Water fluoridation Professor Michael Lennon University of Sheffield and Chair British Fluoridation Society

Fluoride occurs naturally in all water supplies Fluoride occurs naturally in all water supplies. At the optimum level, it reduces tooth decay. The optimum level for dental health is one part of fluoride per million parts of water. In Britain, around 500,000 people drink water whose natural fluoride content is high enough to benefit their dental health. Worldwide, over 50 million people drink naturally fluoridated water.

Since the mid-1940s, it has been possible to replicate the benefits of natural fluoridation. Around 350 million people in over 30 countries drink water whose natural fluoride content has been supplemented to the optimum level by means of water fluoridation schemes. In the UK, 5.5 million people drink fluoridated water – in the North East, West Midlands, East Midlands, Cheshire, Cumbria, Lincolnshire and Bedfordshire.

In the United States, where individual liberty is prized, 170 million people drink fluoridated water. Forty three out of the 50 largest US cities receive fluoridated water supplies, including New York, Washington DC, Chicago, Los Angeles and San Francisco. In his report, the US Surgeon General said: “Fluoridation continues to be the most cost effective, practical and safe means for reducing and controlling the occurrence of tooth decay in the community.”

Some parts of the UK still have unacceptably high levels of tooth decay among children. Children in non-fluoridated Salford and many other parts of Greater Manchester have around twice as many decayed, missing and filled teeth as children in fluoridated Birmingham and the West Midlands. General anaesthesia for children’s dental treatment is used five times more often in non-fluoridated Greater Manchester than in fluoridated Birmingham and The Black Country.

Birmingham East and North Decayed teeth - how non-fluoridated Salford PCT compares with fluoridated Birmingham East and North PCT Average number of teeth decayed, missed and filled per 100 five year olds (2005/06 study). 242 teeth affected per 100 children Salford (non-fluoridated) Birmingham East and North (100% fluoridated) 104 teeth affected per 100 children

Birmingham and The Black Country Tooth extractions - how non-fluoridated Greater Manchester compares with fluoridated Birmingham and The Black Country Number of children under 10 years old given a general anaesthetic for tooth extraction (2002/03). 3,424 general anaesthetics Greater Manchester (non-fluoridated) Population: 2.5 million Birmingham and The Black Country (97% fluoridated) Population: 2.3 million 683 general anaesthetics

In all social groups, children in fluoridated areas have significantly less tooth decay than similar children in non-fluoridated areas. However, in social classes lll, lV and V, the benefits of fluoridation are particularly obvious. Mean number of decayed missing or filled teeth per 5-year-old child. Social Class Data from York Review, 2000 – quality of evidence level B or C

Children in some relatively deprived fluoridated areas of the West Midlands have fewer decayed, missing or filled teeth than children in parts of the more affluent non-fluoridated South East of England. Average number of dmft per 100 5-year-olds % of pop. receiving fluoridated water Wednesbury & West Bromwich 84 teeth 100% Rowley Regis & Tipton 90 teeth Wolverhampton 94 teeth Walsall 100 teeth Eastern Birmingham 119 teeth Western Sussex 125 teeth 0% Windsor, Ascot & Maidenhead 127 teeth

The efficacy and safety of water fluoridation have been endorsed by many health organisations. In 1994, a World Health Organisation Expert Committee on Oral Health concluded that: “fluoridation for the purpose of preventing tooth decay is safe and effective.” The safety of fluoridation has been endorsed by the Royal College of Physicians, the British Medical Association and many other leading medical and scientific organisations.

Outcomes of reviews of the evidence on safety by leading medical and 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 strong ethical basis for fluoridation: preventing disease, pain, suffering and anxiety. 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”.

Results of NOP public opinion survey, 2003. Sample size 2000+ Percentage of people who think fluoride should be added to water if it can reduce tooth decay

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

For more information contact: The British Fluoridation Society Ward 4 Booth Hall Children’s Hospital Charlestown Road MANCHESTER M9 7AA Tel/Fax: 0161 918 5223 Email: bfs@bfsweb.org Website: www.bfsweb.org