Professor Michael LennonProfessor Michael LennonUniversity of SheffieldUniversity of Sheffield

and and Chair British Fluoridation SocietyChair British Fluoridation Society

Water fluoridationWater fluoridation

• The optimum level for dental health The optimum level for dental health is is one part of fluoride per million one part of fluoride per million parts of water.parts of water.

• In Britain, around In Britain, around 500,000 people500,000 people drink water whose natural fluoride drink water whose natural fluoride content is high enough to benefit content is high enough to benefit their dental health.their dental health.

• Worldwide, Worldwide, over 50 millionover 50 million people people drink naturally fluoridated water. drink naturally fluoridated water.

Fluoride Fluoride occurs naturallyoccurs naturally in all water in all water supplies.supplies.

At the optimum level, it At the optimum level, it reduces tooth reduces tooth decay.decay.

Since the mid-1940s, it has been possible Since the mid-1940s, it has been possible to to replicate the benefits of natural replicate the benefits of natural fluoridationfluoridation..

• Around Around 350 million people in 350 million people in over 30 countriesover 30 countries drink water drink water whose natural fluoride content has whose natural fluoride content has been supplemented to the been supplemented to the optimum level by means of water optimum level by means of water fluoridation schemes.fluoridation schemes.

• In the UK, 5.5 million people drink In the UK, 5.5 million people drink fluoridated water – in the North fluoridated water – in the North East, West Midlands, East East, West Midlands, East Midlands, Cheshire, Cumbria, Midlands, Cheshire, Cumbria, Lincolnshire and Bedfordshire.Lincolnshire and Bedfordshire.

In the United States, where In the United States, where individual individual libertyliberty is prized, 170 million people drink is prized, 170 million people drink fluoridated water.fluoridated water.

• Forty three out of the 50 largest US Forty three out of the 50 largest US cities receive fluoridated water cities receive fluoridated water supplies, including New York, supplies, including New York, Washington DC, Chicago, Los Angeles Washington DC, Chicago, Los Angeles and San Francisco.and San Francisco.

• In his report, the US Surgeon General In his report, the US Surgeon General said:said:

““Fluoridation continues to be the Fluoridation continues to be the most cost effective, practical and safe most cost effective, practical and safe means for reducing and controlling means for reducing and controlling the occurrence of tooth decay in the the occurrence of tooth decay in the communitycommunity.”.”

Some parts of the UK still have Some parts of the UK still have unacceptably high levels of tooth decay unacceptably high levels of tooth decay among children.among children.

• Children in non-fluoridated Salford Children in non-fluoridated Salford and many other parts of Greater and many other parts of Greater Manchester have around twice as Manchester have around twice as many decayed, missing and filled many decayed, missing and filled teeth as children in fluoridated teeth as children in fluoridated Birmingham and the West Midlands. Birmingham and the West Midlands.

• General anaesthesia for children’s General anaesthesia for children’s dental treatment is used five times dental treatment is used five times more often in non-fluoridated more often in non-fluoridated Greater ManchesterGreater Manchester than in than in fluoridated Birmingham and The fluoridated Birmingham and The Black Country.Black Country.

Salford

(non-fluoridated)

Birmingham East and North

(100% fluoridated)

242 teeth affected per 100 children

104 teeth affected per 100 children

Decayed teeth - howDecayed teeth - how non-fluoridatednon-fluoridated Salford PCT Salford PCT compares withcompares with fluoridatedfluoridated Birmingham East and North PCTBirmingham East and North PCTAverage number of teeth decayed, missed and filled Average number of teeth decayed, missed and filled per 100 five year olds (2005/06 study).per 100 five year olds (2005/06 study).

3,424 general anaesthetics

683 general anaesthetics

Tooth extractions - how Tooth extractions - how non-fluoridated non-fluoridated Greater ManchesterGreater Manchester compares with compares with fluoridated fluoridated Birmingham and The Black Birmingham and The Black CountryCountryNumber of children under 10 years old given a general Number of children under 10 years old given a general anaesthetic for tooth extraction (2002/03).anaesthetic for tooth extraction (2002/03).

Greater Manchester

(non-fluoridated)

Population: 2.5 million

Birmingham and The Black Country

(97% fluoridated)

Population: 2.3 million

0

1

2

3

4

l & ll lll lV & V

High fluorideLow fluoride

Social ClassSocial Class

Data from York Review, 2000 – quality of evidence level B or C

In all social groups, children in fluoridated areas have In all social groups, children in fluoridated areas have significantly less tooth decay than similar children in significantly less tooth decay than similar children in non-fluoridated areas. non-fluoridated areas.

