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The role of Public Health England in water fluoridation

Public Health England (PHE) is an executive agency of the Department of Health.  In this capacity it fulfils many of the Secretary of State for Health’s functions with regard to water fluoridation. These include:

  • providing evidence-based advice about the safety and effectiveness of fluoridation;

  • monitoring the performance of water companies under legal agreements held with them for fluoridation schemes;

  • providing advice to local authorities interested in ascertaining the technical feasibility of new fluoridation schemes;

  • negotiating the terms of legal agreements with water companies for new schemes;

  • paying water company bills for the running costs of fluoridation schemes, and subsequently recovering these costs from the local authorities whose populations are benefiting from the schemes;

  • managing fluoridation capital investment;

  • monitoring and reporting on the health effects of water fluoridation schemes.

PHE’s water fluoridation toolkit for local authorities

In March 2016, PHE published Improving oral health: a community water fluoridation toolkit for local authorities.  This sets out in detail the responsibilities of local authorities, PHE and other agencies (including the Drinking Water Inspectorate) for water fluoridation.  It describes tooth decay as “a serious health problem” and “the most common cause of hospital admissions among children aged between five and nine”

Persistent dental health inequalities to be addressed

The toolkit emphasises the need to address persistent dental health inequalities in England: “While there have been improvements in children’s oral health over the past 40 years, the rate of reduction in tooth decay levels has slowed in the past decade. Major dental health inequalities remain. Children from the most deprived areas experience the highest levels of decay. The consequences of decay are lifelong; extracted teeth are lost for ever; fillings need to be replaced.”

Safe and effective public health measure suitable for consideration where tooth decay levels are of concern

The toolkit goes on to explain that water fluoridation is one of a range of interventions available to improve oral health, and the only one that does not require behaviour change by individuals.  It adds: “Reviews of studies conducted around the world confirm that water fluoridation is an effective, safe public health measure suitable for consideration in localities where tooth decay levels are of concern.”

Sources of advice to local authorities thinking about introducing fluoridation

The toolkit says: “Local authorities with longstanding schemes, such as those in the West Midlands (the most extensively fluoridated part of England) may form a valuable source of advice on effectiveness, absence of harm and public acceptability to any local authority minded to consider water fluoridation.

It adds: “Local NHS bodies and clinicians are well placed to contribute to the health debate about water fluoridation in a locality and about its potential to reduce health inequalities.

Hearing from those in greatest dental need

The toolkit says: “In discussions about the impact on patients and carers of patients with high levels of dental decay, and the options for tackling that problem, it will be important to ensure that the voices of a diverse range of local people are heard in an appropriate way, including those in greatest dental need, and that their contribution to the debate is facilitated.”

Pivotal role of local health and wellbeing boards

The toolkit says: “Health and wellbeing boards (HWBs) have a key role in relation to consideration of fluoridation, through their duty to produce a joint strategic needs assessment (JNSA) for their area and a joint health and wellbeing strategy (JHWS).  It is anticipated that if dental decay levels are a source of serious concern in an area, the matter would feature in the JSNA and JHWS. In making decisions about proposals for water fluoridation schemes, local authorities are required to have regard to the JNSA and JHWS published by the health and wellbeing board.”


Particularly beneficial for those at increased risk of tooth decay

“Water fluoridation, which has both topical and systemic effects, is the only intervention to improve dental health that does not require sustained behaviour change over many years. It is therefore particularly beneficial for individuals and communities at increased risk of tooth decay, such as those from more deprived backgrounds and other vulnerable groups.”

Reducing tooth decay and minimising its severity

“Fluoride in water can reduce the likelihood of experiencing dental decay and minimise its severity. Evidence reviews confirm that it is an effective, safe public health measure suitable for consideration in localities where levels of dental decay are of concern.”

Routine monitoring has not revealed health problem.

“Regarding claims that water fluoridation might be a cause of ill health, some 370 million people worldwide, including six million in England and 200 million (70% of the population) in the United States, have an artificially fluoridated water supply and there is over 50 years’ experience of the measure. Routine monitoring of health in these areas has not revealed any health problems associated with water fluoridation.”