‘I alone cannot change the world, but I can cast a stone across the waters to create many ripples.’ Mother Teresa.
It is surprising that the only areas of the UK that have water fluoridation are Birmingham, Newcastle upon Tyne and their surrounding areas meaning that a total of 6 million people are benefiting from this public health measure. Why is the rest of the country missing out?
A consultation on the introduction of community water fluoridation (CWF) into the North East region has recently closed and the profession awaits with interest as to the outcome and the next steps in the process.1,2 The aim in the North East is to extend CWF taking in a larger urban reach that includes Sunderland and Middlesborough, resulting in access to an additional 1.6 million people. Water fluoridation is back on the government’s health agenda and the British Fluoridation Society (BFS) is ready to help. Our aim is to promote the improvement of dental health by adjusting the fluoride content of community water supplies to one part per million. We wish to see this happen in areas where high caries levels remain a public health problem and aim to promote and co-ordinate medical, dental, educational, and administrative efforts to achieve this important dental health measure.
Other major UK cities are watching this process closely, meaning that we must be ready for public debates and make our views known during consultations There is renewed interest in fluoridation, and our patients and the public will be looking to the dental profession for our opinion. Such ripples of interest are likely to become a wave of water fluoridation. Events are moving quickly and this new impetus began with the Chief Medical Officers of all four UK nations releasing a statement containing several references to the evidence base surrounding CWF and their support for it.3 The BFS website provides more information and fact sheets that outline the advantages. All these articles report on the reduction in tooth decay which leads to improved health and wellbeing in the community. The BFS also provides information on the reported disadvantages which have largely not stood up to expert scrutiny. With much of this evidence, there are difficulties in distinguishing between causality and correlation of the effects in the community. The evidence base to date shows that CWF is a safe and effective method of reducing tooth decay.
There are other ways to deliver fluoride. The introduction of fluoride to toothpaste in the 1960s has contributed to the reductions in tooth decay seen in the UK. There are many schemes that have capitalised on the delivery of fluoride, with the most recognised being Childsmile. The introduction of fluoride toothpaste and fluoride varnishes to nursery school children has been a successful initiative for this cohort of young patients. However, CWF reaches everyone and is available to all ages, irrespective of their background and social economic status. The delivery of fluoride by these different approaches will benefit not only the young but adult and older populations.
Fluoridation has a place especially as NHS dentistry faces a crisis with dental deserts being created around the country. Now more than ever does the community need help…
Fluoridation has a place especially as NHS dentistry faces a crisis with dental deserts being created around the country. Now more than ever does the community need help in reducing the pain and distress that is associated with toothache. The last oral health survey reported that one out of four children under the age of five will have tooth decay. Fluoridation is one of several interventions that will lead to improvements in dental health. It could be argued that the single intervention of CWF has the means to reduce dental tooth decay significantly. Since 1964, the population of Birmingham has benefited from water fluoridation. Over 60 years, countless children, many of whom are now adults, have not had to worry about problems associated with tooth decay. On a personal level, I have seen the benefits to my family and the community around me.
There is a tsunami of ripples as the public seek ways to help in their long-term fight against tooth decay; fluoridation is seen as a sensible way forward. The BFS is one of several organisations supporting the process and helping those who are tasked with the decision-making process. However, the BFS will always need to keep a watching brief on the political viability and what the barriers are to the implantation. We are also maintaining a soft and hard evidence base whilst remaining part of the CWF network. Together, we can change the landscape of tooth decay and make the disease history. Adding fluoride to the water is a major leap along the way.