A recent review suggests that the dental health benefits of adding fluoride to drinking water have diminished compared to the period before fluoride toothpaste became widely accessible.
Researchers from the universities of Manchester, Dundee, and Aberdeen analyzed data from 157 studies that compared communities with fluoridated water supplies to those without. Their findings indicate that the advantages of water fluoridation have lessened since the 1970s, a time when fluoride toothpaste began to gain popularity.
Fluoride is well-documented for its ability to reduce tooth decay, and the introduction of low levels of fluoride into drinking water has long been hailed as one of the most significant public health advancements of the last century. “When interpreting the evidence, it is crucial to consider the broader context and how society and health have evolved over time,” said Anne-Marie Glenny, a professor of health sciences research at the University of Manchester and co-author of the review. “Most studies on water fluoridation are over 50 years old, predating the availability of fluoride toothpaste. More recent studies provide a clearer understanding of current benefits.”
Analysis of studies conducted after 1975 indicates that water fluoridation may result in a minor reduction in tooth decay among children’s baby teeth. A review of these studies, which included 2,908 children in the UK and Australia, estimated that fluoridation could lead to an average of 0.24 fewer decayed baby teeth per child. However, the researchers cautioned that this estimate carries uncertainty, suggesting that newer fluoridation initiatives may have no significant benefits.
In contrast, studies from 1975 or earlier, involving 5,708 children, indicated that fluoridation reduced the average number of decayed baby teeth by 2.1 per child. The Cochrane review primarily focused on children’s dental health, finding similar results for both baby and permanent teeth, but noted a lack of studies involving adults that met their criteria.
“The evidence suggests that water fluoridation may provide a slight reduction in tooth decay among children,” stated Dr. Lucy O’Malley, a senior lecturer in health services research at the University of Manchester and co-author of the review. “Given that the benefits have decreased over time, any new fluoridation scheme should carefully consider costs, acceptability, feasibility, and the need for ongoing monitoring.”
Proponents of water fluoridation have argued that one of its key advantages is its potential to reduce oral health disparities. However, the review did not find sufficient evidence to support this claim, although the researchers noted that this does not necessarily imply there is no effect.
“While water fluoridation can lead to modest improvements in oral health, it fails to tackle underlying issues such as high sugar consumption and poor oral health practices,” explained Janet Clarkson, a co-author and professor of clinical effectiveness at the University of Dundee. “It is likely that any effective oral health prevention program will need to adopt a multifaceted, multi-agency approach.”
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