Sixty seconds on . . . water fluoridation
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2359 (Published 24 September 2021) Cite this as: BMJ 2021;374:n2359
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Dear Editor
I have read your nice article on Sixty seconds on . . . water fluoridation by Kmietowicz in the journal of 24th September 2021. According to four Chief Medical Officers of the UK, the Inequality in dental caries in the United Kingdom may be ameliorated by water fluoridation.
Consumption of ultra-processed foods is associated with increased incidence of childhood caries(1). Implementation to reduce ultra processed food consumption can be of help to improve children’s oral health. Dental caries is a preventable oral health problem and a most chronic infection. Dental caries is highly prevalent in many developing countries (2). Oral health education program and parents' involvement in oral hygiene of children will be of great help to reduce dental caries. Frequent consumption of snacks is associated with increase in dental caries prevalence (3). Swishing with water after consumption of snacks will help in removal of food particles from the mouth (4).
Reduction in consumption of snacks will help in the reduction of dental caries in addition to fluoridation of water.
References
1. de Souza MS, Vaz JDS, Martins-Silva T, Bomfim RA, Cascaes AM. Ultra-processedAPrevalenceof foods and early childhood caries in 0-3-year-olds enrolled at Primary Healthcare Centers in Southern Brazil. Public Health Nutr. 2021 Aug;24(11):3322-3330. doi: 10.1017/S1368980020002839. Epub 2020 Aug 27. Erratum in: Public Health Nutr. 2021 Feb;24(2):377. PMID: 32847638.
2. Shitie A, Addis R, Tilahun A, Negash W. Prevalence of Dental Caries and Its Associated Factors among Primary School Children in Ethiopia.
International Journal of Dentistry 2021,March Article ID 6637196 | https://doi.org/10.1155/2021/6637196
3. Zahid N, Khadka N, Ganguly M, Varimezova T, Turton B, Spero L, Sokal-Gutierrez K. Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal. Int J Environ Res Public
Health. 2020 Oct 28;17(21):7911. doi: 10.3390/ijerph17217911. PMID:
4. Math, M., Balasubramaniam, P. Water swishing. Br Dent J 207, 304 (2009).
33126647;
4. Math, M., Balasubramaniam, P. Water swishing. Br Dent J 207, 304 (2009).
Competing interests: No competing interests
Dear Editor
I don't understand how fluoridation could be deemed a success when evidence out of the US shows it has failed to achieve its objective - to prevent tooth decay, save money, close the disparity gap, put dentists out of business and keep Americans out of the hospital for dental conditions with only 10% of children afflicted with the mildest, little noticed form of fluoride fluorosis. After 76 years of fluoridation reaching record numbers of Americans:
• 70% of US children and adolescents are afflicted with dental fluorosis (1) – much of it moderate/severe – requiring expensive cosmetic dentistry (2)
• Tooth decay is epidemic, according to the American Association of Pediatric Dentists (3)
• In 1950 there were 42 dental Schools. Now there are 68.(4)
• 16,555 were enrolled in dental school in 1969-70. Now 25,995 are enrolled, the most ever. (4)
• Dental spending reached a historic high of $136 billion, according to the American Dental Association (5)
• Dental hospital emergency room visits doubled from 1 million in 2000 to 2.2 million in 2012, costing 1.6 billion dollars annually. (6)
• Dental disparities persist (7)
Maybe, as in the US, UK children are “dentist-deficient” and need dental care; not fluoride?
References:
1) Ecotoxicology and Environmental Safety: "Associations of low level of fluoride exposure with dental fluorosis among U.S. children and adolescents, NHANES 2015–2016" https://www.sciencedirect.com/science/article/pii/S0147651321005510?via%...
2) Dentists advertisements to cover fluorosis
http://tinyurl.com/DentalFluorosisBeforeAfter
3) Contemporary Pediatrics https://www.contemporarypediatrics.com/view/tooth-decay-epidemic-among-t...
4) American Dental Association "Then and Now Dental Education in the US" https://pages.ada.org/ada-news/dental-education-then-now?utm_campaign=AD...
5) Dentistry Today: "Dental Spending Increases in 2018"
https://www.dentistrytoday.com/news/industrynews/item/5981-dental-spendi...
6) USA Today: "ER visits for dental problems rising" https://www.usatoday.com/story/news/local/2015/06/24/er-visits-dental-pr...
7) Int J Environ Res Public Health. 2019 "The Persistence of Oral Health Disparities for African American Children: A Scoping Review" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427601/
Competing interests: No competing interests
Implementing water fluoridation
Dear Editor
Poor oral health has an important influence on an individual’s general health and wellbeing, including pain and infection, leading to difficulties in eating, sleeping and socialising. Research from the Oral Health Foundation has indicated that one in 20 working British people have been forced to take time off work in 2017 due to oral health issues, which is equivalent to more than 1.2 million days taken off work. Oral health problems are costing the UK economy more than £105 million each year in sick days. [1]
Following the statement on water fluoridation from the UK Chief Medical Officers on 23 September 2021, [2] the Chief Dental Officer England Sara Hurley has also added her statement of support. She said she strongly believes that water fluoridation can benefit the nation’s oral health. [3]
The Oral Health Improvement Plan published in 2018 set out the future of oral health improvement and NHS dental services in Scotland. Within the Plan, it recognised that water fluoridation could make a positive contribution to improvements in oral health. However, the view from the Scottish Government was that alternative solutions are more achievable considering the practicalities of implementing water fluoridation. [4]
A recent online survey among adults in the UK found that, although 70% of the respondents knew that the purpose of adding fluoride to water to impact dental health benefits, only 50% considered fluoridated water to be safe for consumption and 62% believed that there should be an option to opt-in or out of community water fluoridation for their individual water supply. [5]
Before new community water fluoridation schemes can be introduced successfully in the UK, there is an urgent need for better communication and to engage better with the public.
To help the dental professionals better engage with the public, the British Fluoridation Society is hosting a conference with the theme of ‘Making a Difference’ in Birmingham on 23 October 2021. [6]
References
[1] Hiscott S. Oral health problems cost UK economy £105m every year in sick days. 15 May 2017. https://dentistry.co.uk/2017/05/15/oral-health-problems-cost-uk-economy-...
[2] Department of Health and Social Care. Independent report. Statement on water fluoridation from the UK Chief Medical Officers. 23 September 2021. https://www.gov.uk/government/publications/water-fluoridation-statement-...
[3] NHS England and NHS Improvement. Your NHS dentistry and oral health update. 30 September 2021 (Issue 27). http://createsend.com/t/d-A98C3682CD6499622540EF23F30FEDED
[4] Scottish Government. Oral Health Improvement Plan. 24 January 2018. https://www.gov.scot/publications/oral-health-improvement-plan/pages/3
[5] Vasantavada PV, Ellis L, Sanderson R, Zohoori FV. Public Perception of Community Water Fluoridation in the UK. Caries Research 2020;54:447. Abstract no. 188. https://www.karger.com/Article/Pdf/511860
[6] British Fluoridation Society. The British Fluoridation Society Conference 2021. https://bfs-conference.co.uk
Competing interests: No competing interests