Future benefits of water fluoridation not guaranteed, study shows

Existing drinking water fluoridation schemes in England still provide marginal savings for the NHS, but there is no guarantee that new schemes will continue to do so. new study called LOTUS led by researchers at the University of Manchester.

It is the largest study ever done on the effects of water fluoridation on the dental health of adults.

The results of the study of data from 6.4 million UK adults and teenagers across England were published in Community Dentistry and Oral Epidemiology. Researchers estimate that the public sector saved £16.9 million between 2010 and 2020 as a result of water fluoridation.

People who received optimally fluoridated water in the study had a 3% reduction in invasive NHS dental treatments such as fillings and extractions, and a 2% reduction in the number of decayed, missing and filled teeth, compared to the suboptimally fluoridated cohort. 10 years.

The research team found no conclusive evidence that water fluoridation reduced social inequalities in dental health and that the number of missing teeth between the cohorts was the same.

Around 6 million people in England live in areas that receive drinking water with fluoride added to prevent tooth decay, including those in Birmingham and Newcastle. Water that contains enough fluoride to prevent tooth decay is known as “optimally fluoride”.

Most of the research on the benefits of water fluoridation was done before fluoride was added to toothpaste in the 1970s and involved only children, showing that water fluoridation had a big impact on dental health – almost halving levels of tooth decay.

New research was needed to investigate the dental health benefits of people who have access to fluoride in toothpaste. More people are now keeping their teeth into old age, so understanding the benefits for adults was also a priority.

Over the 10-year period studied, optimal water fluoridation cost £10.30 per person. NHS treatment costs were £22.26 lower per person (5.5%) and patients paid £7.64 less (2%) in dental costs.

Using the data, the researchers estimate that if 62% of adults and teenagers in England attended NHS dental services at least twice in 10 years, the total return on investment would be £16.9m between 2010 and 2020.

The findings echo the recently published NIHR CATFISH prospective cohort study in UK children, which showed smaller than expected health benefits from water fluoridation in children.

Lead author Dr. Deborah Moore, Honorary Lecturer at the University of Manchester, said: “This study is the first in the UK to document the health and economic impacts of water fluoridation on adults with widespread access to fluoride in toothpaste, mouthwash and dentist – applied varnishes.

“Patients who received optimal water fluoridation had very little positive health effects.

“But as the cost of NHS dentistry is much higher than the cost of water fluoridation, the relatively small reductions seen in dental visits still had a positive return for the public sector.

“This performance should be evaluated against the projected cost and lifetime of any proposed capital investment for water fluoridation, including new programs.”

The capital cost of setting up a new system covering a similar number of people in 2009 has been estimated at around £50 million in today’s prices. which would take 30 years for NHS dental treatment savings to recover.

Cost recovery for new programs, the researchers say, may not be guaranteed in future generations, since children’s teeth are in much better shape than their parents’ and may not need as much dental treatment as they grow into adulthood.

Dr. Moore added, “Drinking water fluoridation is rightly recognized as one of the greatest public health achievements of the 20th century.

“However, since fluoride toothpastes became available in the mid-1970s – considered the key factor in dramatically reducing the prevalence and severity of tooth decay – the context of water fluoridation has changed.

“There is no doubt that mass preventive interventions for caries at the population level are still needed.

“Tooth decay remains almost universal into adulthood, even in populations that have had access to fluoridated toothpaste and fluoridated water since birth.

“However, in high-income countries, we may be reaching the limit of what we can achieve through fluoride alone.

“The link between sugar consumption and tooth decay is very clear: average sugar consumption in the UK is more than double the recommended level for teenagers and almost double that for adults.

“Managing sugar consumption is another policy area that needs to be explored.”