In the USA a 1951 policy on water fluoridation enabled 74% of the USA to access fluoridated water by the time when I qualified in the early 1980's. The prediction was that by the year 2000 decay in children would be irradicated. This never happened. Instead, as in the UK, where currently water fluoridation is only 11%, and despite the increased explosion of marketing of toothbrushes, toothpaste, and mouthwashes, it didn't work. How come? Why won't it work in the future? What can we do?
As you can see around 1990, the decay rate plateaued. It explains why with our 11% of fluoridated teeth, the decay rate in the uk is worse, and from the last review in 2019 increasing. The graph is taken from the dentist below who qualified ten years before myself, and voicing an opinion similar to my own, and a lot of GDPs. Click on the picture for her enlightening presentation.
We need to integrate our health delivery to the public in a different way. It is so disappointing to retire when our knowledge is greater than ever, but by any standards our results are so poor.
We have failed because we work in isolation, and as everyone knows you need to get in a helicopter and take time out from dealing with indervidaul decay, and see we are a small aspect of health. The governments green paper states the following regarding the savings for prevention for the under fives. For the general population the average is now a £14 saving.
This is all the evidence we need, I don't think anything has changed. Why procrastinate?
When I moved to Anglesey in 1996, water was fluoridated, but a bit late for me to have the maximum benefit. In 1992 Welsh Water unilaterally withdrew the water's fluoridation, and the dmf rate more than doubles in a five year period. The public, and the profession were not informed. The evidence is there. Just Google it.
A BHAG I remember from years ago in the early 1990's, before I had a computer at work. It's a Big Hairy Audacious Goal devised by Jim Collins. I didn't know it was attributed to him then, but I googled it. More recently I came across OKR on a Ted Talk. Objectives, and Key Results. The objective or goal in my lifetime has never changed, its prevention in oral health. I always found it depressing having to restore childrens teeth, listening to parents telling me their children ate too many sweets. Occasionaly, when brave, I asked where they got the money. My results were satisfactory, but nationally my gut feeling is we are worse. A lot worse, as outlined in the excellent presentation by Marielle Pariseau, with some insight in how to overcome it.
A famous quote attributed to Eintein was " the definition of insanity is doing the same thing over and over expecting different results".
Governments regularly publish results, such as childhood GA extractions and obesity. Similar for adults, but at this age, our prevention focus should be on their "gums". Let's try something different.
The government paper on "Advancing our health: prevention in the 2020s" from July 2019. prevention mentions targetting the under 5's only with OHI, and water fluoridation (page 51 gov paper prevention).
In the PHE report on water fluoridation from 2018 on page 8
Water Fluoridation: Health monitoring report for England 2018
The findings of this report agree with the view that water fluoridation is an effective and safe public health measure to reduce the frequency and severity of dental decay, and narrow differences in dental health between more and less deprived children and young people.
and then on page 14 of the 135 page document.
"PHE continues to keep the wider evidence under review and will consult with local authorities prior to publication of a further report within the next 4 years. "
Why support water fluoridation?
Fluoride in water can reduce the likelihood of experiencing dental decay and minimise its severity and is the only intervention to improve dental health that does not require behaviour change by individuals.
How this programme can be implemented at scale
Since April 2013 the power to make new proposals to establish, vary or terminate water fluoridation schemes sits with local authorities. There are a number of local authorities currently considering water fluoridation. Although decision making lies with the local authority, local partners such as the NHS have already been integral in supporting plans for proposals.
The intervention has been included in PHE's return on investment tool for oral health. The PHE return on investment tool can be found on the gov.uk website. Based on the average dmft (decayed, missing or filled teeth) for 5-year-old children in England (national oral health survey of 5 year old children in 2013), the return on investment tool suggests for every £1 invested there is a £12.71 return on investment after 5 years and £21.98 after 10 years. This includes savings to primary and secondary NHS services.