Benefits of fluoridation

The format of this page is

• A summary of the key points relevant up to 2020
• An online and printable version of the 2012/3 publication “one in a million”
• A summary of the main points raised by more recent papers and reports
• Access to a list of the key papers and reports published since 2012/3
• Access to an archive of other reports etc.

• Fluoridation of water supplies reduces the number of decayed, missing and filled teeth in children and adults.
• As a result of fluoridation, children experience less toothache, have fewer dental abscesses and require fewer dental extractions and general anaesthetics.
• The cost to the NHS of treating avoidable disease is therefore reduced.
• While tooth decay levels have fallen in both fluoridated and non-fluoridated communities in recent years, inequalities in dental health remain wide .
• There is still a strong case for extending fluoridation on a targeted basis in those parts of the UK with persistently high tooth decay levels among children, particularly in the North of England, Scotland, Wales, Northern Ireland and inner London.
• Water fluoridation reduces these social inequalities particularly in the numbers of young children admitted to hospital for dental extractions.

• Two new systematic reviews (Iheozor-Ejiofor 2015; Jack et al, 2016; NHMRC, 2017a; 2017b) confirm once again the effectiveness of community water fluoridation in reducing dental decay. However, disappointment was expressed that the Cochrane review (Iheozor-Ejiofor 2015) used rather restrictive inclusion criteria (CDC 2015; Rugg-Gunn et al 2016). An opportunity lost.

• An additional review (McClaren and Singhal 2016) concluded that, “overall, the published research points more to an increase in dental caries post community water fluoridation cessation than otherwise”. 
• Blinkhorn et al (2015) presented data evaluating the effectiveness of a new fluoridation scheme in New South Wales, contrasting the dental health of 5 to 7- year-old children in the newly fluoridated area against those living in positive and negative control areas. 
• Recent and large-scale monitoring studies in the US, UK, Australia and Brazil (Slade et al, 2018; PHE, 2014; PHE,2018; Spencer et al 2018; Firmino et al, 2018) confirm the continuing importance of community water fluoridation
• Further evidence has accumulated that community water fluoridation narrows the unacceptable social inequalities seen in children’s dental health (Cho,2014; Do et al 2018; PHE 2018; Weston-Price et al 2018; Matsuo 2020).
• Roberts et al (2022) use an ecological study to show benefits of water fluoridation.
• And in particular data from the UK, New Zealand and Israel (PHE 2018; Hobbs 2020; Kivitsky et al 2015) show how community water fluoridation dramatically reduces the numbers of young children from the most deprived backgrounds being admitted to hospital for dental extractions.
• A new (2021) study from Australia finds that children with much higher lifetime exposures to fluoridated water (LEFW) were less likely to experience tooth decay in their primary or permanent teeth than children with much lower LEFW. https://onlinelibrary.wiley.com/doi/abs/10.1111/cdoe.12697
• Cessation studies are a unique opportunity to see the effects of fluoridation in reverse: one recent study (
  McLaren, L, et al. Fluoridation cessation and children’s dental caries: A 7-year follow-up evaluation of Grade 2 schoolchildren in Calgary and Edmonton, Canada. Community Dent Oral Epidemiol. 2021; 00: 1– 13) shows how even today, removing fluoride from water results in increased caries.
• The U.S. National Institutes of Health (NIH) report 2021 is intended as a follow-up to the 2000 U.S. Surgeon General’s landmark report on oral health. There is much in here on water fluoridation.  The NIH report is accessible at https://www.nidcr.nih.gov/oralhealthinamerica
• In 2023, The Office for Health Improvement and Disparities (OHID) and the UK Health Security Agency (UKHSA), show children and young people in areas in England with higher fluoride concentrations were up to 63% less likely to be admitted to hospital for tooth extractions due to decay than those in areas with low fluoride concentrations. https://www.gov.uk/government/news/new-report-confirms-fluoridation-can-reduce-tooth-decay-among-children
• Information on the benefits of fluoridation may not be readily accessible to the public through official channels, so informal ones have been studied: for example, understanding how fluoride information and misinformation is shared in social circles.