Affected individuals no more likely to have caries
Dose response – fluoride and caries
1ppm optimal dose
Grand Rapids / Muskegon / Aurora study 50% reduction in Grand Rapids vs Muskegon after 6.5yrs
“ Water fluoridation significantly improves health and reduces inequalities” “ The present legislation on fluoridation is not working” “ We have commissioned an expert scientific review of fluoride and health” Fluoridation - the recent years Saving lives – our healthier nation
What are the effects of fluoridation of drinking water supplies on the incidence of dental caries?
If water fluoridation is shown to have beneficial effects, what is the effect over and above that offered by the use of alternative interventions and strategies?
Does water fluoridation result in a reduction of caries across social groups and between geographical locations bringing equity?
Does water fluoridation have negative effects?
Are there differences in the effects of natural and artificial water fluoridation?
The increase in proportion of caries free children in fluoridated compared with non-fluoridated communities
Does fluoridation prevent dental cares?
The best available evidence suggests that the difference in the change in caries prevalence from baseline to final examination in fluoridated compared to non-fluoridated areas was 14.6% caries free or 2.25 DMFT
This probably equates to a preventive fraction of about 40% (Worthington and Clarkson 2003)
“ Sham review that deliberately excluded studies that would show fluoridation in a bad light”
Fluoride causes brain damage and lowered IQ in children
Fluoridation causes unsightly discolouration of teeth
The York Review noted in relation to adverse events …there was not enough good quality evidence to reach conclusions.
Cheng, Chalmers & Sheldon, BMJ, Oct 2007 Lennon, Beal & Rugg-Gunn, CDH, March 2008 … . Those opposing fluoridation often claim that it does not reduce caries and they also overstate the evidence on harm. On the other hand, the Department of Health’s objectivity is questionable – it funded the British Fluoridation Society, and along with many other supporters of fluoridation it used the York review’s findings selectively to give an overoptimistic assessment of the evidence in favour of fluoridation. ….
We suggest the adoption of local decision making procedures that take into account the context in each area … … ongoing monitoring and further research to strengthen the evidence base.. … policy makers and the public need to have access to clear and accurate information (Nuffield Council on Bioethics, 2007)
Fluoridated water – food or medicinal product?
Not regarded as a medicinal product by the MHRA
Water is not a food until it emerges from the tap
(EU directive on addition of vitamins and minerals)
Drinking water quality regulated by UK drinking water regulators
Fluoride policy decided by Department of Health (Eng), Scottish Executive, Wales Assembly Government, Northern Ireland Health and Social Services Board
Devolution and fluoridation Scottish Dental Action Plan Inter sectorial / multi agency approach Emphasis on diet School toothbrushing as method of fluoride delivery
Devolution and fluoridation “ Designed to smile” – £1.44M programme Based around school toothbrushing April 2008 “ Given that it may take some time to introduce a water fluoridation scheme in Northern Ireland, an alternative, evidence based, regional prevention programme for caries in children should be developed and implemented as soon as possible” Oral Health Strategy for Northern Ireland June 2007
“… I have seen the benefits for myself. One reason for us putting extra money from the health budget into fluoridation is to encourage it to happen around the country … £14M of extra money is being put in to help with this.
It is a good thing for the teeth of the people of this country.” Rt Hon Gordon Brown PM PMQs 26th March 2008 (Hansard, 2008)