Public health


The experience of other countries over several decades tells us that water fluoridation is safe and effective, explains Colwyn Jones


fluoridation statistics for 2008, which showed that 58 per cent of people living in California receive fluoridated water, more than double the 27 per cent who benefited in 2002.1 Thanks to efforts led by a charitable trust established by the California Dental Association (CDA) Foundation, it has steadily expanded access to water fluoridation. California now has the largest total num- ber of residents of any American state receiving fluor- idated water; 21.5 million people or four times the Scottish population. Before the CDA Foundation-


led efforts to expand fluorida- tion in the late 1990s, only 17 per cent of California’s population received the benefit of fluoridat- ed water. Progress was achieved largely by legislation approved in 1995. The CDA fulfils the same role in the state of California as the British Dental Association does in Scotland, including being an advocate for water fluoridation. Since then, the CDA


Foundation and its partners, often working with private fun- ders, have provided grants to help communities initiate fluoridation projects. The USA federal govern-


ment’s Healthy People 2010 objective for fluoridation is 75 per cent, which is a target that the CDA foundation reports it plans to achieve in the near future. Across the USA, 72 per cent of the population on mains water receives water fluorida-


44 Scottish Dental magazine


Glass half empty? T


he USA Centers for Disease Control and Prevention recently released the latest water


supply water to more than 1,000 people, to add fluoride to the public water supply under their control or management. The Queensland legislature


Across the USA 72 per cent of the population on mains water


receives water


fluoridation


also committed AUS$35 million to improve the infrastructure of water treatment plants over this six-year period and implement fluoridation. The new water bill followed a petition from the Australian Dental Association of Queensland signed by more than 25,000 Queenslanders sup- porting water fluoridation.2 In 2008, 65 per cent or 11.5 mil-


lion Australians benefited from drinking fluoridated water and this proportion is increasing. Like the USA and the UK, fluor- idation of water supplies has been practised for more than 50 years without credible evidence of any harmful effects


Current water fluoridation (selected countries, various years)


Country Scotland


Percentage 0%


Australia


New Zealand Israel


45% 10% 67% 65% 61% 75%


Population receiving water fluoridation none


USA 64.3% 195 million Canada England Eire


31 million 6 million 2 million


Singapore & Hong Kong 100%


tion; the state of Maryland has 99.8 per cent benefiting from water fluoridation. Across the Pacific in 2008, the


state of Queensland in Australia also adopted legislation to pro- mote water fluoridation with the aim of 90 per cent of Queensland residents having access to fluoridated water by 2012. Under this legislation, a statutory duty was placed on public water suppliers who


11.5 million 2.3 million 4.2 million 10 million


on general health. For genera- tions, millions of people have lived in areas where fluoride is found naturally in the drinking water in concentrations as high as or higher than those recom- mended to prevent tooth decay. Research conducted among these groups confirms the safety of fluoride in the water supply. While we welcome more research, there are no concerns about the safety


and effectiveness of water fluoridation. In Canada, 45 per cent of the population receive fluoridated water, in Eire 67 per cent or two million people, in Spain about 10 million, in Singapore and Hong Kong the proportion is 100 per cent. In New York, with a pop- ulation of eight million, the water was fluoridated 45 years ago in 1965. Virtually all of the major cities in the United States of America are fluoridated. In the UK, water fluoridation, either natural or adjusted, is available to only about 10 per cent of the English population. The only area in Scotland which did have naturally fluoridated water at 1ppm was on the Moray coast.3


However, the water came


from a borehole supply which is no longer used. Most of the water collected for domestic use in Scotland has a moorland catchment, which means it will be low in fluoride. So, in Scotland, despite having a pub- lic water supplier, there is essentially no water fluorida- tion, either natural or artificial. Across Europe only England,


Ireland and Spain practise arti- ficial water fluoridation and while many other European countries do have natural water fluoridation, they prefer to rely on professionally applied fluo- rides for the preventive benefits; those countries within the European Union are governed by water quality directives which allows for natural fluo- ride levels of up to 1.5ppm. (Council Directive 98/83/EC. 3 November 1998. The quality of water intended for human con- sumption). The target level for artificial water fluoridation in temperate climates is lower at 1mg/L and unlike school-based


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