Fluoride Action Network


To understand the possible beneficiary effects of artificial and naturally occurring water fluoridation on dental health of children, using routinely collected NHS Dental Statistics.

A secondary analysis of the NHS Dental Statistics for England 2018-2019 dataset. The proportion of Band 1 courses of treatments are compared with Band 2, Band 3 and urgent treatments collectively, for children attending dental practices in naturally and artificially fluoridated local authorities compared with non-fluoridated authorities who are their statistical peers. Proportions of dental treatments are described by the levels of Index of Multiple Deprivation for the area in which the practice is located.

The dataset had, 2,001,921 banded paediatric courses of treatment; 1,227,282 provided by dental practices in fluoridated local authorities and 774,639 in non-fluoridated local authorities. Water fluoridation was associated with a significant reduction in dental interventions in the most deprived populations. The proportions of active interventional treatments in the 10% most deprived decile (decile 1) are 0.243 (Cl 0.239-0.247) and 0.188 (Cl 0.184-0.191), in non-fluoridated and fluoridated local authorities, respectively.

Analysis of routinely collected NHS dental statistics shows potential utility as a tool for demonstrating the effects of community water fluoridation schemes in reducing oral health inequalities among the most deprived socioeconomic populations. The pattern of dental need and intervention is not as expected and therefore, further research is required to control for systematic confounding factors.

Key points

  • Further research is needed to understand the economic and clinical impact of community water fluoridation on paediatric patients beyond the usual decayed, missing and filled teeth measure.
  • The results from this study may demonstrate that community water fluoridation schemes may benefit deprived socioeconomic populations the most, since these populations experience significantly fewer dental interventions than their non-fluoridated statistical peers.
  • The pattern of dental need and intervention is not as expected and therefore, further research is required to control for systematic confounding factors.

*Original abstract online at https://www.nature.com/articles/s41415-021-3822-1#Ack1


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The authors would like to thank Dr Richard Holmes, Dr John A. Morris and Dr Sheena E. Ramsay for their expertise and advice during this project.

Author information



David Landes designed and directed the project. Claudy Henein carried out the data analysis and wrote the manuscript under the supervision of David Landes.

Corresponding author

Correspondence to Claudy Henein.

Ethics declarations

The authors declare no conflicts of interest.

  • Received
  • Accepted
  • Published
  • DOIhttps://doi.org/10.1038/s41415-021-3822-1

*Original abstract online at https://www.nature.com/articles/s41415-021-3822-1#Ack1