Oral health inequalities a major issue in reducing extractions, says BFS

Targeted Community Water Fluoridation (CWF) should be included in any programme to drive down the unacceptable level of dental decay in children, says  The British Fluoridation Society in a response to the Faculty of Dental Surgery at the Royal College of Surgeons of England (FDS RCSEng).

While supporting the call from FDS (in a press release issued 23/09/20) for the roll-out of supervised tooth brushing schemes in early years settings and for a renewed commitment to sugar taxes, BFS spokesperson Ray Lowry highlighted  the important role of water fluoridation.

He said: “Water fluoridation requires no behaviour change and the evidence (1) shows that it is highly effective in reducing dental decay and delivers the most benefit to the most deprived. Let us not forget that the oral health of children in England generally is improving at the same time as worsening among those living in areas of high need.  Work to reduce decay among the most deprived is ongoing and needs to be multi-faceted.”

Dr Lowry added: “Uncertainty over public health is a worry following the disbandment of Public Health England (PHE) but their work continues to inspire and inform. For instance, their guidance on water fluoridation for local authorities and water monitoring reports (2,3).”

“Following on from its excellent green paper on prevention (4), we would like to see the Government rolling back the cuts it has made to local authorities who have responsibility for public health and allow them to invest in areas of highest need. ”

References:

1)   https://academic.oup.com/ije/article-abstract/49/3/908/5826797

2)   https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2018

3)   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/774128/Fluoridation_Toolkit_-_Publications_gateway_version_20160304.pdf

4)   https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

Two high-profile advocates for CWF appointed to BFS

The British Fluoridation Society is delighted to announce that two highly experienced advocates for community water fluoridation are now working with the Society. Alan Johnson, former Labour MP and a Secretary of State for Health, is a Vice President and Barry Cockcroft, the former Chief Dental Officer for England, has joined the BFS council.

The Chair of BFS, Steve Bedser, commented: “Alan joins a long line of high profile social justice campaigners who have added their name to a BFS Vice President role. Both Alan and Barry have a great record as water fluoridation advocates. I am confident that both will be great assets to the society.”

British politician Alan Johnson was for 20 years the Labour MP for Hull West and Hessle where he actively supported the proposal to introduce water fluoridation. The oral health of children in this area is among the worst in England, making water fluoridation a ‘no brainer’ (1) he says. No longer an MP, he remains a champion of targeted water fluoridation both in Hull and nationally. Alan served in both the Blair and Brown Governments and was Secretary of State for Health from 2007-2009. He is now a celebrated author.

Barry worked tirelessly to introduce water fluoridation in Southampton while CDO (2005 – 2015). Supported by the BFS, the BDA and many other organisations, his impeccable campaign was ultimately successful at judicial review. Regrettably, the scheme was not implemented because new legislation – the Health and Social Care Act 2012(1) – was introduced at a critical juncture and abolished Strategic Health Authorities, consigning this important victory to history.

Barry says his commitment to water fluoridation stretches back to the 1970s.  Having been a dental student in Birmingham, where the water was fluoridated in 1964, and then moving to work in Coventry, he was also aware of the oral health benefits bequeathed by fluoride. “The difference was plain to see. It felt wrong that some children were given a much better start in life, simply due to a fluoridation postcode lottery.”

He recalls, as a young dentist, writing to a local paper in Bolton in support of a water fluoridation scheme there. Once established at a dental practice in Rugby, he provided regular general anaesthetic sessions for extractions of severely decayed children’s teeth and witnessed the devastating impact this disease can have. He is aware of how distressing it is for parents to witness their child experiencing extractions. Prevention was always a priority for him and the landmark Delivering Better Oral Health toolkit was commissioned while he was CDO England.

Of his new role on the Council of BFS he commented: “I have always been a fan of water fluoridation and being on the BFS council is a great opportunity to help move forward on this invaluable preventative measure.”

For more information, on BFS: https://bfsweb.org

References:

  1. https://www.nature.com/articles/s41415-019-0943-x
  2. https://en.wikipedia.org/wiki/Health_and_Social_Care_Act_2012#Medical_establishment_reaction

New study finds water fluoridation reduces the number of children admitted to hospital for dental treatment under GA

Children living in greatest deprivation have most to gain from having a fluoridated drinking water supply, according to new research. Fluoride is added to water in order to prevent tooth decay and the new study demonstrates that community water fluoridation is particularly beneficial for the youngest children in the poorest communities.  

The research was carried out in New Zealand and published in the International Journal of Epidemiology. It adds to the body of research demonstrating that community water fluoridation (CWF) reduces dental health inequalities.  The key findings of the research are:

  • Children from the most deprived areas are more likely to be admitted to hospital for the treatment of pain or sepsis (abscesses) caused by dental decay
  • Fluoridation of the water supply reduces the number of children being admitted to hospital for dental extractions under a general anaesthetic
  • The youngest children in the 0-4 age category in the most deprived areas benefit most from water fluoridation

In New Zealand, around 60% of the population benefits from fluoridated water, mostly city-dwellers. The team from the University of Canterbury in Christchurch compared the number of hospital visits of children in 0-4 and 5-12 age categories from both fluoridated and non-fluoridated areas.

Professor Mike Lennon, a member of the British Fluoridation Society’s executive, said: “This paper shows the evidence supporting the benefits of fluoride in drinking water is getting stronger. It demonstrates that you can reduce the risk of negative dental experiences for children from poor homes. Without fluoride in the water, they are more likely to end up in hospital with toothache.”

The role of water fluoridation in reducing health inequalities was identified in the UK in the University of York Systematic Review of 2000.  Since then, the evidence base has continued to grow with more research undertaken in the UK as well as Israel, Korea and Australia.

Professor Lennon said the data collected by the team from the University of Canterbury had been rigorously analysed. Their focus was ambulatory sensitive hospitalisation (ASH) which are hospital outpatient admissions for preventable conditions, in this instance for tooth decay and infection.

Comparisons were carried out between different census areas and then adjusted for factors which could negatively influence the result, such as living miles away from a dental practice. The overall conclusion of the study is: “As deprived areas have the highest incidence of dental ASH, caries and poor oral health, those who live in the most deprived areas have the most to gain from CWF. In summary, our study supports evidence linking CWF to better health in children. Variation in CWF contributes to structural inequities in oral-health outcomes for children.”

Simon Hearnshaw, the Chair of the Local Dental Network for North Yorkshire and Humber and coordinator of the National Community Water Fluoridation Network, welcomed the research, saying: “This paper provides more support for the argument that fluoridation is effective and reduces the social-health gradient. The challenge now is to implement schemes to bring these important benefits to deprived communities.”

The latest research is entitled: Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand https://doi.org/10.1093/ije/dyaa043