New study brings hope of decline in dental  decay levels in UK children of the future

The role of water fluoridation in strengthening children’s primary teeth has been given further affirmation by an important new Canadian study (1). A 14-year comparison of schoolchildren aged around seven found that children in fluoridated Edmonton had fewer cavities and thus healthier teeth than in non-fluoridated Calgary.

Due to its scale and its precision, the research is important on many levels, not least because it showcases what happens when water fluoridation is stopped. In 2011 the municipal government in Calgary decided to discontinue fluoridating the water supply.  At the start of the study in 2004, schoolchildren aged 7-8 in Calgary had fewer cavities than in Edmonton. Now, 65% of Calgary children – nearly two out of every three – have cavities and the number is rising. Meanwhile, compared with 14 years ago, the dental cavity rate for Edmonton children is virtually the same. 

In the UK, where the Government has announced it is planning to resume control of water fluoridation schemes (2), the findings are a valuable predictor of potential oral health improvements in future generations of  0-7s. Public consultations are a mandatory precursor of any water fluoridation scheme and BFS believes that the findings from Canada, published in the latest Community Dental Oral Epidemiology, will explain powerfully and graphically the benefits of water fluoridation to the health of children.

The research team additionally looked for evidence of fluorosis, a condition linked to fluoride consumption, which causes a change in the appearance of tooth enamel. While they found that children in fluoridated areas had signs of fluorosis, as would be expected, in 99% of cases it was mild. Additionally, in questionnaires which formed part of the study, parents’ reports of the general health of their child’s mouth were very similar in Calgary and Edmonton, with around half of parents in both cities rating their child’s mouth health as excellent or very good.  

BFS Chair Dr Barry Cockcroft commented: “We welcome the findings of this carefully calibrated study by McLaren et al which helps build on the existing body of research.  By compiling the many authoritative studies from around the world, such as this latest work from Canada, we see a reassuring picture of the positive impact of water fluoridation on improving children’s oral health and reducing inequalities.”

“Let us not forget that water fluoridation positively benefits all ages and with the number of people living into older age, the ability to strengthen tooth enamel and reduce cavities with the simple addition of fluoride to water is a powerful and cost effective tool, along with other preventive measures, of course.”

In the UK, around one tenth of people have benefited from water fluoridation since the introduction of schemes from the 1960s. These are in the West Midlands, Bedfordshire, Cumbria, Cheshire, Tyneside, Northumbria, Durham, Humberside, Lincolnshire and Nottinghamshire.  A map is available on our website (3). There are also a few areas which benefit from naturally fluoridated water supplies.

By and large, all the UK’s schemes have remained operational, with the exception of Cumbria where it was halted temporarily.  A study (4) is currently underway to examine how children’s teeth were impacted when water fluoridation was stopped and restarted due to maintenance work by the water authority. The Catfish study is due for publication later this year.

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  1. McLaren L, Patterson SK, Faris P, 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. cdoe.12685 


Research summary by the authors:

…. we observed significant and consistent differences in dental caries experience in the primary dentition between Grade 2 children in Calgary (fluoridation cessation) and Edmonton (still fluoridated), Canada, 7-8 years following cessation in Calgary. Our findings are consistent with an adverse impact of fluoridation cessation on children’s dental health in Calgary, and point to the need for universally, publicly funded prevention activities including, but not limited to fluoridation. Our study makes a rigorous contribution to the relatively sparse and methodologically variable literature on fluoridation cessation.

Key strengths included:

1. a strong study design with a comparison community and multiple data points;
2. large, population-representative samples of children;
3. high-quality data collected by trained and calibrated experts who demonstrated high levels of accuracy and consistency;
4. multiple sources of post-cessation data to permit corroboration.