Research Blow to Finances of Water Fluoridation
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- Published: Tuesday, 23 January 2024 12:41
- Written by Peter Ingle
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If and when the much delayed dental recovery plan is published it may include the promotion of water fluoridation as part of a preventative strategy. For decades this has been recognised as a cost effective public health measure.
With reducing inequalities a key ambition, supporters have claimed that fluoridation reaches the parts (of the public) that other measures do not reach. But a new study led by researchers at the University of Manchester raises serious questions about the actual benefits.
In what is claimed to be the largest ever study of the effects of water fluoridation on the dental health of adults, the National Institute for Health and Care Research (NIHR) funded study considered 6.4 million UK adults and adolescents across England.
Published in Community Dentistry and Oral Epidemiology, the study estimates that the public sector saved £16.9 Million between 2010 and 2020 as a result of water fluoridation.
In terms of benefits, the study showed that those receiving optimally fluoridated water experienced a 3% reduction in NHS invasive dental treatments such as fillings and extractions, and a 2% reduction in the numbers decayed, missing, and filled teeth, when compared to the non-optimally fluoridated cohort over the 10 year period.
Financial calculations suggest that savings to the NHS from the existing schemes are “marginal.” From 2010 to 2020 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 charges. Based on this, the researchers estimate if 62% of the adults and teenagers in England attended NHS dental services at least twice within 10 years, the total return on investment would have been £16.9 Million between 2010 and 2020.
The findings echo those of the recent NIHR CATFISH study, which showed smaller than expected health benefits of water fluoridation in children. That study, published in late 2022, concluded that fluoridation of water supplies might provide modest benefits to child dental health. Importantly it was the first contemporary study of the effects of initiating a water fluoridation scheme in the UK, since the widespread uptake of fluoride toothpaste in the 1970s.
Given the focus on reducing inequalities, there was further bad news for supporters of increased water fluoridation. The research team found no compelling evidence that water fluoridation reduced social inequalities in dental health, with the numbers of missing teeth between the cohorts being the same.
Lead author Dr Deborah Moore, honorary lecturer at The University of Manchester, said: “This study is the first in the UK to capture health and economic effects of water fluoridation on adults with widespread access to fluorides in toothpastes, mouthwashes and dentist-applied varnishes.
“The patients who received optimal water fluoridation had very small positive health effects,” she said. The modest return on investment shown in the study, “should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.”
It may be difficult to justify new schemes since the capital costs of setting one up from scratch to cover a similar number of people in 2009 was estimated at around £50 million in today’s prices. This would take 30 years to recover in NHS dental treatment savings.
Even that level of cost-recovery for new schemes, cannot be guaranteed for future generations, as children’s teeth are in better condition than those of their parents, and they may not need as much dental treatment as they reach adulthood.
Dr Moore added: “Fluoridation of drinking water is justifiably recognised as one of the twentieth century’s greatest public health achievements.
But as fluoride toothpastes became available in the mid-1970s - considered to be the key factor in the dramatic decline in the prevalence and severity of dental decay – the context of water fluoridation has changed.”
While Dr Moore agreed that mass preventative interventions were still needed, she said that, “in high income countries, we may be reaching the limit of what can be achieved through fluorides alone.”
In an opinion that may not make her very popular in the Secretary of state for Health and Social Care’s household, she did have a suggestion for alternative preventative actions to reduce levels of caries.
“The relationship between sugar consumption and tooth decay is very clear: average consumption of sugars in the UK is more than double the recommended level for adolescents, and is almost double for adults. Managing sugar consumption is another area of policy that needs to be investigated.”
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