The British Fluoridation Society discusses the future of water fluoridation in light of COVID-19 and the abolition of PHE.
How important is fluoridation in a post-COVID world?
The appeal of water fluoridation has never been greater. COVID-19 and the consequent imperative to avoid aerosol generating procedures (AGP) underscore how counter-intuitive it is to be treating disease when it could and should be prevented. COVID has informed us that we need to invest in public health programmes that build health resilience. Especially in deprived communities where health is poorest. Water fluoridation is the most cost-effective and far-reaching of preventative measures.
As expressed by the British Society of Paediatric Dentistry in its position statement on water fluoridation, it is: ‘unique in its ability to reach all people at minimal cost.’ A fluoridated water supply allows populations to drink and cook with water that will benefit their oral health.
Manufacturers in areas where there is fluoridated water contribute to a so-called halo effect, their fluoride-containing food and drink products being distributed to non-fluoridated areas, extending their beneficial reach.
Dental caries is more prevalent in non-fluoridated areas, with the impact being greatest in the most deprived areas (PHE, 2018). This is backed up by copious research papers, the most recent from New Zealand (Hobbs M, 2020).
The scale of the problem in England was highlighted recently by the Local Government Association. It estimated that in the most recent year (ie prior to the pandemic), 177 hospital-based procedures were taking place every day in England to remove multiple teeth in children – at a cost of more than £41.5m annually.
Can you bring Dentistry readers up to date on BFS activities?
The green paper (Cabinet Office, 2019) published last year gave fluoridation schemes in England a timely boost. The government pledged to remove the funding barriers to fluoridating water to drive expanded coverage of this important measure.
It’s worth pointing out that following the introduction of the world’s first water fluoridation scheme in 1945, the UK was one of the first countries to trial and then introduce water fluoridation. Several schemes followed but there have been no new programmes in the UK since the 1980s. Only 10% of the population in England have the benefit of water fluoridation compared with over 70% in the US. It’s time to push forward.
We are trying to work proactively to support local authorities and communities who are interested in reducing oral health inequalities in this way. We anticipate that two schemes will go out to public consultation in the North East in 2021.
Meanwhile, the work of the BFS is boosted by the activities of the CWF (Community Water Fluoridation) network. This is linked to the grass roots Local Dental Committee movement. Every year for the last few years, the conference has voted unanimously or overwhelmingly in support of water fluoridation.
What are the implications of Public Health England (PHE) being abolished?
Currently the future is very unclear. Besides its statutory and contractual functions on behalf of the Secretary of State for Health, PHE also has a role in supporting local authorities in developing oral health plans, including fluoridation proposals. PHE has produced valuable documents to assist local authorities wanting to pursue water fluoridation:
- Health monitoring reports (the most recent in 2018) and
- A toolkit for local authorities (PHE, 2016)
While there appears to be support from on high for water fluoridation, it’s uncertain how local authorities will develop their proposals for Community Water Fluoridation (CWF).
What can dental practices do?
A survey we carried out recently showed that the public view dental practices as a valued source of information on water fluoridation. Additionally, they are seen as a really important part of our campaign for positive change.
We are planning to produce resources for dental practices to give to patients. This highlight how important fluoride and fluoridation are to the maintenance of healthy teeth. We are aware there are parents who do not fully understand fluoride or its benefits; dental teams are valuable channels of communication for unbiased, evidence-based information.
We encourage dental teams to get involved, especially those in the North East of England. For example, Durham, Sunderland, South Tyneside and Northumberland are expected to move to public consultation in the Summer of 2021.
Meanwhile, for those who want to develop their knowledge and understanding, our website has copious resources: www.bfsweb.org. BFS has worked closely with the CWF Networks and LDCs to develop the one part per million website: https://onepartpermillion.co.uk
What are your predictions on the future of water fluoridation?
Reducing inequalities is a priority. Professor Sir Michael Marmot, professor of epidemiology at UCL, the foremost UK authority on health inequalities, believes that austerity made England easy prey for COVID-19.
In a recent article, he explains that since public health was taken out of the NHS and made the responsibility of local authorities, the budget for public health services was reduced by £700m in real terms between 2014-15 and 2019-20.
Water fluoridation is indisputably the best way to reduce oral health inequalities. It is a measure endorsed by the World Health Organisation since the 1960s. As stated at the outset, it makes sense for all four UK governments to champion it.
Despite the loss of PHE, we believe the time is right for expansion of fluoridation coverage. The most deprived areas are the highest priority – and we like to think this will start to happen in 2021.
Cabinet Office (2019). Advancing our health: prevention in the 2020s – consultation document
Hobbs M, Wade A, Jones P, Marek L, Tomintz M, Sharma K, McCarthy J, Mattingley B, Campbell M, Kingham S (2020), Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand, International Journal of Epidemiology, 49:3, 908–916.
Peterson P and Ogawa H (2016) Prevention of dental caries through the use of fluoride – the WHO approach, Community Dental Health, 33, 66-68.
Public Health England (PHE) (2016). Improving oral health: a community water fluoridation toolkit for local authorities
Public Health England (PHE) (2018). Water Fluoridation: Health monitoring report for England 2018.
Q&As authored on behalf of the British Fluoridation Society by Professor Mike Lennon OBE, Dr John Morris an academic and former PHE programme lead for water fluoridation, and Barry Cockcroft, former chief dental officer and a member of the BFS council.