Britons should be given water containing fluoride to fight tooth decay

Everyone in Britain should get fluoride added to their drinking water to save NHS millions in the fight against tooth decay, health chiefs rule as they dismiss ‘exaggerated’ cancer fears

  • The UK’s chief medical officers have advised adding fluoride to water supplies
  • It would slash cavities by up to 28% and hospitalisations for decay by up 68%
  • Health Secretary Sajid Javid is reportedly keen to implement the policy

Everyone in Britain should have fluoride added to their water, health officials ruled today as they dismissed ‘exaggerated’ cancer fears.

The UK’s four chief medical officers say adding the mineral to water would help to combat tooth decay, which costs the NHS millions every year.

Ministers are likely to accept the advice, with Health Secretary Sajid Javid keen to press ahead with the move. 

The health and care bill currently going through parliament would allow ministers to add fluoride to water across the country.

Around 5.8million Britons live in areas where fluoride is already added to tap water. And 300,000 drink supplies naturally fluoridated by rocks in the ground. 

Professor Chris Whitty and fellow officials recommended the scheme is widened to include the rest of the country.

Tooth decay is largely preventable and a massive burden on the NHS, costing the health service £54.6million for treating children alone in 2019. Adding fluoride to water could prevent two-thirds of hospital admissions for tooth decay, the health bosses said.

People can get fluoride onto their teeth by using certain toothpastes or having the mineral applied to their teeth by a dentists. But adding it to the water supply in parts of the UK where it is on present in low levels would slash cavities by up to 28 per cent and cut hospital admissions for tooth decay by up to two thirds

Professor Whitty and colleagues wrote: ‘There is unquestionably an issue with tooth decay in the UK and an entrenched inequality which needs to be addressed. 

‘Fluoridation of water can reduce this common problem.’

Calls to expand the scheme, thought to cost as little as 40p per person per year, have attrached criticism in the past. 

Some have warned that the mineral can increase the risk of babies being born with Down’s syndrome, kidney stones and some cancers. 

Professor Whitty and his colleagues today dismissed the concerns as ‘exaggerated and unevidenced’. 

Experts today welcomed the move, saying it would improve oral health ‘for decades to come’.

What is fluoride? 

Fluoride is a naturally-occurring mineral that is found in water and helps prevent tooth decay.

But how much fluoride is in people’s water depends on which part of the country they live in.

The mineral is added to the water supplies in some countries to boost oral health, which is called fluoridation.

People can also get fluoride on their teeth by using certain toothpastes, eating certain foods such as spinach and grapes, or have the mineral applied to their teeth by a dentist.   

Water fluoridation is not a substitute for dental hygiene, but can improve oral health by across the population without requiring behavioural change.

By the age of five, around a quarter of children in England and Scotland will have tooth decay, while the figure is more than a third in Wales and 40 per cent in Northern Ireland.

The oral disease, which gets worse if left untreated, is triggered by a sugary diet, poor dental hygiene and a lack of fluoride. 

It can cause pain and difficulties eating, sleeping as well as socialising and can harm children’s education by causing absences — with six per cent of under-16s in England having time off in a six-month period because of tooth decay.  

Fluoride is a naturally-occurring mineral found in water and some foods — but the amount in water varies across the UK due to geological differences. 

Only 10 per cent of the UK’s population currently get water with sufficient fluoride levels, according to the British Fluoridation Society.

These areas include parts of North Hampshire and South Berkshire.

In a statement to ministers, Professor Whitty and his colleagues said if all five-year-olds with drinking water containing less than 0.2 milligram per litre (mg/l) of fluoride started drinking water with 0.7 mg/l, the number with cavities would fall by up to 28 per cent in the poorest.

And hospital admissions for tooth decay extractions would be slashed by 45 to 68 per cent, they said.  

By the age of five, around a quarter of children in England suffer tooth decay, which can cause agonising pain. 

Around 35,000 children are admitted to hospital to have decaying teeth extracted every year.

It is caused by sugary diets. Bacteria in plaque turn sugar into acid, which breaks down the surface of the tooth, causing cavities. 

Professor Whitty’s report dismissed as a ‘small risk’ concerns that the programme would increase rates of dental fluorosis — stains on the teeth that can range from very white lines when mild to discolouration when severe — if teeth are exposed to too much fluoride. 

It acknowledged ‘weaker studies’ saying fluoride may raise the risk of hip fractures and bladder and bone cancers.

But the chief medical officers — Dr Frank Atherton for Wales, Dr Michael McBride for Northern Ireland and Dr Gregor Smith for Scotland — said evidence to support the claims were ‘conflicting’.

They added: ‘Prevailing public health opinion is now that there is no significant association between water fluoridation and these conditions.

‘As with all things in medicine and public health, there is a balance of risk and benefit.

‘On balance, there is strong scientific evidence that water fluoridation is an effective public health intervention for reducing the prevalence of tooth decay and improving dental health equality across the UK.’

The World Health Organization recommends that fluoride should not go above 1.5 mg/l, which is more than double the level proposed by the report.

Just 6.1million Britons — around 10 per cent of the population — currently received water with fluoride levels sufficient to benefit oral health, according to the British Fluoridation Society. These areas include Hartlepool, Easington, parts of North Hampshire and South Berkshire

Professor Whitty and his fellow CMOs said the plan is ‘not a substitute’ for brushing teeth, regular dentist visits and limiting sugar intake.

The UK’s current approach to boost dental hygiene includes supervised tooth brushing schemes for younger children in schools and some local authorities.

People can also put fluoride toothpaste or have the mineral applied to their teeth by a dentists.

But water fluoridation would be effective because they don’t require behavioural change and can benefit those ‘less likely to engage with other methods’.

And it could help narrow differences in dental health between the most and least deprived parts of the country. 

Some 25 countries around the world already add fluoride to tap water, including Ireland, the majority of the US and Australia.

The bill going through parliament will give the Health Secretary the power to order the fluoridation of water supplies.

After the bill becomes law early next year, he is expected to open a consultation on whether the plans to add fluoride to water should go ahead.

Professor John Fawell, visiting professor at the Cranfield University Water Institute, said: ‘It is clear that fluoridation is of significant benefit, particularly to children from deprived communities where the uptake of dental hygiene measures is much lower.

‘The level normally recommended for fluoridation of drinking water to reduce the risk of dental decay is between 0.5 and 1 mg/l fluoride.’

The risk of dental fluorosis only increases as the concentration rises above 1 mg/l, he added.

Dr Nigel Carter, head of the Oral Health Foundation, told the Times adding fluoride to water ‘is the single most effective public health measure there is for reducing oral health inequalities and tooth decay rates, especially amongst children’.

Water fluoridation would improve the UK population’s teeth ‘for decades to come’, he added.

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