The interminable fluoridation debate - is it time to call a halt?

Published On:17-03-2014 by Dr John Renshaw

An article in a recent British Dental Journal revisits the issue of fluoride intake of children. The article points out that very young children are particularly and positively affected by the availability of fluoridated drinking water, that diet is the only source of fluoride for most infants and the importance of dietary evaluation prior to recommending the use of additional fluoride supplements Zohoori, F.V., Whaley, G., Moynihan P.J. and Maguire A. BDJ, 216, E3 (2014).

The scientific validity of claims for the effectiveness of drinking water fluoridation are generally questioned only by those whose position is radically anti-fluoride, whether their opposition is claimed to be based on the science or the ethics. For decades the benefits of water fluoridation have been set out in research paper after research paper, politicians have been battered by propaganda and Local Authorities have been begged to adopt local fluoridation schemes for the good of the oral health of the children who live in their areas.

And little or nothing has actually been achieved. Southampton is the latest city to attempt to fluoridate the water supply serving the poorest areas of the city and they have run into the same objections and legal blockades.
Is it not time to accept that, notwithstanding the validity of the scientific argument supporting water supply fluoridation, the idea of medicating the water supply is a step too far for the vast majority of the people of this country? What might have been possible when mass medication was believed to be the way to improve general public health is now seen as politically unacceptable and a definite vote loser for whatever political party puts it forward.

The days of mass medication are surely over. People nowadays know how to look after themselves and have no wish to have additional chemicals added to their drinking water. They see this as an unwarranted and highly personal interference in their lives without public support and without a real chance for the people to object. Councillors and MPs listen to their constituents listen to the views they express loudly and sincerely and then vote accordingly. The result is exactly what we have seen since Birmingham’s water supply was successfully fluoridated in 1964. Little or no further water fluoridation progress has been made.

This is not a rant against water fluoridation so much as a plea to listen to, recognise and understand the strength of the public opposition and to realise it is highly unlikely we will ever see mass fluoridation of the water supply and perhaps that might not be so bad.

Oral health is improving generally and the minority of children who need the help we could offer via the water supply are not likely to ever receive it. That may seem harsh and unkind but if the mass of the people have implicitly or explicitly decided that water supply fluoridation is not to their taste we are wasting precious time and resources on a project that is doomed to repeated failure.

Would it not make more sense to accept the ‘realpolitik’ we face and spend our time and energy pursuing a different approach that might have a greater degree of acceptability and effectiveness?

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John Renshaw has been a general dental practitioner for 44 years and still works four days a week in private practice in Scarborough. He specialises in dental practice management, primary care dental service commissioning issues, legal compliance within the practice, complaints resolution and wider healthcare policy.

John was chairman of the BDA between 2000 and 2006, and has held senior representative roles with the NHS and the Department of Health. He was Dental Practice Adviser to various primary care organisations over a period of 15 years and is still Secretary to the Yorkshire Branch Council of the BDA.