Professor Michael Lennon

1
Water fluoridation

• Professor Michael Lennon
• University of Sheffield
• and
• Chair British Fluoridation Society

2
Fluoride occurs naturally in all water
supplies.At the optimum level, it reduces tooth
decay.

• The optimum level for dental health is one part
  of fluoride per million parts of water.
• In Britain, around 500,000 people drink water
  whose natural fluoride content is high enough to
  benefit their dental health.
• Worldwide, over 50 million people drink naturally
  fluoridated water.

3
Since the mid-1940s, it has been possible to
replicate the benefits of natural fluoridation.

• Around 350 million people in over 30 countries
  drink water whose natural fluoride content has
  been supplemented to the optimum level by means
  of water fluoridation schemes.
• In the UK, 5.5 million people drink fluoridated
  water in the North East, West Midlands, East
  Midlands, Cheshire, Cumbria, Lincolnshire and
  Bedfordshire.

4
In the United States, where individual liberty is
prized, 170 million people drink fluoridated
water.

• Forty three out of the 50 largest US cities
  receive fluoridated water supplies, including New
  York, Washington DC, Chicago, Los Angeles and San
  Francisco.
• In his report, the US Surgeon General said
• Fluoridation continues to be the most cost
  effective, practical and safe means for reducing
  and controlling the occurrence of tooth decay in
  the community.

5
Some parts of the UK still have unacceptably high
levels of tooth decay among children.

• Children in non-fluoridated Salford and many
  other parts of Greater Manchester have around
  twice as many decayed, missing and filled teeth
  as children in fluoridated Birmingham and the
  West Midlands.
• General anaesthesia for childrens dental
  treatment is used five times more often in
  non-fluoridated Greater Manchester than in
  fluoridated Birmingham and The Black Country.

6
Decayed teeth - how non-fluoridated Salford PCT
compares with fluoridated Birmingham East and
North PCT
Average number of teeth decayed, missed and
filled per 100 five year olds (2005/06 study).
242 teeth affected per 100 children
Salford (non-fluoridated)
Birmingham East and North (100 fluoridated)
104 teeth affected per 100 children
7
Tooth extractions - how non-fluoridated Greater
Manchester compares with fluoridated Birmingham
and The Black Country
Number of children under 10 years old given a
general anaesthetic for tooth extraction
(2002/03).
3,424 general anaesthetics
Greater Manchester (non-fluoridated) Population
2.5 million
Birmingham and The Black Country (97
fluoridated) Population 2.3 million
683 general anaesthetics
8
In all social groups, children in fluoridated
areas have significantly less tooth decay than
similar children in non-fluoridated areas.
However, in social classes lll, lV and V, the
benefits of fluoridation are particularly obvious.
Mean number of decayed missing or filled teeth
per 5-year-old child.
Social Class
Data from York Review, 2000 quality of
evidence level B or C
9
Children in some relatively deprived fluoridated
areas of the West Midlands have fewer decayed,
missing or filled teeth than children in parts of
the more affluent non-fluoridated South East of
England.
Average number of dmft per 100 5-year-olds of pop. receiving fluoridated water
Wednesbury West Bromwich 84 teeth 100
Rowley Regis Tipton 90 teeth 100
Wolverhampton 94 teeth 100
Walsall 100 teeth 100
Eastern Birmingham 119 teeth 100
Western Sussex 125 teeth 0
Windsor, Ascot Maidenhead 127 teeth 0
10
The efficacy and safety of water fluoridation
have been endorsed by many health organisations.

• In 1994, a World Health Organisation Expert
  Committee on Oral Health concluded that
• fluoridation for the purpose of preventing
  tooth decay is safe and effective.
• The safety of fluoridation has been endorsed by
  the Royal College of Physicians, the British
  Medical Association and many other leading
  medical and scientific organisations.

11
Outcomes of reviews of the evidence on safety by
leading medical and scientific bodies.

• ROYAL COLLEGE OF PHYSICIANS 1976
• There is no evidence that the consumption of
  water containing approximately 1mg/litre of
  fluoride is associated with any harmful effects.
• NHS CENTRE FOR REVIEWS AND DISSEMINATION at the
  UNIVERTISITY OF YORK 2000
• .no association was detected between water
  fluoridation and mortality from any cancer, or
  from bone or thyroid cancers specifically.
• MEDICAL RESEARCH COUNCIL WORKING GROUP CHAIRMAN
  2000
• There is no reason to believe that water
  fluoridation is responsible for any adverse
  health effects.

12
The strong ethical basis for fluoridationprevent
ing disease, pain, suffering and anxiety.

• THE LORD BISHOP OF NEWCASTLE
• I cannot think of another measure that could
  be introduced so economically and yet produce
  such a healthy gain for so many.
• PROFESSOR JOHN HARRIS, Professor of Bioethics at
  the University of Manchester, since dental
  decay may itself be responsible for a small
  number of deaths each year from anaesthesia used
  in dental treatment, it could be unethical not to
  fluoridate water where it is practicable to do
  so.

13
Results of NOP public opinion survey,
2003.Sample size 2000
Percentage of people who think fluoride should be
added to water if it can reduce tooth decay
14
Fluoridation schemes are subject to extensive
public consultation, discussion and debate.
Health authorities wishing to fluoridate water
supplies to reduce tooth decay must undertake
public consultation in the areas potentially
affected. Consultations conducted in the 1980s
and 90s have included

• media publicity to ensure maximum awareness
• mass distribution of consultation materials,
  including household leaflet drops
• opinion surveys conducted by independent research
  companies
• public meetings
• radio and television debates and phone ins
• formal consultation with local authorities
• engagement with community organisations

15
For more information contact
The British Fluoridation Society Ward 4 Booth
Hall Childrens Hospital Charlestown
Road MANCHESTER M9 7AA Tel/Fax [phone]
5223 Email bfs_at_bfsweb.org Website
www.bfsweb.org