Have your say: what do you think about putting fluoride in the water? 1. Do you agree or disagree with the following statements? The consultation document describes the evidence in a clear way Adjusting the level of fluoride in the water supply will help improve dental health I support increasing the level of fluoride in the water supply up to one part per million Strongly agree Agree Disagree Strongly disagree 2. What are the main reasons that you support or disagree with putting fluoride in the water? Fluoridation of the water supply reduces dental decay across all age groups of the population affected. The consultation document cites key research confirming this statement, for example: O Mullane and Whelton (1992), The York Review (2000), MRC (2002), and Australian National Health and Medical Research Council (2007). A recent UK-wide data survey of hundreds of thousands of children clearly illustrates the benefits of fluoridation on children s dental health. This survey by the British Association of Community Dentistry found that the dental health of children in primary care trusts in fluoridated areas was significantly better than those in non-fluoridated areas 1. 1 British Association of Community Dentistry (BASCD) eg: BASCD Survey Report 2005/6 at
In addition to the studies cited in the consultation document, research carried out on adults in the US, who lived all or most of their lives in fluoridated areas (2007) 2, were found to have experienced 27% less tooth decay than adults in non-fluoridated areas. Fluoridation of the water supply at one part per million (1ppm) is the level defined as safe and sufficient to ensure improved dental health of the population as a whole, 3 in line with the provisions of the Water Act 2003. 4 The basis for dental health improvements at 1ppm is concisely explained by the World Health Organisation (WHO): the level of dental caries (measured as the mean number of decayed, missing or filled teeth) falls from seven at a fluoride concentration of 0.1 mg l to around 3.5 at a fluoride concentration of 1.0 mg l 5. It should be added that the WHO specifically supports fluoridation at a ratio of 1ppm 6. Although the references cited below refer to the last 20 years, the ratio of 1ppm has been supported by research by the dental profession and other healthcare colleagues since the 1940s 7. 3. What are the main advantages and the main problems with putting fluoride in the water supply? Main advantages Fluoridation of the water supply is the safest means to achieve a significant beneficial effect on dental health across the whole population affected. This benefit is illustrated by the following example: In areas where water is fluoridated, only 25% of 5-year olds in South Birmingham and 23% from South Staffordshire have experienced tooth decay compared with 42% of 5-2 Griffin SO, Regnier E, Griffin PM, Huntley V: Effectiveness of Fluoride in Preventing Caries in Adults, Journal of Dental Research 86 (5). 2007. 3 Murray JJ, Rugg Gunn A J, Jenkins G N, Fluorides in Caries Prevention, Third Edition, Oxford, 1991. Hamilton M, Water Fluoridation: A risk assessment perspective. Journal of Environmental Health, 54, 27 32, 1992. World Health Organisation, Fluorides and Oral Health. WHO Technical Report Series 846. Geneva, 1994. World Health Organisation, Fluoride in Drinking-water, WHO, Geneva, 2006. The Scientific Basis of Dental Health Education: A Policy Document. NHS Health Development Agency, 2001. Demos et al, Water Fluoridation, Osteoporosis, Fractures Recent Developments, Australian Dental Journal, vol 26, 2: 481 482. A Systematic Review of the Efficacy and Safety of Fluoridation, Australian National Health and Medical Research Council, 2007. McDonagh M et al. NHS Centre for Reviews and Dissemination, University of York. A systematic review on water fluoridation, September 2000. Medical Research Council, Medical Research Council working group report: Water fluoridation and health, September 2002. Government of Ireland Forum on Fluoridatin 2002 at www.fluoridationforum.ie 4 Water Act 2003, Chapter 37, Office of Public Sector Information at: http://www.opsi.gov.uk/acts/acts2003/ukpga_20030037_en_1 5 World Health Organisation, Fluoride in Drinking-water, WHO, Geneva, 2006. 6 World Health Organisation, Fluorides and Oral Health. WHO Technical Report Series 846. Geneva, 1994. World Health Organisation, 7 Finding Aid to the H. Trendley Dean Papers, 1914-1961, United States National Library of Medicine, http://www.nlm.nih.gov/hmd/manuscripts/ead/dean.html#a3
