Using the legislation in the Health & Social Care Act 2012 and PHE toolkit to improve oral health Dr John F Beal MBE Hon Senior Lecturer in Dental Public Health, University of Leeds and former Regional Consultant in Dental Public Health, Yorkshire and the Humber

Oral Health in children While improved Inequalities Many places over 1/3 5-year-olds have tooth decay Especially North West, Yorkshire & the Humber and London

Consider water fluoridation Effective Cost-effective Reduces need for dental treatment Reduces general anaesthetics for tooth extraction Reduces inequalities All ages benefit – children, young adults and older people

Fluoride varnish programmes They are effective BUT Don’t start until children at school Only in those schools in programme Stop when children go to 2ndary sch Needs repeating 2 or 3 times pa Cost – expensive (c£88 per child pa)

Health and Social Care Act 2012 Local authorities now responsible for consultations and decision-making on fluoridation schemes Water fluoridation consultation regulations 2013 lay down procedures for local authorities to follow Secretary of State now responsible for implementation of schemes and entering into formal agreements with water companies 6

Health and Social Care Act 2012 Similar processes, including public consultation for varying or terminating established schemes Local authorities cannot just decide to terminate existing fluoridation schemes 7

Australian National Health & Medical Research Council, 2016 Benefits There is consistent evidence that water fluoridation is associated with decreased occurrence and severity of tooth decay by 26-44% in children, adolescents and adults. Australian National Health & Medical Research Council, 2016

PHE Water fluoridation health monitoring report for England 2014 Benefits In fluoridated areas there are 48% fewer hospital admissions of children aged one to four for dental caries PHE Water fluoridation health monitoring report for England 2014

Safety ‘The report provides further reassurance that water fluoridation is a safe and effective public health measure’ PHE Monitoring Report 2014

Safety ‘The current review shows that CWF within the current Australian range (0.6 to 1.0 mg/L) does not cause harm’ Australian NHMRC 2016

Steps for taking forward PHE “Improving oral health: a community water fluoridation toolkit for local authorities” 2016 Sets out the legislation and step by step guidance

Targeted water fluoridation Not every local authority needs water fluoridation But areas with the poorest oral health would benefit greatly Best estimate 25-30% of England (currently about 10%) Particularly conurbations in North of England

Help and advice are available (PHE and BFS) Take away message Don’t put in the ‘too difficult box’! Yes, it is challenging, hard work But benefits to your community are great - Especially to the most vulnerable sections of the community Help and advice are available (PHE and BFS)

British Fluoridation Society Email: info@bfsweb.org www.bfsweb.org