Debate
International levels of water fluoridation (Selected countries) Country Scotland
Percentage of population
0%
exactly in line with system- atic reviews confirming that water fluoridation is effective. However, a more interesting quote is: “This correlation was found in spite of the extensive use of fluoridated toothpaste and caries-preventive prog- rammes implemented by the municipal dental services in Denmark.” For those who might suggest
that the Danish study was looking at natural fluoride, not added compounds, so is not relevant, can read the recent European Union Scientific Committee on Health and Environmental Risks Report; a critical review of any new evidence on the hazard profile, health effects and human exposure to fluoride and the fluoridating agents of drinking water, published in May 20ıı. It concluded that “these compounds are rapidly and completely hydrolysed to the fluoride ion”. So fluoride is fluo- ride, regardless of the source. The conclusions of the
Danish study confirm results found in both the systematic reviews of water fluorida- tion and the Cochrane review of fluoridated toothpaste (Marinho et al 2003) that the preventive benefits of fluoride toothpaste and water fluorida- tion are independent. They are complementary, not mutually exclusive. A new and innovative study
using intra oral photographs, comparing ı2-year-olds in fluoridated Newcastle and non- fluoridated Manchester gave results which “support existing work suggesting water fluori- dation together with the use of fluoridated dentifrice provides improved caries prevention over the use of fluoridated dentifrice alone.” It continues: “The social gradient between caries and deprivation appears to be lower in the fluoridated population compared to the non-fluoridated population,
England USA
Canada Ireland Israel Chile
Malaysia Australia
10%
73.9% 45% 67% 70% 70% 75% 65%
New Zealand 61% Singapore
100% Hong Kong 100%
particularly when consid- ering caries into dentine, demonstrating a reduction in inequalities of oral health for the most deprived individuals in the population.” (McGrady et al 20ı2). In April 20ı3, NHS England
was established to ensure that the NHS delivers better outcomes for patients, and the new local Clinical Commis- sioning Groups (CCGs) will commission the majority of NHS services for their popu- lations. Is this a possible way that water fluoridation could be developed for the benefit of the wider population? From April 20ı3, oral health
needs assessments are part of joint strategic needs assess- ments (JSNAs). NHS England is expected to work with local authorities and Public Health England to develop and deliver oral health improvement strat- egies and commissioning plans specific to the needs of local populations (NHS Commis- sioning Board 20ı2). One major change is that local authorities will be responsible for commis- sioning surveys of dental health and improving the oral health of their populations. Local authorities in England now have a statutory responsibility for dental health and should come to realise that water fluoridation is effective and safe in preventing tooth decay, and will reduce dental health inequalities. Further evidence now also
shows that water fluoridation provides dental benefits that
Estimated population receiving fluoridated water
Natural fluoride up to 0.5ppm 6 million
204 million 32 million 3 million
4.2 million 11 million
20.5 million 11.5 million 2.3 million 5 million 6 million
Source. British Fluoridation Society website.
extend into adult life. Griffith’s review from 2007 showed adults with lifelong residency in a fluoridated area had a reduced Risk Ratio of carious teeth with an overall rela- tive risk ratio = 0.65. (95 per cent confidence interval [CI]: 0.49-0.874); this is a prevented fraction of 27 per cent. A very recent paper showed that the benefits of water fluoridation to adult dental health with ıı per cent fewer DMF teeth in a nationally representative sample of Australian adults (Slade et al 20ı3). Is there the political will to
introduce water fluoridation more widely in England? Again, evidence from Queensland, Australia confirms that political activity can work. In 2002, only 5 per cent of the Queensland population enjoyed the benefit of water fluoridation. After the launch of a petition supported by the Australian Dental Asso- ciation of Queensland, more than 25,000 Queenslanders supported fluoridation and in 2008, introduced legislation to extend fluoridation to 90 per cent of the population by 20ı2. There was a statutory duty to fluoridate water supplies to more than ı,000 people and by 20ıı, 92 per cent of the Queens- land population were already covered. Just as the ban on smoking in public places was successfully enacted across the UK, to measurably benefit the health of the nation, political action over water fluoridation may be the next public health success.
REFERENCES
Griffin SO, Regnier E, Griffin PM and Huntley V. Effec- tiveness of Fluoride in Preventing Caries in Adults. Journal of Dental Research 2007;86;410-415.
Kirkeskov L, Kristiansen E, Bøggild H, von Platen-Haller- mund F, Sckerl H, Carlsen A, Larsen MJ and Poulsen S. The association between fluoride in drinking water and dental caries in Danish children. Data from health registers, environmental registers and administrative registers. Community Dent Oral Epide- miol 2010; 38: 206–212.
Marinho VCC, Higgins JPT, Logan S and Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane Database of Systematic Reviews 2003, Issue 1.
McGrady MG, Ellwood RP, Maguire A, Goodwin M, Boothman N and Pretty IA. The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation. BMC Public Health 2012, 12:1122. doi:10.1186/1471- 2458-12-1122
NHS Commissioning Board (2012) Securing excellence in commissioning primary care. Leeds: NHS Commis- sioning Board. SCHER 2011. Accessed 14/5/2013.
http://ec.europa.eu/health/ scientific_committees/ environmental_risks/docs/ scher_o_139.pdf
Slade GD, Sanders AE, Do L, Roberts-Thomson K and Spencer AJ. Effects of fluoridated drinking water on dental caries in Australian adults. Journal of Dental Research. 2013 Apr;92(4):376-82.
Scottish Dental magazine 39
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88