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One inch in twenty-three miles

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  Posted by: The Probe      25th September 2020

Former CDO, Barry Cockroft, looks at current provisions within dentistry.

This summer saw the 75th anniversary of the establishment of the first artificial community water fluoridation scheme in Grand Rapids, Michigan in 1945. The American dental health community celebrated this through July with a series of four webinars hosted by the American Dental Association and the American Academy of Paediatric Dentistry. There was a wide range of speakers and it was a really fascinating programme. In the US about 70% of the population lives in areas where the water is fluoridated so their main issue is not initiating more new schemes but defending those that already exist.

It was really interesting to see that the challenges they face when attempts are made to challenge existing schemes are very similar to those we see in this country when new schemes are proposed.

Since I first became interested in the subject as an undergraduate in Birmingham every single disease or malady known to man has been blamed on fluoridation by its opponents and subsequently it has been proved that there is no link.

If, as I hope, we start to see movement on initiating new schemes in the next couple of years I am sure another obscure study will be quoted as a reason not to proceed despite the great wealth of evidence that it is both safe and effective.

Fluoride is the thirteenth most common ion in the earth’s crust and tea contains more fluoride that almost any other foodstuff, but I have not heard of tea being blamed in a similar way!

It is often said by opponents of water fluoridation that fluoride is a poison. This is not correct, but anything can be poisonous in the wrong dose. Six litres of water taken at one time can be fatal, oxygen given under pressure can cause blindness in premature babies, and did so on many occasions when incubators were first invented and used.

A speaker from the Royal Society of Chemistry confirmed this at the seminar in Hull organised as part of Hulls celebration of being that year’s city of culture in 2017. Understanding the meaning of dosage can be really difficult. Someone speaking during the US webinars, when making the point about dosage, said that if you put it into context and compare with distance, the recommended level in the US, of 0.7 parts per million is equivalent to one inch every 23 miles!

I believe everybody has the right to an opinion, but nobody has a right to their own facts, and this is what some people often confuse.

Like the UK, the US has inequalities, though some of the inequalities in America make ours look small by comparison. The key benefit of water fluoridation is that it requires no compliance to be effective so those most deprived or less knowledgeable benefit the most, therefore reducing the impact of inequality.

Fluoridation is not a “silver bullet” that totally prevents dental caries but hundreds of studies since 1945 have shown that it reduces the prevalence of dental caries and especially so in the more deprived parts of society.

Reducing the prevalence of dental caries requires a combination of national, community based and individual actions. When we first published Delivering Better Oral Health in 2007, we focussed on what clinicians could do for their patients in the primary care environment, but we did also recognise and advise on the wider determinants of oral health. It is always easier to criticise public health initiatives and difficult, sometimes, to explain the benefits when statements made without supporting evidence get just as much media coverage as unsubstantiated personal views.

Governments can really influence by supporting evidence based proposals. I was surprised and impressed to hear of the way Ronald Reagan put pressure on individual states to do the right things around controlling alcohol consumption and tackling obesity and drug abuse, over which he had no control as president, by making federal funding for other projects conditional on doing the correct thing on these health issues. I am not sure the current incumbent would do the same unless such policies had a positive impact at the ballot box.

Public Health England has come in for a lot of criticism during the current pandemic but a lot of the work it does, both locally and nationally, will have a significant positive impact on health in the years to come. The green paper on prevention published last year must have involved months of work behind the scenes and is a hugely positive document for the future, including the overt support for the development of new targeted water fluoridation schemes.

I hope the direction of travel indicated in that document does not get lost in the inevitable fallout from the pandemic and the potential descent into looking for scapegoats.


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