Evidence on Fluorides

 

Evidence on Fluorides

Water Fluoridation

After 50 years’ experience of water fluoridation in the UK and nearly 70 years’ experience in the United States, there have been no credible scientific studies to indicate that water fluoridation has caused harm to health.

There have been a number of authoritative reviews of water fluoridation undertaken since the first schemes in 1945.  These contain scientific opinion on both the effectiveness and safety of water fluoridation, reviews undertaken in the past five years are:

You can find the following commentaries that have been published in response to the Cochrane systematic review on water fluoridation in the links below.

The common finding of the reviews looking at dental health is that levels of tooth decay are lower in fluoridated areas and, for reviews which looked at general health effects, that there is no credible scientific evidence that water fluoridation is harmful to health.

The Public Health England report, ‘Water Fluoridation Health Monitoring for England (2014)’ compared a range of dental and non-dental health indicators in fluoridated and non-fluoridated areas in England and can be viewed at: https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2014 

Community Dental Health

Below is a editorial by Poul Eric Peterson and a paper on fluorides and oral health from Community Dental Health July Edition.

 

Oral Health Interventions 2016 - Return on Investment

 

Targeted supervised tooth brushing programme aimed at 5 year olds – 

 
 

After 5 years for every £1 spent £3.06 back
After 10 years for every £1 spent £3.66 back

Targeted fluoride varnish programme aimed at 5 year olds – 

After 5 years for every £1 spent £2.29 back
After 10 years for every £1 spent £2.74 back

The combined supervised tooth brushing and fluoride varnish for every £1 spent after 5 years £5.35, after 10 years £6.40 

Then add water fluoridation - The PHE table states for water fluoridation - 

After 5 years for £1 spent £12.71back
After 10 years for £1 spent £21.98 back

In total by using all three interventions in combination for every £1 spent after 5 years = £18.06, after 10 years £28.38.

 

Annual Teeth Team Report 2016

 

In 2012 Public Health England commissioned a survey, Department of Health (2012) into the dental health of five year- old children. This survey indicated 27.9% of 5-year-olds in England have tooth decay.

The survey also revealed:

  • Children with decay have on average between 3 and 4 teeth affected by decay, treated or untreated.

  • 24.5% of children have untreated decay.

  • 1.7% of children have sepsis (infection) in their mouths.

Unfortunately, this national survey also confirmed that 43.4% of five-year-olds in Hull had tooth decay, compared with the national average of 27.9%. The same survey also revealed 39.2% in Hull and 20.1% for the East Riding suffered from untreated decay.

Figures for the Yorkshire and Humber region showed 29.3% of children were not undergoing treatment to tackle the decay, which may suggest there is an issue of dental neglect.

A further survey was published in May 2016 by Public Health England, Department of Health (2015) again focusing on the dental health of five year- old children. This latest report concluded that 24.8% of five-year-old children in England whose parents gave consent for participation in this survey had experience of dental decay. Among these children with some experience of obvious decay, the average number of teeth that were decayed, missing or filled was 3.4

For the Yorkshire and Humber region, the survey also revealed:

  • 2.2% of children had sepsis compared with 1.4% of children nationally

  • 11% of children had experienced fillings compared with 12% of children nationally

  • 3.7% of children had one or more teeth extracted compared with 2.5% of children nationally.

These statistics highlight the fact that there clearly is a regional problem which most certainly needs to be addressed. If we want to break the cycle of poor oral health amongst generations of families in the Yorkshire and Humber region it is paramount there is a “joined-up” approach where a range of services work collaboratively in partnership, rather than in isolation, which is often the case.

If we compare this to the map of the indices of deprivation, we can see direct correlation between the prevalence of disease and areas of deprivation – See Page 3 of the Teeth Team report 2016.

Undoubtedly, encouraging parents to access routine primary dental care for their children should be high on the agenda, as should raising the awareness of the importance of regular tooth brushing with a fluoride toothpaste and the provision of dietary advice, including information on hidden sugars and the frequency of their consumption.

On a positive note, if we look at the specific figures pertaining to Hull, the same survey identified that 37.8% of five-year-old children had experience of dental decay. This is an  improvement on the 2013 survey where 43.4% of five year- olds had experienced decay, showing a reduction of 5.6%.  However  Looking at the 95% confidence intervals from a statistical point of view, the improvement is not significant.

....but even this improvement still leaves Hull at the bottom of the dental health league with a handful of other Cities, so we need to do more for our children and our population generally.

 

Hull Oral Health Statistics: Latest Survey for 5 Year Olds 2015

 

In Hull by the time the average child gets to 5 years old he or she will have on average 1.6 decayed, extracted or filled teeth.

Those children with decay (normally from the poorest communities in the City) will have on average 4.1 decayed, extracted or filled teeth and those with the poorest dental health will have 4.6 teeth decayed, extracted or filled.

On Average by the time a child in hull reached 5 years of age, 12.7% will have decay in their front teeth and in poorer areas this will rise to 16.77%

Both the proportion of children experiencing tooth decay and the severity of tooth decay increases with increasing deprivation. Hull has high levels of deprivation as compared with other local authorities and is within the 5% most deprived local authorities in England.  Just over 30% of children under 16 years old live in poverty which is the highest in North Yorkshire and Humber.

There have been no measurable improvements in proportion of 5 year children with tooth decay or the severity of tooth decay levels in children in Hull between 2007/08 and 2014/15. So in spite of all the efforts by the dental community between 2007 and 20015 there has been no significant improvement in the dental health of 5 yr olds. We need help.

This data demonstrates that Hull is in the top 10 % worst areas in England out of 152 Local Authority Areas BUT it also demonstrates the INEQUALITY in dental health in our City.  

The results of the 5yr Old survey are available at:

 

Overview of Oral Health: Public Health England North East

 

In the North East, areas with fluoridation have less decay in 5 year old children and rates of decay are around double in non-fluoridated areas.

Data demonstrates that there is a huge difference in acute infection and pain between children growing up in fluoridated Gateshead and Newcastle, compared with non-fluoridated Middlesbrough and Sunderland. This is 2 - 3 times the difference.

Sadly, infected teeth and severely decayed teeth causing pain need to be extracted. Here are the rates of extraction across the North East:

 
 
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Unsurprisingly, there is a trend of more extractions in Sunderland, Darlington and Middlesbrough compared to Gateshead and North Tyneside. Again, these can be over 3 times the difference.

According to evidence, we can expect 59% fewer hospital admissions in fluoridated areas and this certainly seems to be the case in Teesside. Hartlepool has half the rates of general anaesthetics compared with non-fluoridated Redcar & Cleveland and Middlesbrough.

In addition, In Darlington, Middlesbrough and Sunderland; decayed front teeth is the reality for 1 in 10 children and the local data shows fluoridation can half these rates.

Evidence tells us that fluoridation benefits everyone, especially less privileged children. Therefore, it is great at reducing inequalities and we can expect to see tooth decay reductions of 53% in the most deprived communities, compared to 23% in affluent communities. The gap in decay rates between rich and poor in Hartlepool is much smaller than the rest of non-fluoridated Teesside.

Although we have talked about all the benefits of fluoridation, it is important to consider the potential side effects - one of these being mild fluorosis. It affects a small number of children but rates are higher in fluoridated Newcastle compared to non-fluoridated Manchester.