Impetus from on high for community water fluoridation

NHS England is signalling strongly that community water fluoridation is the optimum intervention to improve the oral health of children and tackle health inequality among disadvantaged communities.

The new impetus is fully supported by the Community Water Fluoridation (CWF) network, which is pressing for targeted water fluoridation in areas of high need. Dr Simon Hearnshaw, speaking for the CWF network, says that the latest unprecedented support from government inspires optimism that the first new scheme in a generation could get the go-ahead.

Health minister Jo Churchill has referenced water fluoridation in the House of Commons, responding to a written question about plans for improving children’s oral health and reducing the high number of extractions for decayed teeth. Meanwhile, Sir Paul Beresford, MP for the Mole Valley, and a dentist, gave a powerful speech in favour of community water fluoridation in Westminster.

New content (1) has been added to the NHS England website and a whole page (2) is dedicated to Dental Care and Fluoridation. According to NHS England, if 5-year-olds with the most tooth decay drank fluoridated water they would have 28% less tooth decay and be 45-68% less likely to need teeth removed in hospital.

Dr Hearnshaw, Chair of the Local Professional Network  (LPN) in Hull which instigated the CWF Network, said:  “NHS England is making the same case that is being made by us and by Public Health England (3). The whole philosophical thrust is towards the prevention of disease and the most cost-effective measure is water fluoridation.”

He welcomed the recognition on the new NHS England web page that support at a local level by NHS representatives is important.  Dr Hearnshaw believes this is a reference to the co-commissioning of feasibility studies by local authorities working with the NHS at local level to provide a strong strategic and collaborative lead.

The CWF network would like NHS England to go one step further and fund the recurring costs of water fluoridation as it is the health service which will benefit from a reduction in child hospital admissions for tooth extractions, estimated to be as much as £50m annually in the UK.

Dr Hearnshaw continued: “We have some way to go in the UK. Last month the USA celebrated 75 years of CWF. They have around 70% coverage, compared to only around 10% in the UK. All around the world new water fluoridation schemes are being adopted. We have not seen a new scheme in the UK since 1985.”

References:
1. https://www.england.nhs.uk/ltphimenu/
2. https://www.england.nhs.uk/ltphimenu/better-care-for-health-conditions-for-dental-healthcare/dental-care-and-water-fluoridation/
3. https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2018

Notes to Editors

Six million people in the UK live in areas where the water supply is fluoridated and a further one third of a million live in areas where the water has naturally occurring fluoride. Water fluoridation is approved by parliament but since 2012, local authorities which want to implement the public health measure must first carry out a public consultation.

Water fluoridation is supported by:

·      The World Health Organisation
·      The British Medical Association
·      The British Dental Association
·      The Royal College of Paediatrics and Child Health
·      Federation Dentaire Internationale
·      International Association of Dental Research
·      Faculty of Dental Surgery of the Royal College of Surgeons
·      Faculty of General Dental Practice (UK)
·      The Oral Health Foundation
·      The World Health Assembly

The most recent commitment to the addition of fluoride to community water schemes first arose in the Green Paper: ‘Advancing our health: prevention in the 2020s’. Published in July last year, it committed to consulting on options for rolling out a national school toothbrushing scheme in more pre-school settings and primary schools, and to consulting on the role of water companies in support water fluoridation initiatives in England.

For more information, contact Caroline Holland 020 8679 9595/07974 731396

Dentists rally to support local authorities in bid to improve kids’ teeth in the North East

A campaigning group of dentists who want to see children’s dental health improved have announced their support for local authorities moving ahead with consultations on whether to top up the fluoride in local water supplies.

 Formal letters have been submitted to the Secretary of State for Health and Social Care Matt Hancock proposing two new community water fluoridation schemes, one for Northumberland and the other for Durham, Sunderland and South Tyneside.

 Dr Tom Robson is a dentist in Consett, and a spokesperson for the National Community Water Fluoridation network. He explained: “We are passionately committed to improving children’s teeth through prevention. The most effective measure is making sure that the fluoride in the water is at the right level, which is one part per million.”

 He said a new web resource (https://onepartpermillion.co.uk/north-east) has been created by the network with information on the positive impact that community water fluoridation could have on children living in the most deprived areas of the region.

 The North East has a long and positive association with water fluoridation. There are already communities with fluoridated water in Newcastle upon Tyne, Gateshead, Consett, North Shields, Wallsend, Whitley Bay, Hexham and Alnwick. In these communities, dental health is better than in neighbouring non-fluoridated areas.

