Fluoride has played a pivotal role in oral health promotion over the past 50 years. This paper reviews key issues currently impacting on the role of fluoride in preventing dental caries. The understanding of the process of dental caries and the mode of action of fluoride has changed in recent years. Dental caries is a continuous process of demineralisation and remineralization of the enamel and fluoride plays a key role in this process through its action at the plaque enamel interface. It is now accepted that the primary mode of action of fluoride is post-eruptive. The post-eruptive action of fluoride has resulted in new methods of delivering fluoride. The paper discusses the impact of these new methods of delivering fluoride on total fluoride intake in children and on the prevalence of dental fluorosis. The role of different methods of delivering fluoride both on a community and individual basis is presented and recommendations are outlined.