New research suggests that water fluoridation is a cost-effective measure but only leads to a slightly lower prevalence of caries in children.
The contemporary studies analysed within the review found that water fluoridation leads to a slight reduction in decayed, missing and filled teeth. It was also linked to a greater proportion of caries-free children, though the effect was smaller than in studies from before 1975.
The review suggests that this is due to wider use of fluoride-containing toothpaste after this date.
Anne-Marie Glenny is a professor of health sciences research at the University of Manchester and co-author of the review. She said: ‘When interpreting the evidence, it is important to think about the wider context and how society and health have changed over time.
‘Most of the studies on water fluoridation are over 50 years old, before the availability of fluoride toothpaste. Contemporary studies give us a more relevant picture of what the benefits are now.’
The post-1975 studies included in the review contained data from 2,908 children in the UK and Australia. On average, water fluoridation led to 0.24 fewer decayed baby teeth per child. In contrast, studies from 1975 or earlier found a reduction of 2.1 decayed teeth per child, including 5,708 participants.
Co-author Lucy O’Malley, a senior lecturer in health services research at the University of Manchester, said: ‘The evidence suggests that water fluoridation may slightly reduce tooth decay in children.
‘Given that the benefit has reduced over time, before introducing a new fluoridation scheme, careful thought needs to be given to costs, acceptability, feasibility and ongoing monitoring.’
However, the review also suggests that water fluoridation is a cost-effective measure due to low delivery cost per head.
A multi-faceted approach to water fluoridation
The review’s authors also pointed to other oral health issues that cannot be addressed with water fluoridation.
Janet Clarkson, professor of clinical effectiveness at the University of Dundee, said: ‘Whilst water fluoridation can lead to small improvements in oral health, it does not address the underlying issues such as high sugar consumption and inadequate oral health behaviours.
‘It is likely that any oral health preventive programme needs to take a multi-faceted, multi-agency approach.’
The British Dental Association (BDA) said that water fluoridation ‘should form part of a package of measures to improve oral health’. The association’s position has not changed as a result of the new research.
Mick Armstrong, chair of the BDA Health and Science Committee, said: ‘We have never pedalled silver bullets, or one size fits all solutions. What this new evidence shows is that water fluoridation has a role to play, as one of many tools in the fight against decay.
‘Government needs to offer a joined-up response to close the nation’s oral health gap. That means investing in tried-and-tested preventive programmes, while ensuring patients can access the care they need.’
Around 5.8 million people in the UK currently receive fluoridated water. The majority of the fluoride is artificially added, though some areas have a water supply with the appropriate level occurring naturally.
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
