Key points from the Public Health England water fluoridation report March 2018

fluoridevarnishwk4Public Health England (PHE) has recently published a report on water fluoridation in England. This document is published every four years and represents the findings of an ongoing study of how increased levels of fluoride in our water supplies are helping tackle the current high rate of caries.  

Children’s tooth decay is a regular headline topic in the world news and is a frequent topic of discussion amongst dental professionals. We are seeing the effects that tooth decay is having on young children on a daily basis, even when we are following the Department of Health’s guidance on better oral health. Approximately 40,000 children and young people are having teeth removed in hospitals each year due to tooth decay. Around 12% of 3-year-olds and 25% of 5-year-olds have tooth decay in their deciduous teeth.

Below are some key dental points that I have retrieved from the PHE report for dental professionals. I have included an explanation of what fluoride is.

About the study

The study is an ongoing investigation of the positive effects the increased levels of fluoride are having on our dental health. The study is being conducted in four cities around the UK. Two of the cities (Birmingham and Newcastle) are currently part of the water fluoridation scheme, and they have increased fluoride levels in their water supply, The other two cities (Manchester and Liverpool) are not part of the current scheme and have lower levels of fluoride in their water. The study examines levels of tooth decay in these cities.

What is fluoride and the water fluoridation scheme?

Fluoride is a naturally occurring element (fluorine) and is part of a group of chemicals known as halogens. Fluoride is found (at various concentrations) in natural sources of water, natural products such as rocks, and many plants. It is in many foods and drinks. Fluoride is also added to many branded toothpastes and mouthwashes as well as in products such as fluoride varnish gels, drops and tablets. 

The fluoridation scheme is in place to adjust fluoride levels in the water supplies to a level that is safe for consumption while helping to reduce levels of tooth decay. Many schemes like this have been operating for over 50 years, and many local authorities have joined the scheme in order to improve oral health for children in their area. PHE recommends the water fluoridation scheme as one of nine evidence-based community interventions, and it is satisfied that fluoridation is an effective intervention.

The current statistics show that 6 million people who live in England live in an area that is part of the fluoridation scheme. Water supplies in these areas are reaching their target concentration levels of one milligram per litre (1mg/l), otherwise shown as one part per million (1ppm).

The findings of the study

The findings of this report have been consistent with the view that water fluoridation schemes are an effective and safe public health measure to reduce the prevalence and severity of dental caries.

The results of the study show that the higher the concentration of fluoride in the water supplies – up to 1ppm – the greater the effects it is having on reducing the levels of tooth decay. Whilst children from both deprived and affluent areas experienced benefits from fluoridation schemes, those from relatively deprived areas benefited the most;  in less deprived areas, tooth decay reduced by 23% and in more deprived areas it decreased by 52% with the concentrations of fluoride being  >0.7mg/l. Public Health England takes that view that these figures represent a significant reduction and that water fluoridation is reducing dental health inequalities between deprived and non-deprived areas. 

Possible side effects of fluoridation

As with any scheme, there are advantages and disadvantages. The main disadvantage from the perspective of dental professionals is dental fluorosis. 

Dental fluorosis creates a mottled or flecked appearance on the teeth and is caused by increased levels of fluoride. The study did show that levels of fluorosis were higher in the fluoridated cities (Newcastle and Birmingham) than in the non-fluoridated cities (Manchester and Liverpool). However, the report states that fluorosis is typically considered to cause mild aesthetic concern to children compared to other issues that children might face such as orthodontic malalignment, trauma to the teeth or caries.

If you would like more information about the water fluoridation reports and you want to read the document in its entirety, please follow the link below. Also, if you would like to find out about the level of fluoride that is in your water supply, you can ring your local water board and they will be able to inform you of this.  

View the full report here.

Author: Emma Leather RDN, OHE, TAQA, IQA, PTLLS. 

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