Since the South African Department of Health had tabled legislation to
make fluoridation of public water supplies mandatory the issue of whe
ther fluoride is beneficial or harmful has, once again, become controv
ersial in South Africa. We reviewed the literature, the experiences of
fluoridation in overseas countries and the latest WHO recommendations
, and have found that fluoride is desirable at certain levels, and und
esirable above these. The following recommendations are made for optim
um fluoride levels in South Africa's potable water: The decision to fl
uoridate a public water supply must be a community decision taken afte
r public consultation. However, it can only be reached when the public
is properly informed about the issue. Optimum levels of fluoride for
human health range from 0.4 to 0.7 mg F/l, depending on the maximum me
an annual temperature. The maximum level of 0.7 mg F/l should not be e
xceeded. Accordingly, it is recommended that in areas where natural fl
uoride concentrations in the drinking water exceed 0.7 mg F/l steps be
taken to defluoridate the water. As an interim measure, a scale of te
mperature-adjusted optimum fluoride levels should be adopted in South
Africa, rather than a single level covering the wide-ranging ambient t
emperatures (and corresponding consumption rates of drinking water) in
the country. A sliding scale would mean that the community within a w
ater supply region can determine its own fluoride consumption within t
he optimum range. Fluoridation should be considered only a short-term
measure, until economic conditions are such that all South Africans ha
ve access to proper dental health care. The duration of fluoridation o
f a community water supply, and the level of fluoridation (within the
optimum range of fluoride levels) should both be considered a communit
y decision. However, defluoridation should be a permanent necessity in
those areas where the drinking water exceeds levels of 0.7 mg F/l.