Public health
programmes, it should be noted that people of all ages do bene- fit from water fluoridation. Dental fluorosis is present in
areas both with and without water fluoridation and in a European context the mild den- tal fluorosis found is a minor cosmetic issue. The suggestion that water fluoridation is mass medication is false. All water supplies, even in Scotland, have some natural fluoride and the water fluorida- tion process just involves adding fluoride (or removing fluoride in some areas of the world) to the level that protects dental health. It does not involve adding anything to the water that is not already present. There is no difference between fluoride present naturally and that which is added to water. Water fluoridation both
reduces tooth decay and also the need for dental treatment. In Scotland extraction of teeth is still the main reason that young
children are admitted to hospi- tal for treatment under a general anaesthetic. Dental treatment creates additional problems for some (e.g. diabetics, haemophil- iacs, transplant patients, the immune compromised) for whom a healthy mouth is essential. Some evidence shows that fluoridation is particularly ben- eficial in preventing tooth decay in deprived groups of children who may have difficulty with their own preventive care. However, it benefits all children, and reduces dental health inequalities. A recent paper reporting on
natural fluoridation and the effect on the dental health of children across Denmark con- cluded that: “The study confirmed previous findings of an inverse relation between fluoride concentration in the drinking water and dental caries in children. This correlation was found in spite of the extensive
use of fluoridated toothpaste and caries-preventive programs implemented by the municipal dental services in Denmark.” They reported that at a level of fluoride of about 1ppm, a reduction in tooth decay of around 50 per cent was found.4 So even in countries with widespread use of fluoridated toothpaste and caries-preven- tive programmes, such as in Scotland, the evidence shows that water fluoridation would provide major, additional improvements in child dental health. The recent lesson from
California and Queensland, and historically elsewhere, is that local dentists need to engage politicians in promoting a statu- tory duty on public water suppliers to fluoridate.
® Colwyn Jones is a Consultant in Dental Public Health for NHS Health Scotland
References 1:
www.cdc.gov/ fluoridation/statistics/
2008stats.htm 2:
http://statements.cabinet.
qld.gov.au/MMS/ StatementDisplay
Single.aspx?id=56475 3: Stephen KW, Macpherson LMD, Gilmore WH, Stuart RAM, Merrett MCW. A blind caries and fluorosis prevalence study of schoolchildren in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland. Community Dent Oral Epidemiology 2002; 30: 70-9. 4: Kirkeskov et al 2010. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers. Community Dent Oral Epidemiol 2010; 38: 206–212.
Disclaimer The views expressed in this article are solely those of the author.
Scottish Dental magazine 45
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