The case for fluoridation to protect children’s oral health

In a blog to mark World Oral Health Day (Wednesday 20 March), RCPCH member Dr John Furness considers a simple and safe way to protect children from tooth decay – community water fluoridation.

Do you know the most common reason for children to have an operation in the UK? It is dental extraction for dental caries. Have any of you been to a dental list? I did, to learn to insert laryngeal masks. I thought a handful of children would be having occasional teeth extracted. What I saw was children having half their mouth cleared.

So how does that affect my work? Isn’t that a dental problem? Well, it’s costing the NHS millions every year; millions that could be spent on preventing and treating other childhood diseases. It affects the most deprived children and areas. Worse still, tooth decay is preventable. In my view, the most efficient and safe way to prevent it is by adding fluoride to water in 1 ppm (parts per million)

Isn’t fluoride already in water?

No, it isn’t.

Birmingham, Severn Trent, parts of Newcastle upon Tyne and Northumbria have it added. Major areas of deprivation that do not include Manchester, most of South Yorkshire, Hull and North Yorkshire, County Durham and Teeside.

National government has deferred to local authorities. It is up to local authorities to carry out feasibility studies and public consultation before deciding whether to do it. In affluent areas it is not cost effective.

Why is it not done?

In two words: money and fear. Public Health England (PHE) has calculated that for every £1 spent on community water fluoridation (CWF) in 10 years, £21 will be saved. The problem is that the saving is made by acute NHS Trusts who will do fewer operations, and the payment is by local authorities which have responsibility for public health. There is legislation that would allow NHS acute trusts to offer to offset local authority costs, but few know about it.

Lobby groups have led to some members of the public, and some politicians, being wary of CWF. But water fluoridation is safe, and recommended by Public Health England, the World Health Organisation and the Centers for Disease Control and Prevention.

So what can I do about it?

  1. Tell people!
  2. In particular, you could tell colleagues and patients in areas of deprivation where CWF would benefit children that it is (a) not in the water and (b) safe.
  3. You could contact local authorities, local councillors, local dental networks, the British Society for Paediatric Dentistry or the British Fluoridation Society to find out more and join up in a public health campaign to call for a measure that will benefit deprived children, release funds, and save money.