Water fluoridation: ‘a safe way of stopping tooth decay’

Water fluoridation: ?a safe way of stopping tooth decay?

A new study carried out by by researchers from Public Health England (PHE) has concluded that water fluoridation is a ‘safe and effective’ way of preventing tooth decay in children. Although the beneficial effects of the measure are well established,  the study showed no adverse effects such as various cancers, kidney stones, hip fractures of Down’s syndrome births.

The study was carried out by researchers from Public Health England (PHE) and was published in the journal of Community Dentistry and Oral Epidemiology. The study used national data to compare the rates of tooth decay and other health outcomes in areas of England where fluoride either has or has not been added to the water.

It was a cross-sectional study that aimed to look at the association between water fluoridation schemes in England and selected health outcomes. Six million people in England are said to live in areas where the level of fluoride in water has been adjusted, the main reason being to reduce the public health burden of dental caries. Dental caries, or tooth decay, are reported to affect more than one-quarter of young children, with higher rates in areas of greater deprivation.

Fluoride has long been recognised to reduce the risk of dental caries. Water fluoridation schemes in England (mostly introduced from the late-60s to mid-80s) aim to achieve a level of one part fluoride per million (1ppm) in water, with a maximum permitted level of 1.5ppm.

However, while the dental effects of fluoride are well established, what is less known is whether fluoride could have other detrimental health effects or, conversely, possible health benefits. This study aimed to compare rates of dental and other health outcomes in areas of England with and without water fluoridation.  

Health outcomes examined for the regions (and their data source) were as follows:

  • dental caries at five and 12 years old – National Dental Epidemiology Programme for England
  • hospital admissions for dental caries in young children aged one to four years – 2012 Annual Report of the Chief Medical Officers
  • hip fractures – Hospital Episode Statistics (HES) data
  • kidney stones – HES data
  • Down's syndrome – National Down syndrome Register
  • bladder cancer – English Cancer Registration
  • bone cancer – English Cancer Registration
  • overall cancer – English Cancer Registration
  • all-cause death – Office for National Statistics

Looking at the dental outcomes, water fluoridation was associated with a significant reduction in the odds of child dental caries (28% reduction for five-year-olds and 21% for 12-year-olds). The rate of hospital admission for dental caries was 42 per 100,000 young children in fluoridated areas, compared with 370 in non-fluoridated areas. This was calculated as a 55% risk reduction.

Looking at other health outcomes, three statistically significant associations were found. Water fluoridation was associated with a reduction in the number of cases of bladder cancer and kidney stones (both 8% reduced incidence) and a small reduction in all-cause death (1.3% reduction). There were no other associations found for any other health outcomes. 

The researchers concluded that: "This study uses the comprehensive data sets available in England to provide reassurance that fluoridation is a safe and highly effective public health measure to reduce dental decay.  Although lower rates of certain non-dental outcomes were found in fluoridated areas, the ecological, observational design prohibits any conclusions being drawn regarding a protective role of fluoridation." 

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