Dental caries (tooth decay) is the most common oral disease and among the most prevalent health conditions in Australian children. It is therefore not surprising that child oral health is never out of sight of those concerned with health and health care delivery in Australia. Fortunately, research continues to shed light on the biological mechanisms of tooth decay and reveal more opportunities to intervene to improve oral health.

Improvement in children's oral health is needed for two simple reasons. First, oral diseases, mainly tooth decay, cause infection, discomfort, pain and suffering for the child and affect the family through those distressing symptoms and the burden of costly and sometimes difficult treatment. Second, poor oral health early in life is the strongest predictor of further oral disease in adult life. Effective treatments are sometimes scarce and can be expensive, affecting patient access.

For more than 60 years Australia has pursued measures to reduce or prevent tooth decay in children. The National Health and Medical Research Council (NHMRC), with its core membership that includes the leading public health officials from all States and Territories, has provided advice in support of public water fluoridation since 1952. Australia first introduced water fluoridation in 1953 and since then has achieved one of the highest population coverage rates when compared to similar countries. An internationally recognised Australian study in the 1960s reported on the effectiveness of fluoridated toothpaste in preventing and minimising caries. The combination of water fluoridation as a public health intervention and the use of fluoridated toothpaste as an individual action (used so widely as to mimic a population health initiative) has transformed child oral health. Compared to the 1950s, the prevalence of caries in children has more than halved and the number of teeth with caries has decreased by about 90%.

Access to dental services, prompt diagnosis and early treatment are key to limiting the impact of children's poor oral health. Those dental services can also help prevent oral disease. Australia has seen decades of mixed public and private delivery of childhood dental services, and this varies considerably across States and Territories. Access to dental services is still a challenging issue and developing evidence-based policy is now both vital and timely.