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Debate Water fluoridation

The government is expected to recommend that drinking water is fluoridated as a way of reducing tooth decay.

This week we ask: Will fluoridation of water supplies improve the country's long term dental health?


Young children living in the poorest, non-fluoridated communities suffer unacceptably high levels of tooth decay. For example, five-year-old children in non-fluoridated Manchester suffer three times more decayed teeth and suffer three times more tooth extractions than in Birmingham, where water supplies have been fluoridated for almost 40 years.

Tooth decay is a nasty disease It causes pain and infection and often results in tooth extraction under general anaesthetic.

In its July 1999 White Paper 'Our Healthier Nation', the Government said it would change the law so that when communities decide they want fluoridation, water suppliers are obliged to comply (under current legislation, several water companies have refused such requests).

The proposal to change the law was subject to confirmation of the safety and benefits of fluoridation by an independent systematic review of fluoridation, conducted by the University of York. The review findings, published last month, confirm that fluoridation is safe, effective in reducing levels of tooth decay and, importantly, effective in reducing inequalities in dental health. These findings are in line with at least 18 other major scientific reviews.

Over 300M people worldwide drink fluoridated water - including over 50% of the population of the United States. In the UK, only around 10% of the population benefit. The British Dental Association recommends this should be extended to 25% to 30% of the population, targeted to areas where tooth decay rates are unacceptably high (eg the West of Scotland, the North of England, parts of Wales, Inner London and Northern Ireland).

The National Alliance for Equity in Dental Health is pressing Government to introduce the promised new legislation so that children in non-fluoridated Manchester, Leeds, Liverpool, Glasgow, Belfast, Swansea and London can have the same chance of good dental health as children in fluoridated Birmingham and Newcastle.


Promoters of fluoridation claim that 'the optimal level' of one part fluoride per million parts of water reduces the incidence of dental cavities.

However, there are more than 40,000 scientific studies published in peer-reviewed biomedical journals documenting fluoride health effects, including genetic damage found at 0.5 ppm and thyroid effects at 0.34 ppm.

And it is illogical that any 'dose' is determined only by the amount of water drunk by the individual.

The recent NHS York review examined 214 studies, but most of these were classed as 'Level C' - poor quality with a high risk of bias.

The selection criteria specifically excluded all animal studies, all biochemical studies and all statistical or mathematical models and ignored fluoride exposure from any source other than water.

They concluded that fluoridation reduces tooth decay by 15% (not 50-60% as previously claimed) and that dental fluorosis (mottled teeth) affects 48% of the people in fluoridated areas with 12.5% of them moderately to severely affected - a risk they cannot avoid.

The British Dental Association dismisses dental fluorosis as 'merely a cosmetic problem.'

But international scientists describe it as 'a manifestation of systemic toxicity'.

In 1993, The US Agency for Toxic Substances & Disease Registry produced the report Toxicological profile for fluorides, hydrogen fluoride and fluorine, which highlighted areas of the population susceptible to the effects of fluoride.

These populations include the elderly, people with deficiencies of calcium, magnesium and vitamin C, and people with cardiovascular and kidney problems.

It also said poor nutrition increases the incidence and severity of dental fluorosis and skeletal fluorosis.

The facts

The recently published independent review into the safety of fluoridation by the University of York, commissioned by the Government, found that dental cavities can be reduced by 15% by drinking fluoridated water.

The Department of Health says that 10% of the British population drinks fluoridated water.

The National Alliance for Equity in Dental Health is a consortium of more than 40 organisations, including the British Dental Association, the British Medical Association and the Royal College of Physicians. They campaign to reduce inequalities in dental health by securing fluoridation for those areas where tooth decay rates remain unacceptably high.

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