The College is supporting government proposals to extend community water fluoridation in north east England.
Around half of the North East either has naturally fluoridated water or has had its water artificially fluoridated for around half a century, including Newcastle, Gateshead, North Shields, Wallsend, Whitley Bay and parts of County Durham. The Department of Health and Social Care, supported by the relevant local authorities, is proposing to extend this to a further 1.6 million people in Cleveland, Darlington, Durham, Hartlepool, Middlesborough, Northumberland, Redcar, Stockton, Sunderland and Tyneside, as well as neighbouring parts of Westmorland, Furness and North Yorkshire.[i]
The College has submitted a positive response to the proposals, in which Simon Hearnshaw FCGDent, the College’s lead on community water fluoridation, highlights epidemiological data demonstrating significant differences in the prevalence of tooth decay, and rates of extraction, between fluoridated and non-fluoridated areas in the region which otherwise have similar indicators of deprivation.
Tooth decay is the most prevalent disease in the UK, and the College supports localised water fluoridation as one means to help reduce its incidence and severity, and the consequent need for invasive oral health interventions, particularly in areas of high need.
There is evidence that the provision of water which is either naturally or artificially fluoridated to around 1 milligram per litre is both safe [ii] [iii] and effective [iv] [v] [vi] in reducing dental caries in a given population. A Cochrane Review in 2015 estimated that water fluoridation resulted in children with no other sources of fluoride having 35% fewer decayed, missing and filled baby teeth and 26% fewer decayed, missing and filled permanent teeth. It also led to a 15% increase in children with no decay in their baby teeth and a 14% increase in children with no decay in their permanent teeth.[vii]
Tooth extraction due to preventable decay remains the most common cause of hospital admission in England for five- to nine-year-old children [viii], and the Office for Health Improvement and Disparities (OHID, formerly Public Health England) estimates that if all five-year-olds currently drinking water with 0.2mg/l of fluoride instead received fluoridated water of at least 0.7mg/l, then the number experiencing decay would fall by 28% in the most deprived areas, and the number of hospital admissions for tooth extractions due to decay would reduce by up to 68%. An analysis by OHID also found that water fluoridation is the most cost-effective intervention to prevent tooth decay, offering a return on investment of over £12 after 5 years, and £22 after 10 years, for every £1 spent.[ix]
While the four UK Chief Medical Officers have published a statement describing water fluoridation as an effective public health intervention in reducing both tooth decay and oral health inequalities [x], only around one in ten households in England currently receives tap water containing fluoride at the recommended level [xi], and since 1985 over 60 local health authorities have consulted on initiating water fluoridation without success.[xii] But the government now has the power to directly introduce or vary water fluoridation schemes [xiii], and the proposals for the North East will test whether this will lead to new community water fluoridation schemes in England for the first time in 40 years.[xiv]
[i] Department of Health and Social Care. Community water fluoridation expansion in the north east of England. June 2024. Available at: https://www.gov.uk/government/consultations/community-water-fluoridation-expansion-in-the-north-east-of-england/community-water-fluoridation-expansion-in-the-north-east-of-england
[ii] Public Health England. 2022. Water fluoridation Health monitoring report for England 2022. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/1060471/water-fluoridation-health-monitoring-report-2022.pdf
[iii] National Health and Medical Research Council. 2017. Information paper—water fluoridation: dental and other human health outcomes. Available at: https://www.nhmrc.gov.au/about-us/publications/water-fluoridation-dental-and-other-human-health-outcomes
[iv] Griffin SO, Regnier E, Griffin PM and Huntley V, 2007. Effectiveness of fluoride in preventing caries in adults. Journal of Dental Research, 86(5), pp.410-415
[v] Slade GD, Grider WB, Maas WR, Sanders AE. Water Fluoridation and Dental Caries in U.S. Children and Adolescents. J Dent Res. 2018 Sep;97(10):1122-1128
[vi] Touyz LZG, Nassani LM. Affirmation: Fluoridated Water Reduces Caries in Children. J Pediatr Dent Hyg. 2019; 1(1): 1003
[vii] Iheozor-Ejiofor Z, Worthington HV, Walsh T, O’Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny AM. Water fluoridation for the prevention of dental caries. Cochrane Database Systematic Review. 2015 Jun 18;2015(6):CD010856. Available at: https://www.cochrane.org/CD010856/ORAL_water-fluoridation-prevent-tooth-decay
[viii] Office for Health Improvement and Disparities. Hospital tooth extractions in 0 to 19 year olds: short statistical commentary 2023. 8 February 2024. Available at: https://www.gov.uk/government/statistics/hospital-tooth-extractions-in-0-to-19-year-olds-2023/hospital-tooth-extractions-in-0-to-19-year-olds-short-statistical-commentary-2023
[ix] Public Health England. 2016. Return on investment of oral health improvement programmes for 0–5-year-olds. Available at: https://assets.publishing.service.gov.uk/media/5a80ee0bed915d74e6231403/ROI_oral_health_interventions.pdf
[x] Department of Health and Social Care. Statement on water fluoridation from the UK Chief Medical officers. 23 September 2021. Available at: https://www.gov.uk/government/publications/water-fluoridation-statement-from-the-uk-chief-medical-officers/statement-on-water-fluoridation-from-the-uk-chief-medical-officers
[xi] Department of Health and Social Care. Community water fluoridation expansion in the north east of England. June 2024. Available at: https://www.gov.uk/government/consultations/community-water-fluoridation-expansion-in-the-north-east-of-england/community-water-fluoridation-expansion-in-the-north-east-of-england
[xii] Goodwin M, Emsley R, Kelly MP, et al. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study [Internet]. Southampton (UK): National Institute for Health and Care Research; 2022 Nov. (Public Health Research, No. 10.11.) Chapter 3, History and implementation of water fluoridation as a public health intervention. Available at: https://www.journalslibrary.nihr.ac.uk/phr/SHMX1584/
[xiii] Morris AJ, Lowry R. Community water fluoridation: legislation and evidence base. Dental Update 2024 50:6, 707-709. Available at https://www.dental-update.co.uk/content/guest-editorial/community-water-fluoridation-legislation-and-evidence-base/
[xiv] Department of Health and Social Care. Community water fluoridation expansion in the north east of England. June 2024. Available at: https://www.gov.uk/government/consultations/community-water-fluoridation-expansion-in-the-north-east-of-england/community-water-fluoridation-expansion-in-the-north-east-of-england