 Much of the research which confirms the efficacy of water fluoridation has taken place at the University of Newcastle Dental School. Meanwhile, during WW11, children who were evacuated from South Shields – with its fluoridated water supply - to the Lake District – without fluoridated water - surprised school dental officers with their remarkably healthy teeth.

 Research published in 2019 and carried out locally by members of the public health team shows that nearly 40% of children in deprived areas with non-fluoridated water have teeth which are decayed, missing or filled (dmf). This contrasts starkly both with the more affluent and fluoridated areas where it is down to less than 10%.

 Meanwhile, children with severe decay of this kind have to be referred into hospital to have teeth extracted under general anaesthetic. This number could be brought down dramatically if go-ahead is given for the water across the North East to be evenly fluoridated at the right level of one part per million.

 The National CWF Network represents local dental committees across England, and is supported by the British Dental Association and the British Society of Paediatric Dentistry, among many others. It includes non-dental representative organisations like the National Children’s Bureau and organisations of medics.

 Simon Hearnshaw is co-ordinator of the National CWF Network. He commented:” As a Society we have had enough of children having anaesthetics for the removal of decayed teeth. It’s upsetting and unnecessary because dental disease is largely preventable. We regard water fluoridation as one of a range of measures to ensure our children’s teeth are healthy. In the short-term the most cost-effective is water fluoridation but we also want to see tooth brushing schemes in early years settings as well as improved education on diet.”

 Six million people in the UK live in areas where the water supply is fluoridated and a further one third of a million live in areas where the water has naturally occurring fluoride. The principle of water fluoridation in targeted areas is supported by:

·      The World Health Organisation

·      The British Medical Association

·      The British Dental Association

·      The Royal College of Paediatrics and Child Health

·      Federation Dentaire Internationale (FDI)

·      International Association of Dental Research

·      Faculty of Dental Surgery of the Royal College of Surgeons

·      Faculty of General Dental Practice (UK)

·      The Oral Health Foundation

·      The World Health Assembly

 Public Health England says fluoridation “is an effective and safe public health measure to reduce the prevalence and severity of dental caries, and reduce dental health inequalities.”

 

For more information, contact Caroline Holland 020 8679 9595/07974 731396

International research into water fluoridation

 

After monitoring water fluoridation’s impact on millions of people over 50 years in the UK and nearly 70 years in the United States, we can be reassured of its safety. There have been many authoritative reviews which are clear that water fluoridation is safe and effective. Among them are:

 

Find out why fluoridation is recommended in the North East

FAQs for the North East

What is fluoride?

Fluoride is a mineral that occurs naturally in the environment – it’s found in water, both drinking water and seawater, in the soil and certain foods. When combined with other minerals, fluoride strengthens tooth enamel. The addition of fluoride to toothpaste has contributed over the last few decades to an overall improvement in dental health in England. There are fewer extractions and fewer people wearing dentures. But there is some way to go to achieve across-the-board improvement, which is why community water fluoridation is recommended in some areas.

What is community water fluoridation?

Community water fluoridation (CWF) is the addition of fluoride to the drinking water supply. It adjusts the naturally occurring level of fluoride to one part per million of water and it is recommended as a public health measure to reduce tooth decay. In the UK, six million people benefit from fluoridated water, including in parts of the North East. The communities with fluoridated water in our area are Newcastle upon Tyne, Gateshead, Consett, North Shields, Wallsend, Whitley Bay, Hexham and Alnwick. In these communities, dental health is better than in neighbouring non-fluoridated areas.

Why fluoridate more areas of the North-East?

Children who grow up in the non-fluoridated areas are more likely to suffer from decay than those in areas where the water is fluoridated. Decay doesn’t just mean fillings, it can mean pain and infection, extractions and root canal treatments. Teeth treated in childhood are likely to need more treatment in the future, bringing a lifetime of dental disadvantage. Water fluoridation has been shown to reduce the number of young children admitted to hospital for dental extractions. It also benefits adult teeth and it’s important to give the rising number of people living into older age the best possible chance of keeping their teeth for a lifetime.

How do we know water fluoridation reduces health inequalities?

