TEETH seem to be different from other parts of the human body, at least in terms of their relation to public policy. We have different people, with a different title, who look after them. Everything from lungs to toes to vasa deferentia comes under ‘medicine’, but teeth are the prime targets of those involved in ‘dentistry’. There are obviously historic, and practical, reasons for such a division, but is it sound to treat the dental health of the population on a different principle from other aspects of their wellbeing? I am referring here to the tendency among some health professionals to recommend mass medication – but only in the case of our teeth.

Perhaps that’s not entirely true. There is mass medication in the case of vaccination against some terrible diseases which once ravaged humankind. But in terms of how we look after our bodies in other ways, there is very little. It is entirely up to us how much we exercise, what we eat, whether we smoke tobacco or drink alcohol. If we want to consume deep-fried Mars Bars (I’m told they are more than a figment of a perverted imagination), then we are at liberty to do so. Good health, and the road to it, is a voluntary pursuit.

With regard to teeth, in the United States, it is no longer voluntary. Two-thirds of the population of that country, some 162 million people, now receive a fluoridated supply from a public water system, whether they want it or not. In over half of all states, more than 75 per cent of the population receive a fluoridated supply. In the District of Columbia, which includes Washington, everybody does.

The US Centers for Disease Control and Prevention (CDC) reckon on the fluoridation of water being among the ten greatest public health achievements of the twentieth century and, just over a year ago, the country’s Surgeon General, David Satcher, said that it had ‘helped improve the quality of life in the United States through reduced pain and suffering related to tooth decay, reduced time lost from school and work, and less money spent to restore, remove or replace decayed teeth.’ It is a national policy to reduce the incidence of dental caries by fluoridation, and the addition of the chemical to the public water supply is considered by the CDC to be the ‘most equitable (and) cost-effective… method’ of achieving this.

Certainly, when one looks at the Scottish figures for tooth decay, we have a record that is ripe for improvement. In deprived areas, three in every five children over the age of three have dental disease and by the age of 16, 68 per cent ‘have decay in their adult teeth’, according to NHS figures published last autumn. Look around and you’ll see some pretty bad teeth.

But what of the American figures – are they that much better? According to the CDC, tooth decay still affects 67 per cent of adolescents aged 12-17 years and 94 per cent of adults aged more than 18. And the effectiveness of the American programme is, by their own admission, limited – a reduction of tooth decay among children in a fluoridated population of between 18 and 40 per cent. It is not a panacea in itself.

Of greater worry is the possibility that addition of fluoride to water may cause health problems in the population – from the mottling of teeth, to question marks over brain disease and effects on the immune system. None of these have been proven beyond reasonable doubt, but – a reasonable doubt remains in the minds of many.

In September 2002, the Scottish Executive launched a consultation document on children’s oral health, in which it requested views on the fluoridation of water supplies. There is already legislation in place which would permit that to occur, but the very fact that it has never been employed demonstrates the difficulty the Executive would have in convincing the populace. When it was last considered, under the UK Conservative government in 1991/2, it was clear that the bulk of the population was bitterly opposed but, despite that, the Executive appears to be warming to the notion, stating in their consultation document that ‘the beneficial effects of fluoride in preventing dental decay have been apparent for many decades.’

But it would not be without considerable cost – £30 million to establish the infrastructure and an annual expenditure of £4 million. And it would only reach a little over 80 per cent of the population as it would not be practical to fluoridate everybody. In many other European countries they are not even trying – less than two per cent of Europe’s population has fluoridated water and the percentage has fallen. In 1971 West Germany discontinued its programme of mass fluoridation and today’s Germany, like France, Denmark, Norway and the Netherlands, maintains that stance.

Fluoridation of public water is a mass medication which must, by its very nature, have enormous public benefits to justify its application – for it deliberately reduces human choice. The public benefits of mass vaccination are obvious. Those of fluoridation are much less so. And there are other ways to keep teeth healthy.

We have too much of a dumbed-down approach to many public issues in this country today and the gentle political current towards possible mass fluoridation is a prime example. Let’s not bother trying to educate and encourage and cajole children and their parents. Let’s just dump bags of chemicals into our water supplies and let them get on with it. It’s wrong-headed and it must be resisted.

The Executive has been getting the healthy eating and healthy living message across recently. Let’s have more of the same with regard to our teeth. Let’s not take the American road when it comes to improving our dental health.

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