Fluoride Action Network

Fluoridation in the Highlands may cost too much

Source: The Scotsman | December 4th, 2002 | by John Ross

HEALTH experts in the Highlands want more information and a full public consultation before considering any move to put fluoride in water supplies.

The Highland NHS Board yesterday unanimously agreed fluoride is a safe and effective way of tackling dental problems, but said fluoridation of water in the area could be impractical and too costly.

The Highlands has 157 water treatment plants and more than 2,000 privately-owned water supplies. Research in England suggests that only supplies serving a minimum of 200,000 people would be cost-effective, but the largest in the Highlands serves just 65,000 around Inverness.

The board approved a strategy to improve dental health, including appointing more NHS dentists and looking at the effectiveness of options such as using fluoride in milk, salt, mouth rinses and tablets, especially for children.

However, it is aware of a strong lobby against putting fluoride in the water supply – the optimal dose is one part per million – as it is seen as mass medication and an infringement of individual choice.

Caroline Thomson, the board chairman, said: “Clearly we have to do what the Executive tells us, but we want in some way to find compromises. It might be totally impractical to do it, in terms of cost, through the water supply.”

Colwyn Jones, the board’s consultant in dental public health, said: “The board accepts the evidence that water fluoridation is a safe and effective public health measure. However, we do not know how practical or cost-effective it would be in Highland.

“A cost-benefit analysis of fluoridation compared to other methods of using fluoride would help to inform this debate. Highland NHS Board would also want a full public consultation exercise before any consideration of introducing water fluoridation locally.”

But Gary Coutts, a board member, said: “I encourage my children to use fluoride, but I could not support the fluoridation of the water supply. It is an absolute fundamental principle that people should have freedom of choice.”

Yesterday, the board also heard from the Highland Movement Against Water Fluoridation, who handed over a 5,822-name petition backing their case.

Lois MacDonell, the group’s chairman, said it is ethically unacceptable not to be able to control the dose for individual water consumers. She added: “How much should be drunk and what happens when the dose is exceeded by using fluoridated toothpaste and medicines and drinking tea?”

She said fluoridation has wider health implications: “Fluoride accumulates on bones and makes them more brittle and prone to fracture; it causes fluorosis in about 48 per cent of children; it affects thyroid function; it stresses the kidneys and cannot be processed by the very young and the very old; it is thought to be connected with osteosarcoma in young men, as well as arthritis; it reduces IQ and fertility rates; it causes stomach problems and allergies, and the increased uptake of lead is associated with an increase in violent behaviour.”

At present, there are no artificial fluoridation schemes in Scotland, although legislation exists to allow them to be introduced. But more than five million people in the Midlands and the north-east of England, and 150 million in America, receive fluoridated water.

The Scottish Executive is considering fluoridation as part of a plan to improve dental health, which costs more than £200 million a year. Scottish children have higher decay levels than those in others parts of Britain, with 55 per cent having dental disease by the age of five. The Highland figure is 58 per cent.

The Executive’s discussion paper says water fluoridation reduces decay levels and there is no evidence of adverse health effects. It adds that since Birmingham was fluoridated in 1964, children’s dental health has been significantly better than English targets and Scotland.

It wants the number of five-year-olds with no tooth decay to be raised from 45 per cent across Scotland – 42 per cent in Highland – to 60 per cent by 2010.