UK - Nigel Carter: For our children's sake, let's welcome fluoride

Nigel Carter: For our children's sake, let's welcome fluoride
By Nigel Carter
IN 1970, one in three people over the age of 16 had no teeth at all. Thankfully, the picture today is very different. Quite rightly, people now have an expectation that their teeth are for life.
But what has caused this dramatic improvement in our dental health? The simple answer is fluoride. Fluoride was first added to toothpaste in the late 1960s, and by the early 1970s virtually all toothpaste contained fluoride. This simple action has led to a reduction of about 50 per cent in the levels of decay we experience. Brushing twice daily with a fluoride containing toothpaste remains the most effective measure to reduce dental decay.As a result, our 12-year-olds have some of the best dental health in Europe – but there is a worrying increase in decay levels among younger children. There are also huge variations around the country, with areas of Yorkshire experiencing some of the worst dental health in the country. For many, regular daily brushing is not a reality, or even an option. Clearly, expenditure on toothbrushes and toothpaste is not a priority for many, and there are strong links between high levels of decay and poverty and disadvantage.It is generally recognised that we should replace our toothbrush every three months, which should lead to a purchase of four toothbrushes per person every year. The reality though is that we only purchase about 1.2 toothbrushes each per year. This means that many people are using old ineffective brushes, sharing toothbrushes or simply not bothering to clean their teeth at all. This group are being denied the benefits of fluoride toothpaste and so continue to experience unnecessarily high levels of dental disease, decay, tooth loss and dental pain.The simple answer is water fluoridation.As a general dental practitioner, I was fortunate to practise for more than 20 years in Birmingham, where the water was first fluoridated in 1964. Here I saw first hand the huge benefits that this simple cost effective measure does provide. Child dental decay was a rarity and the population could look forward to adult life with a fully functioning set of largely decay free teeth.Early in my career, my practice was on the border of fluoridated Birmingham and the then non-fluoridated Sandwell. It was possible with unfailing accuracy to tell from which side of the dividing main road a new child patient came.Why then, does only 12 per cent of the UK population, largely in the West Midlands and North East, benefit from the addition of fluoride at the optimum level? After all, surveys show over 80 per cent of the population are in support of this important public health measure, and most cannot understand why, with such strong evidence in its favour, it is not already being added nationwide. Earlier this month Health Secretary Alan Johnson added his support to calls for more widespread fluoridation.Rarely has a public health measure been so widely examined and researched and yet none of the research supports the arguments of adverse side effects the anti-fluoridationists claim. In fact, quite the contrary – 70 per cent of the population in the US and Australia benefit from water fluoridation, as does most of Ireland and research has been carried out extensively since the first water fluoridation scheme 60 years ago. All these reports have come down hugely in favour of continued or increased water fluoridation.Further research is currently being undertaken and we can expect that the results of these studies will continue to support water fluoridation.No support whatsoever has been found for the myriad claims of adverse effects on general health often put forward by the anti-fluoridationists. Indeed, there is evidence that there is, in fact, a lower level of hip fractures in areas with fluoridation.Fluorosis of the teeth is also quoted as a problem with fluoridation. In severe cases this can lead to unsightly mottling of the teeth, commonly seen in areas of the world which contain natural fluoride at extremely high levels, such as parts of India. In practice, mild fluorosis will be seen in a significant proportion of children who receive fluoridated water. This occurs as an increase in opalescence of the teeth and is considered to give a more attractive appearance. More unsightly cases are extremely rare and very often due to over dosage, where a child has swallowed fluoride toothpaste, been given fluoride supplements and also drinks fluoridated water. The civil liberties issue is even harder to understand. Water fluoridation involves the adjustment of the level of a mineral – which occurs naturally in all water supplies – to the optimum level in order to provide protection against dental decay. I am not aware of any suggestion that adding chlorine to water supplies in order to purify it and prevent infection has ever been challenged on the basis of civil liberties – it is just taken as pure common sense. By welcoming new water fluoridation schemes, we can look forward over the next few years to many of our most needy children enjoying greatly improved dental health.
Dr Nigel Carter is chief executive of the British Dental Health Foundation.

All these reports have come down hugely in favour of continued or increased water fluoridation. He tells porkies