An update on community water fluoridation from Simon Hearnshaw MFGDP(UK), Chair of the North Yorkshire and Humberside LDN and Co-ordinator of the National Community Water Fluoridation Network.
The National Community Water Fluoridation (CWF) Network is a partnership committed to improving oral health by supporting the implementation of fluoridation schemes where appropriate in the UK. When it was launched in 2015, I had no idea of how far our campaign bus would roll.
It began in Hull, when a scheme to fluoridate the water supply was included in the local authority’s oral health plan. This remains on the table, but in the meantime schemes elsewhere have been explored, and were it not for COVID-19, public consultations on their introduction would now be done and dusted.
The FGDP was one of the first dental organisations to appreciate the importance of professional engagement in the cause, for which I am very grateful. We are now supported by 16 national organisations - including non-dental ones such as the National Children’s Bureau, which understands the difference that water fluoridation makes to the health and well-being of children, especially in deprived areas – and looking back I am humbled.
The avoidable harm caused by dental disease is costly, both socially and financially, and disproportionately affects the most disadvantaged [i]. Extensive evidence shows that CWF is safe [ii] [iii] [iv], cost effective [v] [vi] [vii], and significantly reduces dental decay [viii] [ix] [x], oral health inequality [xi] [xii] [xiii] and child hospital admissions for tooth extractions [xiv] [xv] [xvi]. And as a whole-population measure, its relevance will only grow as people live longer lives and increasingly retain their teeth into old age.
However in the UK, only around 10% of the population currently receive fluoridated water, and it is our ambition to see this expanded to 20%, covering the areas of greatest oral health need and highest oral health inequality, and where fluoridation is technically and economically feasible.
The support we have garnered for water fluoridation across medicine and dentistry is impressive, and we are getting the messages across to government that as the only intervention that does not require behaviour change, CWF must be part of a national prevention strategy, and that the money saved by reducing dental treatments would significantly outweigh the recurring costs of around £6 million per year.
Recently there has been high-level support for CWF within the Prevention Green Paper [xvii] and the submissions to the Health and Social Care Select Committee’s inquiry into dentistry services [xviii]. Public Health England’s monitoring reports [xix] also include powerful statistics, such as that CWF reduces the odds of a 5-year-old experiencing decay by over 50% in the most deprived areas.
Four Local Authorities in the North East of England - Durham, Sunderland, South of Tyne and Northumberland - are now expected to move to public consultation in 2021. These will be the first public consultations on fluoridation in England for over a decade, and will provide the opportunity for organisations and individuals across dentistry to demonstrate support for councils making decisions to improve the health of the communities they serve.
This year, once again, delegates at the LDC Conference threw their weight behind a motion pledging to stand ‘shoulder-to-shoulder’ with local authorities in the North East. The National CWF Network works closely with LDCs who have set up the One Part Per Million website, which provides up to date information on fluoridation. We also work closely with the British Fluoridation Society, founded 51 years ago, which maintains a rich library of resources and is itself a powerful international lobby group.
What about our patients and winning their support? The best place for people interested in fluoridation to find out more is in their dental practice. If you wish to support the network in a small way, then keep spreading the word, talk to patients, who will respect the point of view of a professional.
If any FGDP members would like to get more involved in the campaign, please email me at email@example.com.
See more blog posts at https://www.fgdp.org.uk/deans-blog.
[i] National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2017:
[ii] Public Health England: Water Fluoridation Health monitoring report for England 2018
[iii] NHMRC: Water Fluoridation and Human Health in Australia
[iv] CDC: Statement on the Evidence Supporting the Safety and Effectiveness of Community Water Fluoridation
[v] The costs and benefits of water fluoridation in New Zealand
[vi] Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review
[vii] Public Health England: Return on investment of oral health improvement programmes for 0-5 year olds
[viii] Rugg-Gunn AJ, Do L. Effectiveness of water fluoridation in caries prevention. Community Dent Oral Epidemiol 2012 (Supplement 2) 55-64
[ix] NHMRC: Water fluoridation: dental and other human health outcomes
[x] Public Health England: Water Fluoridation Health monitoring report for England 2018
[xi] A Systematic Review of Public Water Fluoridation - Centre for Reviews and Dissemination, University of York
[xii] NHMRC: Water Fluoridation and Human Health in Australia
[xiii] Public Health England: Water Fluoridation Health monitoring report for England 2018
[xiv] An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study Elmer, Langford, Morris.
[xv] Reducing Potentially Preventable Dental Hospitalizations of Young Children: A Community-Level Analysis
[xvi] Public Health England: Water Fluoridation Health monitoring report for England 2018
[xvii] Department of Health and Social Care: Advancing our health: prevention in the 2020s