Water fluoridation

Question 1

Definition

Answer 1

The controlled addition of fluoride to a public water supply as a public health measure to reduce the incidence of caries

Question 2

Mechanism of action (3)

Answer 2

Fluoride incorporated into hydroxyapatite crystal – fluorohydoxyapatite more resistant to attack
Saliva promotes remineralisation of early carious lesions
Fluoride interferes with metabolic pathways of bacteria, reducing acid

Question 3

Mechanisms (6)

Answer 3

Pre-eruptive
Post-eruptive
Both

Systemic
Topical
Both

Question 4

Dental caries in UK (4)

Answer 4

Dramatically lower than the 1970s
Low levels of restoration in primary teeth
Continuing reduction in permanent dentition of decay and fillings
Social inequalities remain

Question 5

Contemporary considerations (4)

Answer 5

Availability of fluoridated toothpaste
Other modes of fluoride delivery
Water supply structure- urban v. rural environments
Migration patterns

Question 6

York review objectives (5)

Answer 6

1. Effects of water fluoridation on incidence of caries?
2. Benefits over & above those offered by alternative interventions?
3. Reduce inequalities?
4. Negative effects?
5. Difference between natural & artificial fluoridation?

Question 7

York review conclusions (5)

Answer 7

1. Six people need to receive fluoridated water for one extra person to be caries free
2. Post 1974 studies – effect over & above other sources of fluoride
3. Equity??
4. Fluorosis – of aesthetic concern, one additional person for every 22 people receiving fluoridated water
5. Artificial v. natural?

• Cochrane review 2015 got similar results
• concerns about quality of included studies

Question 8

Cost-effectiveness (3)

Answer 8

Consider nature of water supply
Fluoridation cost-effective if population of 200,000
5 year old dmft > or = 2

Question 9

2017: 5-yos (3)

Answer 9

Mean dmft = 0.8
Caries prevalence = 23.3%
Mean dmft >0 = 3.4

Question 10

UK policy (4)

Answer 10

Water Industry Act 1991
Water Act 2003 (Clause 58)
Water Fluoridation (Consultation) Regulations (2015)
Health and Social Care Act (2012)

Question 11

Responsibilities (4)

Answer 11

Local authorities responsible for oral health improvement including water fluoridation;
Statutory process
SoS currently pays capital costs
PHE acts on behalf of SoS

Question 12

Decision making (4)

Answer 12

Local Authorities decide policy
Requires public consultation
-at least three months
-publish proposals on two consecutive weeks in newspapers
-consult local authorities and -community health councils
local authorities must discuss and decide in public
Water company shall fluoridate
Weighted vote

Question 13

UK fluoridated areas (2)

Answer 13

10% of population fluoridated

6 million people

Question 14

Health Monitoring Report 2018 (4)

Answer 14

4-yearly intervals
5-year-olds caries experience reduced by 17% in the least deprived and 28% amongst the most deprived
Hospital admissions reduced by 59%
Fluorosis (10.3% v 2.2%)

Question 15

Ethics (4)

Answer 15

Beneficence
Non-malfeasance
Autonomy
Justice

Question 16

Summary (6)

Answer 16

Water fluoridation is a safe & effective whole population public health measure at an optimum level of 1ppm
Consider caries prevalence and trends
Inequalities
Cost-effective
Feasibility - UK legislation to support process, consider water supplies
Acceptability – political, social, cultural, ethics