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Fluoride in drinking water – is it good or bad?


As World Water Week draws to a close, we speak to Barry Cockcroft about water fluoridation and what the future looks like in the UK.

This month marked the start of World Water Week, running from the 23 August through to the 1 September.

Organised by Stockholm International Water Institute, the week aims to explore new ways of managing water and tackling its greatest challenges.

Water obviously impacts us in so many ways across all walks of life.

But nothing seems to polarise opinion quite like water fluoridation.

The act of adding fluoride in drinking water to help improve consumer’s oral health has been described as both a panacea for tooth decay and forced mass medication.

We spoke to Barry Cockcroft, former CDO for England and now chair of the British Fluoridation Society, to find out whether there is a future for water fluoridation in the UK.

For those who don’t understand, why is adding fluoride in drinking water so beneficial for our oral health? Why is it so important? 

It’s important for a number of reasons. 

Oral health has improved a lot since I graduated, but what’s not changed is the gap between the deprived people and those more affluent. 

We all know in a perfect world, if you brush your teeth, use the right fluoride toothpaste, see the dentist on a regular basis, eat the right diet and don’t smoke then you’re unlikely to suffer from dental caries and periodontal disease or inflammation. 

We don’t live in a perfect world and some people don’t have a perfect diet and don’t do all the right things. 

And some people can’t afford to. This helps close the gap. But even the most affluent areas of the population would benefit from it too. 

There are certain areas where we have introduced fluoride in drinking water. How has the introduction gone and what’s the outcome been? 

It was introduced in the whole of the West Midlands with the exception of north Staffordshire and also quite a significant part of Tyneside and some other parts of the country. 

The most interesting data comes from Tyneside. 

Water in south Tyneside was naturally fluoridated, whereas the water in the north wasn’t. During the war, people from Tyneside were evacuated to the Lake District. 

Dentists noticed that children from south Tyneside had less caries than those in the north, which led them to discover south Tyneside was naturally fluoridated. 

They quickly went ahead and fluoridated north Tyneside and the caries prevalence fell considerably. 

The real fundamental thing is that all water in this country contains some fluoride. There’s no water that comes out of a tap that hasn’t got fluoride in it. 

But what we want to do is adjust it to a level that impacts our oral health. The amount we’re talking about is incredibly low.

To put it in context, if it was a length, it’s equivalent to one inch in 24 miles. We’re speaking one in a million.

Quite frankly, anything in excess is dangerous. People say there’s a difference between natural fluoridation and artificial fluoridation, but once it’s dissolved in the water, you cannot tell the difference. 

So, with the argument for adding fluoride in drinking water so strong, why is the whole of the UK not fluoridated now? 

Legislation gets in the way. 

The best example of that probably was in Scotland and Scotland has some of the worst oral health in the country, particularly in Glasgow. 

They decided to fluoridate the water and an edentulous lady challenged it. Lord Jauncey carried out a report and he said he came sadly to the conclusion that it was beyond the legal power of the water company to fluoridate. 

If you actually read the Lord Jauncey report, he’s incredibly positive about fluoridation, so the legislation has always got in the way. 

There is a whole range of opposing views to fluoridation. Since I’ve been a dentist every single illness known to man has been blamed on water fluoridation. 

The overwhelming body of evidence suggests it’s both safe and effective. A really brilliant development was the statement by the four chief medical officers of the UK last year. 

They jointly said water fluoridation is safe and effective, and that’s brilliant. 

Credit to the Department of Health for actually grasping it by the horns and taking it forward.  The Health and Care Bill that’s just gone through Parliament got support from both a Conservative party government and the Labour party. 

With the new Health and Care Bill, does that mean water fluoridation is becoming a real possibility? What exactly has changed?

Yes, it’s becoming a real possibility. 

Under previous legislation, the responsibility for water fluoridation passes to local authorities, who cannot afford to carry out a consultation at the moment – the cost is huge. 

This Bill transfers the responsibility to the Secretary of State. 

The government has given its commitment to actually do this and to report back to Parliament on progress. They had a consultation on how to consult, which finished in June.

Hopefully we’ll report in September, and they’ve also just gone out to tender for engineering support. 

A lot of the expertise around actually carrying out fluoridation has been lost over the years.  

That explains why nothing has happened since the new Health and Care Bill has been introduced. It sounds like there’s a lot of background work going on. 

There’s a huge amount of background work going on. 

I think the most important thing is when there’s going to be fluoridation, people who are concerned get their questions answered in an evidence-based way. 

Having a larger consultation run by the Secretary of State means that minority views don’t get as much traction as they possibly would in a very small local consultation. 

Looking forward, when might the general public start to see some action? 

Lord Howe answered the question from Lord Hunt in Parliament to say that he would report back on progress, and they hope to make progress within three years. 

To actually do it is quite complicated. 

You’ve got to get the agreement to do the scheme, consult and answer all the problems and then you’ve got to build the installation at the water plant and the monitoring etc. 

There is all the signs of it happening. 

I’ve recently taken over as chair of the British Fluoridation Society (BFS). We’ve also just got funding to develop and establish a fellowship so that young researchers can go abroad and look at how it works in other areas and what the problems are, to develop the evidence base even further around water fluoridation. 

 How can the profession get behind a campaign or support water fluoridation? 

The best thing to do is to get your facts right. 

The BFS website contains lots of facts and information, and we’re actually doing some media training.  

There will be noise and the anti-fluoridation people will try and scare people locally. 

Dentists need to understand the arguments they will face and be willing to actually address people and explain the facts. 

Dentists on the whole like to be sure of their facts.  

Do you think that dentists should be broaching the subject now with their patients? 

If it comes up in conversation, that’s fine. But I think once the government says they’ll identify certain areas that would benefit most, I think you’ll find patients rather than dentists approaching it. 

It’s really important the dental team know how to answer them confidently. I moved to Birmingham in 1969, so I’ve lived in fluoridated areas since then and I’ve seen the benefit first hand. 

It happened over a period of time and at one point when I was working in Coventry, some of the patients I saw were living in fluoridated areas and some were not. You could actually visibly see the difference. 

I’ve brought up my children in a fluoridated area and my grandchildren now. So if I had any concerns about the health impact I wouldn’t be living here. 

We often talk about it for kids but we’ve got a much more dentate older population. Fluoridation is very important for older people as well. 

But if you get caries in your permanent teeth when you’re six or seven, that’s not just one incident. That’s something that lasts for life, so the detriment of dental caries literally lasts for life. 

If you have a filling at the age of seven, you have it replaced multiple times. Replacements always get slightly bigger. 

Health in this country has improved over a long period of time. 

But fluoride really helps us close this gap between those that are less well off and those from more affluent backgrounds. 

It does benefit everybody, but the people who benefit most are those who need it most.