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Water fluoridation

September 2007

(This briefing paper applies to England and Wales)

The BMA has for many years been in favour of the fluoridation of mains water supplies. We support this policy on the grounds of effectiveness, safety and equity.

The BMA supports Section 58 in the Water Act 2003 that makes it mandatory on water companies to fluoridate supplies wherever this is formally requested by health bodies, following full and proper consultation with local communities. This will give local populations the right to choose to have their water fluoridated.

Fluoridation of water is an effective public health strategy for reducing tooth decay in the population. The evidence accumulated over many years shows fluoride is highly protective to the teeth of children, and is very safe. Water fluoridation is one of the most effective ways of reducing tooth decay in the community.

Not only does water fluoridation reduce tooth decay and consequently the number of extractions needed, but it also brings the added and welcome benefit of a reduction in the number of general anaesthetics administered to children.

The BMA supported the Government action to change the law to oblige water companies to fluoridate water supplies where there is strong local support for doing this.

Medical evidence
The BMA believes there is no convincing evidence of any adverse risk to human health by the introduction of water fluoridation. Evidence through scientific studies shows that fluoride in water, at or around one part per million, does not have any effect on the health of the body other than reducing decay in teeth. This view is supported by the World Health Organisation, the Royal College of Physicians, and the British Dental Association, among others.

There is more than 40 years of experience in England of artificial fluoridation and we are not aware of evidence of harm demonstrated in those areas, other than dental fluorosis in a small number of children. Neither the York review [see reference 1] nor the MRC Working Group [see reference 2] could find convincing evidence of musculo-skeletal disease, kidney disease, infertility, central nervous system damage or damage in the thyroid gland.

Dental health inequalities
Tooth decay is a significant problem in the UK, particularly in socially deprived areas. Dental health inequalities are widening and severe tooth decay is strongly associated with child poverty. Children from less well-off backgrounds may have five times more tooth decay than those in the highest social classes. (Our Healthier Nation, July 1999).

Studies have shown [see reference 3] that children in non-fluoridated under-privileged areas of the UK are more likely to have teeth extracted due to tooth decay than those in either affluent, or similar, but fluoridated areas. For example, 5-year-olds in non-fluoridated Manchester suffer almost two and a half times more tooth decay than those in fluoridated Birmingham and almost three times more than their peers in affluent West Surrey. A few miles from Birmingham is fluoridated Sandwell, one of the most socially deprived districts in the country. Thanks to water fluoridation, the dental health of young children in Sandwell is excellent. The BMA deplores such avoidable health inequalities.

Many more children and adults in this country would have deficiencies in various basic nutrients but for food fortification regulations. We have no concerns about the mandatory addition of vitamins A and D to margarine, and calcium, iron, thiamin and niacin to most types of flour, or the voluntary fortification of common types of food such as breakfast cereals and baby foods. Water fluoridation is simply the ‘fortification’ of fluoride-deficient water supplies, and should be treated no differently.

Fluoridation should be targeted at areas where there are particular dental health problems.

Cost-effectiveness
Studies comparing the cost-effectiveness of water fluoridation compared with other strategies for reducing caries always conclude that water fluoridation is the most cost-effectiveness approach. (University of York, Health Economics Consortium)

Notes:
The Water Act 2003 amends the Water Industries Act 1991 that allowed water companies to accede to health authority requests to fluoridate but did not oblige them to do so.

The All Party Parliamentary Group on Primary Care and Public Health in its April 2003 report recommended that, as matter of public dental health policy, targeted water fluoridation be started as a legitimate and effective means of tackling dental health inequalities.

The following water companies fluoridate their water: Anglian Water Services Ltd., Northumbrian Water Ltd., South Staffordshire Water plc, Severn Trent plc and United Utilities Water plc.

Northumbrian Water Ltd., Yorkshire Water Services Ltd. and Thames Water Utilities Ltd supply water in which flouride occurs naturally, to some areas approaching one part per million. This is the level at which water is artifically fluoridated [see reference 4].

Fluoridation schemes apply in the following Strategic Health Authority areas: Bedfordshire and Hertfordshire, Birmingham and the Black Country, Cheshire and Merseyside, County Durham and Tees Valley, Cumbria and Lancashire, North and East Yorkshire and Northern Lincolnshire. Northumberland, Tyne and Wear, Shropshire and Staffordshire, Trent, and West Midlands South. Flouridation was introduced progressively in these areas over the period 1964 to 1988. [See reference 5]

For further information, please email parliamentaryunit@bma.org.uk.

1. York CRD, (2000): Fluoridation of the Water Supply: a Systematic Review of its Efficacy and Safety. University of York. UK.
2. Medical Research Council, (2002): Working Group Report Water fluoridation and health. London. MRC.
3. Pitts N B, Evans D J and Nugent Z J (2001), The dental caries experience of 5-year old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1999/2000, Community Dental Health, 18, 49 - 55.
4. Hansard Written PQ 15/12/04 col 1159
5. Hansard Written PQ 11/7/06 col 1806