However, in social classes lll, lV and V, the benefits of However, in social classes lll, lV and V, the benefits of fluoridation are particularly obvious.fluoridation are particularly obvious.

Mean Mean number number of of decayed decayed missing missing or filled or filled teeth teeth per 5-per 5-year-old year-old child.child.

Average number of Average number of dmft per 100 5-dmft per 100 5-

year-oldsyear-olds

% of pop. % of pop. receiving receiving

fluoridated fluoridated waterwater

Wednesbury & West Wednesbury & West BromwichBromwich

84 teeth84 teeth 100%100%

Rowley Regis & Tipton Rowley Regis & Tipton 90 teeth90 teeth 100%100%

Wolverhampton Wolverhampton 94 teeth94 teeth 100%100%

Walsall Walsall 100 teeth100 teeth 100%100%

Eastern Birmingham Eastern Birmingham 119 teeth119 teeth 100%100%

Western Sussex Western Sussex 125 teeth125 teeth 0%0%

Windsor, Ascot & Windsor, Ascot & Maidenhead Maidenhead

127 teeth127 teeth 0%0%

Children in some relatively deprived Children in some relatively deprived fluoridated fluoridated areas of the West Midlands have areas of the West Midlands have fewer decayed, missing or filled teeth than fewer decayed, missing or filled teeth than children in parts of the more affluent children in parts of the more affluent non-non-fluoridatedfluoridated South East of England. South East of England.

The The efficacy and safetyefficacy and safety of water of water fluoridation have been endorsed by fluoridation have been endorsed by many health organisations.many health organisations.

• In 1994, a In 1994, a World Health OrganisationWorld Health Organisation Expert Committee on Oral Health concluded Expert Committee on Oral Health concluded that:that:

““fluoridation for the purpose of preventing fluoridation for the purpose of preventing tooth decay is safe and effective.”tooth decay is safe and effective.”

• The safety of fluoridation has been The safety of fluoridation has been endorsed by the endorsed by the Royal College of Royal College of PhysiciansPhysicians, the , the British Medical British Medical AssociationAssociation and many other leading and many other leading medical and scientific organisations. medical and scientific organisations.

Outcomes of Outcomes of reviews of the evidence reviews of the evidence on safetyon safety by leading medical and by leading medical and scientific bodies.scientific bodies.

• ROYAL COLLEGE OF PHYSICIANS: 1976

“There is no evidence that the consumption of water containing approximately 1mg/litre of fluoride is associated with any harmful effects.”

• NHS CENTRE FOR REVIEWS AND DISSEMINATION at the UNIVERTISITY OF YORK: 2000

“….no association was detected between water fluoridation and mortality from any cancer, or from bone or thyroid cancers specifically.”

• MEDICAL RESEARCH COUNCIL WORKING GROUP CHAIRMAN: 2000“There is no reason to believe that water fluoridation is responsible for any adverse health effects.”

• THE LORD BISHOP OF NEWCASTLE:

“I cannot think of another measure that could be introduced so economically and yet produce such a healthy gain for so many.”

• PROFESSOR JOHN HARRIS, Professor of Bioethics at the University of Manchester,

“………since dental decay may itself be responsible for a small number of deaths each year from anaesthesia used in dental treatment, it could be unethical not to fluoridate water where it is practicable to do so”.

The strong The strong ethical basisethical basis for for fluoridation:fluoridation:preventing disease, pain, suffering and preventing disease, pain, suffering and anxiety.anxiety.

67%

22%

11%0%

25%

50%

75%

100%

Yes No Don't know

Percentage of people who think fluoride should be added to water if it can reduce tooth decay

Results of NOP public opinion survey, Results of NOP public opinion survey, 2003.2003.Sample size 2000+Sample size 2000+

Fluoridation schemes are subject to Fluoridation schemes are subject to extensive public consultation,extensive public consultation, discussion and debate.discussion and debate.

• media publicity to ensure maximum awareness• mass distribution of consultation materials, including

household leaflet drops• opinion surveys conducted by independent research

companies• public meetings • radio and television debates and phone ins• formal consultation with local authorities• engagement with community organisations

Health authorities wishing to fluoridate water supplies to reduce tooth decay must undertake public consultation in the areas potentially affected.

Consultations conducted in the 1980s and 90s have included:

For more information For more information contact:contact:The British Fluoridation SocietyThe British Fluoridation SocietyWard 4Ward 4Booth Hall Children’s HospitalBooth Hall Children’s HospitalCharlestown RoadCharlestown RoadMANCHESTER M9 7AAMANCHESTER M9 7AA

Tel/Fax: 0161 918 5223Tel/Fax: 0161 918 5223Email: Email: bfs@bfsweb.orgWebsite: Website: www.bfsweb.org