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10.13 pm
The Minister of State, Department of Health (Mr. John Denham): I congratulate the hon. Member for New Forest, West (Mr. Swayne) on securing a debate on the important issue of improving oral health, especially that of children. As we have heard, the subject provokes forceful reactions both for and against the fluoridation of water supplies, and I think it important for me to discuss it in the broader context of public health.
The country has seen dramatic improvements in health over the past 50 years, and that includes oral health. Along with the key role played by the dental profession, the addition of fluoride to both toothpaste and water has made a significant contribution to reducing the amount of dental decay, especially in children. That is in line with the first of two key aims that we set out in our consultative Green Paper "Our Healthier Nation":
For example, in 1995, five-year-olds in the west midlands had, on average, less than half the number of decayed, missing or filled primary teeth of those in the
north-west, and 19 per cent. more five-year-olds in the west midlands had no tooth decay at all compared with their counterparts in the north-west. A similar picture emerges when we look at 12-year-olds and their permanent teeth.
Above all, all other things being equal, the worst off in society have the poorest oral health. The Government are determined to change that and to narrow the health gap--the second key aim in "Our Healthier Nation". That was also the main theme of the recently published report of the independent inquiry into inequalities in health, which was led by Sir Donald Acheson, former chief medical officer at the Department of Health. The commissioning of that report by the Government should be viewed as a measure of our determination to tackle inequalities in health.
The great challenge for local health authorities is how to improve oral health generally and how to tackle those inequalities in health status. Reducing inequalities in dental health will not be easy. In some places, there is a history of sporadic dental attendance. Many people visit a dentist only when they are in pain. They may not maintain regular brushing regimes with fluoride toothpaste. Some children do not even possess a toothbrush.
That is why proposals are made to fluoridate the water supply in areas with high dental decay. The evidence shows that fluoridation of the water supply to the optimum level of one part per million can reduce the amount of tooth decay in children from similar backgrounds by one third to a half.
In this country, about 500,000 people receive water that is naturally fluoridated at, or about, the optimum level of one part of fluoride per million. A further 1 million people receive water that is naturally fluoridated at a lower level, but that still confers some dental benefit. Those areas are generally found in a band running down the eastern side of the country from Hartlepool in the north to parts of Essex. Some 5 million people receive water where the fluoride content has been artificially increased to a level of one part per million. Major schemes operate in Birmingham and throughout the west midlands, and in Tyneside.
The Government are aware of the persuasive evidence that fluoridation is an important and effective method of protecting the population from tooth decay. In "Our Healthier Nation" we quoted the example of Sandwell. The water supply there was fluoridated in 1986. Over the following 10 years, the amount of tooth decay in children more than halved. During the same period, Oldham, an area with a comparable population mix and no fluoridation, saw little change in children's oral health.
That example has been replicated in many other places over the past 50 years. Sadly, it is also true that, where fluoridation schemes have been withdrawn--in Anglesey and in Kilmarnock, for example--levels of tooth decay in children have risen, after having fallen during periods of fluoridation.
Mr. Alan Duncan (Rutland and Melton):
Does the Minister believe that mass fluoridation ever has any adverse side effects? Is he prepared to commission new modern evidence that will assess both sides of the argument?
Mr. Denham:
If hon. Gentleman will bear with me, I was just going to turn to the scientific evidence and the issues that we need to consider.
I acknowledge that some people have concerns about the safety of fluoride. It is important to examine carefully any claims that risks may attach to fluoridation, as well as the benefits.
On the overall question of safety, it is unfortunately true that virtually all medical and public health intervention carries risks as well as benefits. On fluoridation, it is for scientists--specialists in toxicology and dentistry--to advise on the balance of those risks to the benefits, and for Government to decide what is acceptable.
The current position is that, over the years, many health problems alleged to be linked to fluoridation have been investigated and no link has been found. The most recent research in this country of which we are aware concerns a potential link with hip fractures. So far, that has also proved to be unfounded. There is yet to emerge any convincing evidence of harm to general health as a result of drinking artificially fluoridated water at one part per million. Indeed, it is estimated that, throughout the world, some 210 million people drink artificially fluoridated water.
The view that fluoridation of water at that level is safe is that of the majority of medical and scientific opinion throughout the world, based on practical experience and research over the past 50 years. There is currently evidence of just one minor, cosmetic side effect of fluoridation--dental fluorosis, or slight tooth mottling. Where water is fluoridated at the optimal level of one part per million and parents follow the instructions on fluoridated toothpaste to ensure that children do not swallow excessive amounts, that is seldom noticeable. The teeth are still endowed with extra resistance. If someone is concerned about the cosmetic effect, dentists have several remedies. Often a satisfactory outcome can be achieved by the dentist who polishes the teeth. Within that context, the evidence on fluoridation is highly persuasive.
Half a million people in Britain receive water that contains fluoride naturally present at a level close to or above the optimal one part per million, and 5 million people receive water supplemented to that level. The corresponding figures for the United States are 10 million people receiving naturally fluoridated water and 135 million people receiving supplemented water. Before and during the past half-century of fluoridation, there have been extensive studies of the health of those populations. Apart from improved oral health, the health experience of those receiving the optimal concentration of fluoride is no different from that of the population at large.
As to whether artificially added fluoride would have a different effect on health from the naturally occurring chemical compound, I have been advised that the chemistry of the fluoride ion is identical at relevant concentrations. The effects on levels of fluoride in blood, bone and urine, and the effects on teeth and bone, are identical. Therefore, we can learn from studies of populations who have been exposed to high concentrations of fluoride present naturally in drinking water for generations.
Too much fluoride can, of course, be harmful--just as too much oxygen, too much water or too much of some vitamins can be harmful. The experience on the Indian
sub-continent, where much drinking water comes direct from wells dug locally, reinforces the need for the rigorous controls that we have on water purity in the United Kingdom.
It is impossible to say precisely at what concentration fluoride poses a risk to health, but fluoride at the optimal concentration of one part per million has always been present in some water supplies. All the evidence from the United Kingdom, and other countries practising fluoridation, indicates that the total intake from such water, together with that from food and beverages such as tea, is harmless.
I should like now to deal with the process by which decisions on fluoridation are taken, and answer the question on research asked by the hon. Member for Rutland and Melton (Mr. Duncan).
Mr. Duncan:
I am grateful to the Minister for giving way again; he has a bit of time left. How extensive would the adverse side effects have to be before he would deem mass medication to be unacceptable?
Mr. Denham:
My understanding of the evidence--I have some scientific training, but not in this specific discipline--is that there is no evidence of harm giving rise to any question of deeming it to be unacceptable. I shall therefore decline the hon. Gentleman's invitation to take part in a hypothetical exercise. One should consider the scientific evidence that has been presented. Although millions of people drink water that has been fluoridated--either artificially or naturally--at one part per million, there is no evidence of damage to the health of those parts of the population.
Mr. Brian H. Donohoe (Cunninghame, South):
At what age do people realise the benefits of adding fluoride to the water supply?
"to improve the health of the population as a whole".
However, we cannot be complacent. More than half the country's 15-year-olds still experience decay in their permanent teeth. Significant inequalities remain in the oral health of the population.
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