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Date: October 4, 2024
Recent studies led by researchers from the Universities of Manchester, Dundee, and Aberdeen reveal a significant decline in the dental health benefits of fluoridated water, sparking discussions about the effectiveness of this public health measure in addressing oral health disparities. The findings suggest that while there may be minor benefits for children’s oral health, the role of water fluoridation in reducing dental health inequalities remains uncertain.
An updated Cochrane review analyzed evidence from 157 studies comparing communities with fluoridated drinking water to those without. The researchers found that the positive effects of water fluoridation on dental health have diminished since the 1970s, coinciding with the widespread availability of fluoride toothpaste. This shift raises questions about the continued justification for adding fluoride to drinking water supplies.
Global Context and Study Findings
The studies included in the review primarily focused on high-income countries, with a notable lack of recent research in low- and middle-income nations, where the impact of community water fluoridation is less understood. Fluoride, a common ingredient in many toothpastes and varnishes, is known for its ability to reduce tooth decay. Despite this, opinions are divided on whether adding fluoride to public water supplies is a necessary and effective strategy.
Professor Anne-Marie Glenny, co-author of the review and Professor of Health Sciences Research at the University of Manchester, emphasizes the need to consider the changing context of oral health. “Most studies on water fluoridation are over 50 years old, conducted before fluoride toothpaste was widely available. Contemporary studies offer a more relevant perspective on the current benefits,” she states.
The review revealed that studies conducted after 1975 indicate only a slight reduction in tooth decay among children’s baby teeth due to fluoridation—averaging 0.24 fewer decayed baby teeth per child. In contrast, earlier studies suggested a reduction of 2.1 decayed baby teeth per child. Additionally, the analysis noted a possible increase of just 3 percentage points in the number of children with no decay in their baby teeth, with both estimates clouded by uncertainty.
Implications for Public Health Policy
While the evidence suggests a minor reduction in tooth decay among children, the review underscores the need for a comprehensive approach to dental health. Dr. Lucy O’Malley, Senior Lecturer in Health Services Research at the University of Manchester, cautions against hastily implementing new fluoridation schemes without considering factors such as costs, acceptability, feasibility, and ongoing monitoring.
The review also sought to address claims that water fluoridation helps reduce oral health inequalities. However, the findings did not provide sufficient evidence to support this assertion, which raises further questions about the appropriateness of fluoridation as a public health intervention.
In line with this, the LOTUS study, which analyzed dental health records of 6.4 million adults and adolescents in England from 2010 to 2020, indicated that while people in fluoridated areas required slightly fewer invasive dental treatments, there was no significant impact on oral health inequalities.
Professor Tanya Walsh, co-author of both the Cochrane review and the LOTUS study, emphasized the need for a multifaceted approach to tackle oral health disparities. “Oral health inequalities are an urgent public health issue that demands action. Water fluoridation is only one option and may not be the most suitable for all populations,” she noted.
Adding to this perspective, Professor Janet Clarkson from the University of Dundee stated, “While water fluoridation can lead to small improvements in oral health, it does not address the underlying issues, such as high sugar consumption and inadequate oral health behaviors. Any preventive program must adopt a comprehensive, multi-agency strategy.”
The findings from this review highlight the importance of reassessing current dental health policies and exploring holistic approaches that address the broader determinants of oral health beyond water fluoridation.
Reference: “Water fluoridation for the prevention of dental caries,” Cochrane Database of Systematic Reviews, 4 October 2024. DOI: 10.1002/14651858.CD010856.pub3
Funding: University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Sciences Centre.
