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Lack of recent evidence on fluoridation in Cochrane review

18 June 2015

Lack of recent evidence on fluoridation in Cochrane review

A review on water fluoridation from the Cochrane Oral Health Review has found little contemporary evidence determining the effect of fluoridation on caries levels.

However, although many of the studies analysed in the review were published before 1975, the review nevertheless points to several positive aspects of water fluoridation on a population.

The report says: “Data suggest that the introduction of water fluoridation resulted in a 35% reduction in decayed, missing or filled baby teeth and a 26% reduction in decayed, missing or filled permanent teeth. It also increased the percentage of tooth decay in both children’s baby and permanent teeth.”

They do point out, however, that these reports cannot take into account other possible sources of fluoride. They go on: “Since 1975 the use of toothpastes with fluoride and other preventive measures such as fluoride varnish have become widespread in many communities around the world. The applicability of the results to current lifestyles is unclear.”

While the report cautiously welcomes the positive benefits of fluoride to a community’s oral health, they counter that the lack of current reviews on the matter somewhat bias their findings. As a result, they call for more contemporary reviews on the subject.

Responding to the review, the British Dental Association supports the calls for more contemporary, high quality water studies on fluoridation. The BDA’s scientific advisor, Professor Damien Walmsley, said: “Despite the huge improvements we have seen in people’s dental health since the 1970’s, too many communities still experience unacceptably high levels of tooth decay.

“One in eight three-year olds in England have tooth decay, and poor communities are disproportionately affected. Treating extensive tooth decay remains the main reason why children are admitted to hospital – more than 60,000 children had to have rotten teeth removed under a general anaesthetic in 2012/13.

“As children’s ability to learn, eat and speak is affected by dental disease, a preventable condition, we need a range of strategies to reduce this burden on youngsters, their families and the NHS.

“We believe that targeted fluoridation has an important role to play, along with the need to reduce sugar consumption and the promotion of a good oral hygiene routine.”

Update

The British Association of Dental Therapists have also welcomed the findings of the review. BADT President, Fiona Sandom, said: "I work in an area of high need and poverty and welcome these findings. In Wales, the recently published Dental Epidemiological Survey of three year olds in Wales 2013-14: First Release Report on Caries into Dentine clearly shows that children in the most deprived areas of Wales experience the most disease.

"Whilst we have the invaluable Designed to Smile brushing programme, it fails to reach those very young children who, by the age of three, already have decay. Dental decay in the young affects the child's ability to speak, eat and learn and is the primary reason for children being admitted to hospital for general anaesthetic. I know there are other ways of exposing the teeth to fluoride, but it requires both motivation and opportunity - something not always readily available to the most vulnerable.

"I have also seen first hand the benefit of water fluoridation as I grew up in Anglesey, which was itself fluoridated until 1990 and seen the decay levels subsequently rise in the population. Dental therapists can help child patients out of pain, but fluoride is key to prevention in many cases."

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