Why Community Water Fluoridation Matters in Clinical Practice: Evidence From the Public Health Association of New Zealand’s New Policy Statement

Abstract

Background: Oral health is fundamental to wellbeing in Aotearoa New Zealand, yet dental caries remains a leading cause of childhood hospitalisation and a persistent source of inequity. Community water fluoridation (CWF) is a proven, proportionate, and equitable population measure. This article synthesises the evidence for CWF and translates the Public Health Association of New Zealand’s (PHANZ) 2025 policy position for clinical practice.

Methods: A review of national and international evidence on CWF was conducted, incorporating systematic reviews and policy analyses. Policy development drew on engagement with oral health and public health experts and the PHANZ Policy Subcommittee, followed by broader engagement with PHANZ members and final endorsement by the PHANZ Executive Council in June 2025.

Findings: CWF can significantly reduce dental caries across the life course, particularly in communities experiencing socioeconomic deprivation. Evidence supports CWF as a safe, cost-effective, and scalable public health measure. The analysis also acknowledges community concerns regarding autonomy and consent, highlighting the importance of community partnership alongside culturally safe implementation of CWF. The PHANZ statement positions CWF as a foundational upstream intervention that should be integrated with broader strategies addressing poverty, access barriers, and wider systemic inequities.

Conclusions: Oral health practitioners have a professional and ethical responsibility to advocate for and support CWF through evidence-based communication and culturally safe practice. Implementing and sustaining CWF aligns with clinical ethics and Aotearoa New Zealand’s commitment to equitable oral health outcomes.