Is water fluoridation still effective?

For decades, fluoride has been considered as a cornerstone of dental health, especially in our drinking water. We’ve all heard that fluoride protects our teeth from decay, but have we ever stopped to wonder if water fluoridation is still as effective today?

With fluoride toothpaste now widely available, it’s worth asking if water fluoridation is still pulling its weight.

Community water fluoridation

A team of experts led by the University of Manchester set out to investigate. They conducted a fresh review of the dental benefits of water fluoridation, reviewing evidence from 157 studies.

Each of the studies were focused on communities that have incorporated fluoride in their water supplies against communities that haven’t.

“Community water fluoridation (CWF) is currently practised in about 25 countries; health authorities consider it to be a key strategy for preventing dental caries,” noted the researchers.

The experts found that the benefits of water fluoridation have seen a decline since the 1970s, which is when fluoride toothpaste began to popularize.

The studies under review were primarily conducted in high-income countries. Therefore, the impact of community water fluoridation in low- and middle-income countries remains relatively ambiguous, predominantly due to the absence of recent research.

Outdated studies on fluoride in drinking water

In today’s society, fluoride is a common ingredient in many commercially available dental hygiene products such as toothpaste and varnishes. It’s renowned for its ability to combat tooth decay.

Consequently, governments worldwide have added fluoride to their drinking water supply with the objective of improving the oral health of their populations.

Nevertheless, Anne-Marie Glenny, professor of Health Sciences Research at the University of Manchester, advises caution while interpreting these findings.

“When interpreting the evidence, it is important to think about the wider context and how society and health have changed over time,” said Professor Glenny.

“Most of the studies on water fluoridation are over 50 years old, before the availability of fluoride toothpaste. Contemporary studies give us a more relevant picture of what the benefits are now.”

Does water fluoridation still benefit children?

Post-1975 studies analyzed in the review suggest that the initiation of water fluoridation schemes might result in slightly lesser tooth decay in children’s primary teeth.

An analysis of these recent studies, including a total of 2,908 children from the UK and Australia, estimates that fluoridation might result in an average of 0.24 fewer decayed baby teeth per child.

Nevertheless, this estimate is not absolute and comes with its uncertainty. There exists a possibility that these newer schemes might not provide any tangible benefits.

As a point of comparison, an analysis of studies conducted before 1975 with 5,708 children estimated that fluoridation reduced the number of decayed baby teeth per child by an average of 2.1.

Reducing oral health inequalities

The assumption that water fluoridation is a key method to reduce oral health inequalities has been under scrutiny.

The review did not uncover substantial evidence to justify this claim, although this doesn’t necessarily mean that there is no effect.

“The evidence suggests that water fluoridation may slightly reduce tooth decay in children,” said Dr. Lucy O’Malley, senior lecturer in Health Services Research at the University of Manchester.

“Given that the benefit has reduced over time, before introducing a new fluoridation scheme, careful thought needs to be given to costs, acceptability, feasibility and ongoing monitoring.”

What’s next for water fluoridation?

Concerns about oral health inequalities require immediate public health action. However, water fluoridation may not be the most suitable solution for every population.

Professor Janet Clarkson of the University of Dundee argues that while water fluoridation may lead to small improvements in oral health, it does not address underlying issues like high sugar consumption and inadequate oral health behaviors.

This review sheds light on the evolving landscape of fluoride utilization for dental health benefits. It is evident that the contemporary dynamics of fluoride use in dental health need further examination as the world moves toward a more comprehensive approach to dental care.

The study is published in the journal Cochrane Database of Systematic Reviews.

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