Memorandum by the British Fluoridation
Society (DS 13)
1. Despite an overall improvement in dental
health over the past 30 years, tooth decay remains a significant
public health problem in parts of the UK. Inequalities in dental
health remain wide with children living in the poorest communities
continuing to suffer unacceptably high levels of tooth decay.
2. The purpose of the 2006 Dental Reforms was
to provide patients with easy access to high-quality and clinically
appropriate dental services.
3. The Health and Social Care (Community Health
and Standards) Act 2003 extended PCTs' remit to assessing local
oral health needs and commissioning the appropriate services to
tackle long standing oral health inequalities.
4. Furthermore, for the first time NHS General
Dental Practitioners were given the opportunity to focus on prevention
and health promotion, as well as treatment as part of their NHS
5. Historically, uptake of dental services has
been a classic example of the inverse care lawthose in
greatest need make least use of the service. Clearly PCTs now
need to be very skilful in their commissioning of dental services
to redress the balance.
6. However, even with better provision of primary
dental services including the provision of oral health promotion,
it is likely that inequalities in oral health will persist for
many years to come.
7. Water fluoridation is the single most effective
public health measure available to health authorities to reduce
unacceptably high levels of tooth decay, and reduce oral health
8. Importantly, water fluoridation would significantly
reduce the need for dental general anaesthetic for tooth extraction
in children. (See attached chart comparing general anaesthetics
in non-fluoridated Greater Manchester with fluoridated Birmingham
and the Black Country.)
9. In November 2003 Parliament, with substantial
majorities in both houses, supported the Government's proposal
to correct the legislation (in England & Wales) so that water
companies were no longer able to veto NHS decisions about water
fluoridation. (Water Act 2003 Section 58(2) http://www.opsi.gov.uk/acts/acts2003/20030037.htm)
10. Four years after the new legislation no
new schemes have been implemented, and only one PCT, Southampton,
has requested its SHA to undertake cost and feasibility studies.
The SHA and PCTs in Greater Manchester, where dental health is
among the worst in the country, originally mapped out a timescale
suggesting that in Spring 2007 the PCTs would have sufficient
informationin terms of mapping water distribution and caries
levels, and cost-effectivenessto decide whether or not
to ask the SHA to undertake a formal fluoridation consultation.
However, there is no indication as yet that the NHS in the North
West has any firm timetable for a fluoridation consultation.
11. Elsewhere, there has been little information
in the public domain to suggest that other PCTs might be actively
considering fluoridation as part of their oral health policies.
These delays are unacceptable.
12. We strongly urge the Health Select Committee
to recommend that where the need has been establishedfor
example in the North West of England and Yorkshirehealth
authorities will consult communities with a view to implementing
new fluoridation schemes without delay.
Source: Hansard 1 Nov 2004: Column 134W.
Michael A Lennon OBE
Professor of Dental Public Health, University of
Chairman, British Fluoridation Society
4 December 2007