain 0.7 ppm. fluoride. The efficacy of this programme is reported in follow-up studies. After ten years, mean dmf/DMF reduction of 34.4% was recorded for seven-year old Chinese school children, and 33.6% for the same age group Malay school children. These results are consistent with world-wide studies which show beneficial reduction in carries level in children by 30-80%. Fluoridation of public water supplies is indicated if there is an efficient system of distribution and when there is a moderate-to-high prevalence of dental caries.

Aust Dent J. 1990 Dec;35(6):530-5.

Enamel defects in a fluoridated south-east Asian community.


Department of Operative Dentistry, University of Singapore.


The prevalence and distribution patterns of enamel defects in maxillary incisors was assessed in 194 Singaporean children aged 11-15 years and belonging to three different ethnic groups. All were born and continuously resident in Singapore, which has a tropical climate. The water supply was fluoridated in 1957 at a level of 0.7 ppm. The mouth prevalence of defects was 71.5 per cent and the tooth prevalence was 55.9 per cent; 82 per cent of all affected teeth demonstrated white lesions of various forms. Although there was no sex difference in the prevalence and distribution pattern of defects, some racial differences were observed. The results were compared with data from other studies where the same classification of defects was used.

[PubMed – indexed for MEDLINE]
Community Dent Oral Epidemiol. 1996 Feb;24(1):25-7.

Prevalence of dental fluorosis in children in Singapore.


Department of Preventive Dentistry, University of Singapore.


Prevalence and severity of dental fluorosis was assessed in 1739 Singaporean children aged 9, 12 and 16 yr in three different ethnic groups. All subjects had resided since birth in Singapore, which has a tropical climate. The water supply was fluoridated in 1957 at a level of 0.7 ppm. In this sample, mouth prevalence was 82.6%, tooth prevalence was 66.9%, the community fluorosis index was at 1.96; 9.2% of children had severe fluorosis and 26.2% had moderate fluorosis. There were no significant gender or racial differences. Prevalences were higher than those reported in most other studies. Due to differences in indices used and methodology, comparisons could not be made directly with other studies.

[PubMed – indexed for MEDLINE]

Thirty-eight years of water fluoridation–the Singapore scenario.


Ministry of Health, Singapore.


The high caries rate in Singapore school children was of great concern to dental administrators. Remedial measures alone were not the solution. The success of water fluoridation in Grand Rapids, USA and in Brantford, Canada in reducing dental caries in children in the early 1950s prompted Singapore to introduce fluoride into its drinking water. Singapore is the first country in Asia to institute a comprehensive fluoridation programme which covers 100 per cent of the population. The water was fluoridated at 0.7 ppm fluoride using sodium silicofluoride. The ten year study on the effects of water fluoridation in Singapore showed a decrease in caries prevalence in the children. In the permanent dentition the reduction was 52.3 per cent for Chinese and 31 per cent for Malays in the 7 to 9 year old age group. A similar trend was observed in the mixed dentition in which the decrease was 32.5 per cent for Chinese and 30.6 per cent for Malays. Because of the availability and use of other fluoride products, dental fluorosis was observed in children in later years. Although the decline in dental caries after 10 years of water fluoridation was not comparable to those achieved in other countries, this study further documents water fluoridation as the most cost-effective public health measure for the prevention of dental caries.

[PubMed – indexed for MEDLINE]


From the Straight Times. Fluorosis is not a problem because it “is mostly mild and not normally a cosmetic issue”…. Evidently the government does not care about the small group who suffer from moderate and severe fluorosis.


SINGAPORE: Health Minister Khaw Boon Wan says Singapore will continue to put fluoride in its drinking water supply as it is an effective way to fight tooth decay.

He said this in a written reply to MP for Marine Parade GRC, Mr Seah Kian Peng.

Mr Seah had asked whether putting fluoride in the drinking supply is still necessary to prevent dental caries.

He also asked about the current percentage of developed countries that still fluoridate their water supply and the empirical experience in Singapore on the levels of dental caries.

Mr Khaw said Singapore started putting fluoride into its water supply in 1954.

“Our experts in the Fluoride Review Committee have recommended that we should continue to do so,” he said.

First, it has been effective in reducing dental caries.

Second, research by the World Health Organisation (WHO) has shown that fluoride is most effective in preventing dental caries if a low level of fluoride is constantly present in the mouth.

Mr Khaw said while Singaporeans today have access to more sources of fluoride, such as fluoride toothpastes and mouth rinses, these products are not used by everyone.

He said water fluoridation remains the most cost-effective preventive public health measure for tooth decay.

Third, the Cochrane Collaboration Oral Health Group, an international expert group, has studied allegations of health risk due to water fluoridation.

“They found no evidence of such an allegation, so long as the water fluoridation is kept within a certain fluoride concentration level,” said Mr Khaw.

Mr Khaw said the latest WHO guideline prescribes it at 1.5 mg per litre.

“In Singapore, we have over the years progressively reduced our fluoridation level to its current concentration level of 0.6mg per litre in our tap water. This is well within the WHO’s prescribed safety level,” he said.

Some 40 countries, including the US, Australia, New Zealand and Ireland have water fluoridation schemes in place.

Singapore’s Fluoride Review Committee meets regularly to review the appropriate and safe concentration level of fluoride in drinking water.

Mr Khaw said their conclusion was that dental fluorosis is not prevalent in Singapore, and is only of minor aesthetic concern.

Dental fluorosis is a health condition caused by a child receiving too much fluoride during tooth development.

In its mild form, it appears as tiny white streaks or specks that are often unnoticeable.

In its severe form, it is characterized by black and brown stains, as well as cracking and pitting of the teeth.

– CNA/jy