A recent study in the North East has demonstrated forcibly how health inequalities could be reduced by water fluoridation. Researchers compared decay levels in 5-year-old children in fluoridated and non-fluoridated areas of the North East which were ranked according to income levels. In the most deprived communities water fluoridation had the most positive impact: 29% of five year olds suffering from dental decay compared to nearly 40% of 5-year-olds in a non-fluoridated area.

How does it work?

Fluoride works in several ways, which is the reason why it is so effective. First, when fluoride in drinking water is swallowed at an age teeth are forming, the dental enamel is more resistant to decay – less soluble to acids which form in dental plaque after sugar is eaten. Second, when teeth are in the mouth, fluoride in water, toothpaste, mouthrinses etc. helps to reduce the development of dental decay and, also, helps to heal areas of enamel which might be beginning to decay. Thus, fluoride provides benefit to the very young, whose teeth are forming, and to children and adults of all ages.How do we know it’s safe and effective?
We know water fluoridation is safe and effective because the evidence tells us so in a variety of ways:
• There are water fluoridation programmes in 25 countries covering many major cities of the world - some have been operating for up to 70 years
• The schemes are monitored by public health bodies and the results are published - any adverse effects would have been identified decades ago
• More than 400 million people worldwide live in areas with fluoridated water
• Some populations benefit from water in which the fluoride is naturally occurring – their oral health is better than in comparable non-fluoridated areas
• Occasionally, the addition of fluoride to a water supply is stopped and the level of decay then rises

Claims are made about the negative impact of water fluoridation on health – are they true?

There is no negative impact on health. However, there is a lot of misinformation on the topic of fluoridation which has held back progress in the UK. Most of the claims that are made are untrue and unhelpful. We have known for over 70 years, however, that dental fluorosis can occur when too much fluoride is swallowed by young children. Dental fluorosis is a cosmetic condition featuring white flecks or mottling on teeth. Public Health England monitors the impact of water fluoridation and its 2018 report shows that dental fluorosis is not harmful to health.

Why carry out a public consultation?

Since a change in the law in 2012, local authorities must carry out a public consultation before fluoridating the water supply. This gives local populations the opportunity to debate the issue.

What is the view of the dental profession?

Many of us have united into a campaigning organisation called the National Community Water Fluoridation Network because we want to see the dental health of our children improve across the board. A representative meeting of dentists in 2019 voted unanimously to applaud local authorities which implement water fluoridation. We are doing our best to make sure local authorities have the evidence they need for public consultations. We have the support of the British
Fluoridation Society (BFS), a charity formed 50 years ago by human rights campaigner Lord Avebury and by dentists.
BFS has an archive of evidence that it is ready to share with anyone wanting to know more on the topic. Support for the principle of water fluoridation has also come from the Royal College of Paediatrics and Child Health, the British Medical Association, the National Children’s Bureau and other individuals and organisations which care passionately about reducing health inequalities.

Support for fluoridation in Green Paper welcomed by the National CWF network

 

The National Community Water Fluoridation (CWF) Network welcomes the commitment in the Green Paper ‘Advancing our health: prevention in the 2020s’ that the NHS should work more closely with local authorities to implement water fluoridation schemes. The Green Paper has been published by the Cabinet Office and by the Department of Health and Social Care.

Water fluoridation is a public health measure which adjusts the amount of naturally occurring fluoride to the optimum level – one part per million - to prevent dental decay.  Strong evidence shows that it reduces dental decay. NHS England is offering to share with local authorities some of the ensuing savings achieved thanks to a reduced spend on the treatment of dental decay.

Simon Hearnshaw who is spearheading the national CWF network, a powerful grouping of dental, medical and social justice organisations, praised the initiative, saying that if half the money saved on dental treatment was to be shared with local authorities, this would more than cover the recurring costs of water fluoridation. 

He added: “Although the cost of water fluoridation is not great it nevertheless represents a financial barrier to local authorities which have so many responsibilities and limited budgets. We will be doing what we can to support councils in the most deprived areas by sharing the wealth of evidence that we have amassed on the safety and efficacy of water fluoridation.”

Alan Johnson, the former MP and Secretary of State for Health and a long-time proponent of water fluoridation commented: “In an NHS that is truly focused on prevention and tackling the obscene health inequality statistics, Community Water Fluoridation has to be part of the strategy.”

“We should not accept a situation where children are being hospitalised in droves to have their teeth removed whilst the greatest single proven solution (CWF) is not used widely enough.”