year olds from Southampton 8. Fluoridated water would also be expected to play an important role in helping to maintain the oral health of an ageing population: it is predicted that by 2020 there will be 24 per cent increase in Southampton of residents aged 65-75 9. This group may experience decreased mobility and dexterity, making it more difficult for them to brush their teeth properly or visit a dentist. Main problems Dental fluorosis. In the overwhelming majority of cases, this cannot be observed by the untrained eye 10. The prevalence of fluorosis is typically 3 4% higher in fluoridated areas 11. However, this must be balanced against the disfigurement/discomfort of having decayed or missing teeth, which fluoridation helps to decrease. Fluoridation is also an effective measure for reducing dental health inequalities, as demonstrated by the marked difference found in the dental health of children in Southampton compared with children in fluoridated areas 12. Another concern in relation to fluoridating the water supply is the increase in overall exposure to fluoride. However, the intended fluoridation ratio, at 1ppm, falls well within a wider WHO guideline rate for fluoride in the water supply in Western ( temperate ) climates of 1.5 ppm 13. This guideline, initially set in 1984, was reaffirmed in 1996 and 2004. Regarding the arguments made against fluoridation of the water supply on grounds of personal choice, mass medication and individual human rights, I consider that these issues are fully addressed at section 4.9 of the consultation document. 4. Are there any alternatives or things that health services should be doing to improve dental health? In relation to this consultation, I note the positive oral health measures undertaken in recent years by Southampton City PCT (consultation section 8 British Association of Community Dentistry (BASCD) eg: BASCD Survey Report 2005/6 at 9 Hampshire County Council, Long Term Population Projections September 2006. 10 Government of Ireland Forum on Fluoridatin 2002 at www.fluoridationforum.ie 11 Medical Research Council, Medical Research Council working group report: Water fluoridation and health, September 2002. A Systematic Review of the Efficacy and Safety of Fluoridation, Australian National Health and Medical Research Council, 2007. Government of Ireland Forum on Fluoridatin 2002 at www.fluoridationforum.ie 12 British Association of Community Dentistry (BASCD) eg: BASCD Survey Report 2005/6 at 13 WHO Guidelines for Drinking-water Quality. Volume 2, WHO, Geneva, 1984/1996. WHO Guidelines for Drinking-water Quality, Volume 3, WHO, Geneva, 2004.
2.10). Every SHA and PCT should have an oral health strategy in place. As has been stated earlier, water fluoridation benefits the oral health of the whole population being fluoridated. Methods of increasing the availability of other forms of fluoride be it exposure via rinses, varnish, or toothpaste should also be pursued. In addition, a strategy to improve oral health should include plans to incorporate healthy eating advice, identifying sugar-free medicines, improving periodontal health, stop-smoking guidance, raising awareness of the dangers of alcohol-misuse, and encouraging people to visit a dentist at agreed intervals. A little about you 5. I am a: Dentist Dental Care Professional Dental Surgery staff member 6. I am: Male Female 7. My age is: Under 20 20 44 45 60 61 74 75+ 8. My ethnic group is: WHITE British WHITE Irish WHITE Any other white background ASIAN or ASIAN BRITISH - INDIAN ASIAN or ASIAN BRITISH - Pakistani ASIAN or ASIAN BRITISH - Bangladeshi ASIAN or ASIAN BRITISH Any other Asian background MIXED White & Black Caribbean MIXED White & Black African MIXED White & Asian
MIXED Any other mixed background BLACK or BLACK BRITISH - Caribbean BLACK or BLACK BRITISH African BLACK or BLACK BRITISH Any other black background OTHER ETHNIC GROUP Chinese OTHER ETHNIC GROUP Any other ethnic group I do not wish to disclose my ethnic origin 9. In what general area do you live/work? Southampton SO14 19 Eastleigh SO50 4, SO50 5, SO50 6, SO50 9 Totton SO40 3, SO40 8, SO40 9 Netley SO31 4, SO31 5 Other (please specify)