Fluoride Action Network

Southampton. Q&A: Water fluoridation

Source: The Guardian | February 27th, 2009 | By James Meikle
Location: United Kingdom, England


Fluoride occurs naturally in all drinking water. It helps protect teeth against decay by toughening the surface of the tooth, and is added to some toothpastes. Fluoridation is the process of raising the concentration of fluoride within the water supply to the optimum level deemed appropriate for improving dental health (approximately one part per million).

Which areas have fluoridated water?

It is added to the water drunk by about 5.5 million people in England, a ninth of the population, mainly in Birmingham and the West Midlands and parts of the north-east. Another 500,000 people, in scattered areas mainly down the east coast, have naturally occurring fluoridated water at equivalent levels.

Why does the government want to fluoridate?

The government is keen to fluoridate the water supply in areas affected by high levels of dental decay, mainly deprived areas, where nutrition is poorest and oral health discipline is weakest. Ministers believe that by targeting those people, it can reduce health inequalities. Fluoridation has stalled over the last three decades: local authorities lost their public health powers in 1974, and water companies were privatised.

Does fluoridation work?

The government believes there is a strong correlation between fluoridation and reduced tooth decay. Supporters of fluoridation point out that in Birmingham, where water supplies have been fluoridated for 40 years, the dental health of five-year-olds is noticeably better than in non-fluoridated Manchester, a city of similar size and social makeup. They also say there is evidence from the US that it benefits adults too.

Why is it so controversial?

Anti-fluoridation campaigners claim that it is linked to health risks such as bone cancer and hip fractures, as well as low IQ in children. It also increases fluorosis (staining) of teeth. There are also strong objections on civil liberties grounds – critics claim that fluoridation is “indiscriminate mass medication”, and should not be forced on people against their will through their water supply. They also claim that fluoride – which is classified as a poison – does nothing to improve children’s teeth.

What research exists to prove that it is harmful or otherwise?

In 2002, the NHS Centre for Reviews and Dissemination at York University published its government-commissioned scientific review of research on fluoride and health, to assess the evidence on the effects of community water fluoridation. It confirmed that fluoridation did reduce tooth decay. There was no evidence of a link between fluoridation and bone disease, or cancer, but it did increase the prevalence of dental staining.

It found that “little high-quality research had been undertaken” in this area, despite the high level of public interest: “The research evidence is of insufficient quality to allow confident statements about … potential harms or whether there is an impact on social inequalities.”

Why is fluoridation back as an issue?

The old Water (Fluoridation) Act 1985 allowed water companies to agree to health authority requests to fluoridate, but did not oblige them to do so. Nothing happened. The Water Act of 2003, backed up by later regulations, empowered strategic health authorities (SHAs) or the assembly in Wales to direct water companies to add fluoride. But further NHS reorganisation held up progress. Initial requests will often come from primary care trusts (PCTs).

The Scottish government decided it did not want local authorities to have the power to request fluoridation more than four years ago. The Isle of Man dropped the idea last summer.

Who decides whether an area’s water supply is fluoridated?

SHAs, partly because water distribution areas will usually cover more than one PCT. Opponents of fluoridation are furious that SHAs make the decision as part of NHS machinery, yet also organise public consultations on the idea. Offical guidance says the SHAs’ responsiblity for “objective assessment” of responses to consultation does not stop SHA officers promoting the case for fluoridation. Also, SHAs are required to make decisions on the “cogency of the arguments advanced” and not simply numbers of people and organisations for or against proposals.

Why was Southampton’s scheme first?

All SHAs and PCTs in England were reminded to consider fluoridation by the chief dental officer, Barry Cockcroft, a year ago. The first proposed scheme for about 200,000 people in Southampton and south-west Hampshire is relatively small and, despite covering pockets of deprivation, hardly the test case for the revived drive most supporters of fluoridation hoped for. Unfluoridated conurbations like Greater Manchester would have been a better bet. However, far bigger schemes are expectedsoon, with NHS bodies covering large populations in north-west England likely to be among front runners.