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TOWARDS BETTER ORAL HEALTH IN CHILDREN: ANALYSIS OF CONSULTATION RESPONSES

CHAPTER 13: INFORMATION AND RESEARCH ON FLUORIDATION OF WATER

The consultation stated:

The UK Government commissioned the Centre for Reviews and Dissemination at York University to carry out an expert scientific review of fluoride and health. This review, which was published in 2000, looked at thousands of papers and identified over 200 individual studies of fluoridation which were of an appropriate standard.

The review concluded that ...water fluoride does reduce caries levels; additional benefits accrue from water fluoridation when fluoride toothpaste is also used; the prevalence of dental fluorosis of aesthetic concern may be increased; there is no evidence of other adverse effects on health.

We will consider if further research on fluoride may be relevant to Scotland following this consultation.

Consultees views were:

In Detail:

A substantial body of evidence already exists relating to the effects of adding fluoride to the public water supply. Many respondents referred to selected evidence from this wide base and cited it to support their arguments. In contrast to those who perceived the current research literature compelling, many other respondents were concerned that the current evidence base for making major decisions on fluoridation of water is not sufficiently robust. Some consultees called simply for more research to inform the debate (indivs 45, 574, 685, 1104, 1111, Now Foods, Greater Glasgow PCT, Ian Grant Cummings PR, Inverclyde Council's Education and Social Work Department, Angus Council). One respondent's comments represented the views of many, "…concerned at the shortage of scientifically sound investigations into the value and safety of fluoridation, and the suspect nature of the statistical evidence used in its support" (indiv 484). Another response highlighted the view that evidence did exist (especially in other countries) but needed to be identified and considered in the Scottish context (indiv 921). Other more specific comments included:

More Research on Long-Term Effects of Fluoride

Many respondents felt that the longer-term impact of fluoride on people's health had not been adequately researched. Some were concerned about the wider health risks (such as links with cancer and hip fractures (indiv 443)) whilst others worried about the lack of evidence on the cumulative effects of ingesting fluoride (indiv 1211).

York Review

The York Review ¹¹ highlighted in the consultation document stimulated mixed reactions, with several respondents requesting that its methodology and findings be reviewed and re-considered (e.g. Highland Movement Against Water Fluoridation). Some felt that the findings of the York Review had been discredited (e.g. indiv 474) or that those who undertook the Review had since cautioned about the limitations of its findings (e.g. National Pure Water Association). For others, however, the York Review provided authoritative findings on which to base decisions for future action (Airedale PCT; National Alliance for Equity in Dental Health).

Outdated Research

Indeed the need to update research, and to move on from what was perceived as the current status of outdated findings was proposed by several commentators, one typical remark being that there is " a lot written about fluoride, but they all get their information from the same outdated sources" (indiv 1036). One way of bringing previous research up-to-date was suggested as applying " modern research standards to old research questions" (Dental Surgeon, 1401).

Research to be Objective

People recognised that issues relating to fluoridation of water tended to generate much emotion and strong views (as witnessed in this consultation). Therefore the call for an " unbiased, unemotional and evidence based flow of information on the subject" (indiv 546) was well grounded. In a similar vein, others requested "independent" and "objective" research (indiv 775) which had not been "manipulated" (indiv 1174). Strategies for monitoring and evaluating any oral health improvement projects should also be undertaken as routine (SW Edinburgh LHCC) with efforts made to separate out the multitude of variables which complicated any such research (indiv 931).

Many respondents identified the need for comparative studies (Scottish Consumer Council) with current statistics criticised for being difficult to use (e.g. because of discrepancies in age-groups involved (Highland Health Council)). Some requested further work comparing fluoridated and non-fluoridated areas (Dental School, University of Glasgow, indiv 600). Others recommended that cross-national comparisons be made with countries that have had some specific experience of fluoridation schemes (Oral Health Action Team, SE Glasgow).

Several commentators asked for further cost-benefit analyses to be carried out which weighed up in economic terms the merits and drawbacks of fluoridating the water supply (Dumfries and Galloway NHS Board, Scottish Community Dental Service, Fortrose and Rosemarkie Community Council, British Society for the Study of Community Dentistry, Highland Movement Against Water Fluoridation, Renfrewshire and Inverclyde PCT, Community Dental Service Lomond and Clyde PCT, indivs 861, 1024).

A few individuals proposed research on the effects of fluoride on the wider environment (indivs 797, 989, 1157, 1128). Finally, some respondents wanted more investigations on current levels of fluoride in water (Royal Society of Edinburgh) and those occurring naturally in people's bodies (indiv 976, SNP candidate 584). A study examining the average intake of water by the target audience was also advocated (indiv 491).

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