“Ensuring that local authorities don’t face an additional fiscal pressure as a result of fluoridation is a practical way for the NHS to be true to its founding principles by supporting local authorities like Hull and many others in the North who are determined to act on behalf of children in areas where tooth decay is most prevalent.”

Simon Hearnshaw said the network would be responding in detail to the consultation and in particular making suggestions around the role of  water companies which have the job of implementing water fluoridation.

  • British Dental Association

  • British Fluoridation Society    

  • The Local Dental Network Fluoridation Group        

  • British Society of Paediatric Dentistry

  • Faculty of General Dental Practice

  • British Association of Dental Therapists

  • British Oral Health foundation 

  • British Society of Dental Hygiene and Therapy

  • National Children's Bureau

  • Association of Dental Groups

  • GDPUK

  • British Association fro the Study of Community Dentistry

  • The Society of British Dental Nurses

  • The Dental Professionals Alliance 

  • The National Oral Health Promotion Group

  • Teeth Team

For more information or to interview one of the network, please contact Caroline Holland: 0208 679 9595/07974731396

 

LDC conference votes unanimously to applaud local authorities taking forward water fluoridation

 

The national conference of Local Dental Committees which represents more than 25 thousand NHS dentists working in high street practices is supporting community water fluoridation in areas of need. A motion applauding those local authorities taking forward water fluoridation was approved unanimously at a conference in June.

The vote is an important milestone for the newly formed Community Water Fluoridation network. The network’s role is to make sure that public consultations are informed by scientific evidence and accurate representation of the needs of families in their locality.

Local Dental Committee members have provided the impetus for the network which is supported by a wide range of dental, medical, child and health-related organisations. Among them are NHS England, the British Fluoridation Society, the National Children’s Bureau, the British Dental Association, the British Society of Paediatric Dentistry and the Association of Dental Groups.

Simon Hearnshaw, a dentist who works for Health Education England, and who put forward the motion, said: “To have this kind of unanimous response from dentists highlights just how strongly we all support fluoridation of water and want to see the oral health of our young patients improve.”

Water fluoridation is approved by parliament but since 2012, local authorities which want to implement the public health measure must first carry out a public consultation.

The network is at the ready to put forward dental and medical spokespeople from local communities who will answer questions and describe the dental challenges they are dealing with almost daily and the difference water fluoridation could make. They will be ready to attend events and meetings over the course of the consultations so that there is consistent dental representation.

In 2016-17, more than 42,000 hospital admissions in England were for the extraction of decayed teeth, mostly in very young children, who cannot be treated in general practice, costing more than £50m. Areas where water is not fluoridated have a disproportionately higher number of children suffering from dental decay.

Six million people in the UK live in areas where the water supply is fluoridated and a further one third of a million live in areas where the water has naturally occurring fluoride. Water fluoridation is supported by:

  • The World Health Organisation

  • The British Medical Association

  • The British Dental Association

  • The Royal College of Paediatrics and Child Health

  • Federation Dentaire Internationale

  • International Association of Dental Research

  • Faculty of Dental Surgery of the Royal College of Surgeons

  • Faculty of General Dental Practice (UK)

  • The Oral Health Foundation

  • The World Health Assembly  

Public Health England says fluoridation “is an effective and safe public health measure to reduce the prevalence and severity of dental caries, and reduce dental health inequalities.” (1)

(1) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/692756/EXECUTIVE_SUMMARY_Water_Fluoridation_Health_monitoring_report_for_England_2018_DR.pdf

Notes to Editors

The motion put to the LDC conference was: This Conference applauds Councils moving forward with CWF proposals and commits to support them as they move through the regulatory process.

 For more information, contact Caroline Holland 020 8679 9595/07974 731396

 

 

 

Oral Health Interventions 2016 - Return on Investment

 

Targeted supervised tooth brushing programme aimed at 5 year olds – 

 
 

After 5 years for every £1 spent £3.06 back
After 10 years for every £1 spent £3.66 back

Targeted fluoride varnish programme aimed at 5 year olds – 

After 5 years for every £1 spent £2.29 back
After 10 years for every £1 spent £2.74 back

The combined supervised tooth brushing and fluoride varnish for every £1 spent after 5 years £5.35, after 10 years £6.40 

Then add water fluoridation - The PHE table states for water fluoridation - 

After 5 years for £1 spent £12.71back
After 10 years for £1 spent £21.98 back

In total by using all three interventions in combination for every £1 spent after 5 years = £18.06, after 10 years £28.38.