Tap solution: Scots dentists' move for fluoride in the water supply to combat children's oral health crisis

Between April and November, 2020, the number of courses of treatment delivered was 83% lower than during the same period pre-lockdown.

Pre-lockdown there was concern there was an inequality in dental health across Scotland - that has been exacerbated by the Covid crisis.

According to a National Dental Inspection Programme analysis in October, primary one children from the most deprived communities had a tooth decay level of 1.78.

READ MORE: Fluoride in Scotland's water supply: 'It's not rocket science, it's safe and could save our NHS a fortune'

This compares with 0.40 decayed, missing or filled teeth per child in affluent areas.

Only 58.1 per cent of primary one children in the most deprived areas had no obvious decay - against 86.9 per cent in the least deprived areas.

Tooth decay remains the number one reason for hospital admissions among children aged five to nine across all four UK nations, according to a Royal College of Paediatrics and Child Health report.

But the BDAS says that according to its analysis, Scotland has the highest rates in Europe of oral cancers - which kill three times more Scots than car accidents.

They say that residents in Scotland’s most deprived communities are more than twice as likely to develop and die from oral cancer as those in more affluent areas - although the a direct correlation between dental hygiene and cancer has not yet been made.

Based on a 2018 BDAS study of head and neck cancer mortality undertaken by in oral cancer mortality figures for Scotland were at 521 for the previous year. While rates of mouth cancer have seen moderate increases rates of throat cancer had almost trebled and are the fastest rising cancers in Scotland.

The BDAS now fears any progress on children's dental health risks is going into reverse.

Public Health Scotland has confirmed that the number of children seen by dentists between May and December was around a quarter of the 2018/19 average, while the number of adults seen from September to November was around a third of previous figures.

And the pandemic has also caused a sharp drop in the number of young children being registered with a dentist for the first time. The percentage of 0-2 year-olds registered fell from 47.4 per cent in 2019 to 33.8 per cent last year.

The BDAS said fluoridation would reduce tooth decay in children and benefit adults and would provide a huge health service saving.

Public Health England modelling indicates £1 spent on fluoridation in more deprived areas can secure £12.71 in savings after just five years - through reduction in treatment need - and £22 after 10 years.

And the BDAS say they assume savings could be higher in Scotland given higher levels of inequality and resulting treatment need.

Ashley Dé, head of communications and external affairs said: "Covid is expected to widen existing oral health inequalities as a result of unprecedented disruption to care and public health programmes, as well as poor lockdown diets and increased poverty.

"Dentist leaders have stressed that investment in prevention is now essential, would quickly pay for itself, as a companion to existing schemes like Childsmile."

The pioneering Childsmile programme, which provides supervised brushing and varnishing of teeth, delivered via primary schools and nurseries, has secured reductions in decay but was suspended for much of the last year.

The BDA says that restarting that programme, and providing additional support in high needs areas is at the centre of the its gameplan alongside calls for health boards to be supported to conduct feasibility studies on water fluoridation.

Mr Dé said: "Adding a small amount of fluoride in the water system doesn't change the taste or smell of water and is a safe and effective way to protect against tooth decay.

"Drinking fluoridated water is good for people of all ages including young children, pregnant women and older people.

READ MORE: Coronavirus Scotland: NHS dentistry facing crisis

"Extensive scientific research confirms water fluoridation is not associated with any ill health effects."

NHS advisers are urged ministers to fluoridate Scotland's water supply to mass-medicate children who face poor dental health in 2015.

While opponents claim that adding the chemical can cause tooth mottling and brittle bone diseases, NHS Health Scotland said it was a safe and effective way to prevent tooth decay.

A report from the time by the National Dental Inspection Programme for health boards found about one-third of five-year-olds in Scotland had tooth decay and "clear health inequalities persist" when it comes to dental health.

But a Scottish government consultation paper, published in 2002, which floated the option of adding fluoride to all Scottish water supplies attracted more than 7,500 complaints from Scots.

The BDAS, which is pushing the water fluoridation idea to would-be MSPs say that the believe the main barriers have been financial, in other words, cash-strapped local councils have had no resource to pursue this policy, in the face of sustained cuts to public health grants.

Around 5.8 million people in England receive fluoridated water, the lions share artificially added.

The move was supported by Dr Nigel Carter chief executive of the Oral Health Foundation who said: “The addition of fluoride to water has been researched for over 75 years, and has been proven to reduce tooth decay by 35%. Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to decay.

“Tooth decay comes at a tremendous cost to the economy and it is the most common chronic disease in the country. Around two million people in the UK have taken time of work in the last five years due to poor oral health, at a cost to businesses of more than £35m a year.

“We believe that water fluoridation is the single most effective public health measure there is for reducing oral health inequalities and tooth decay rates, especially amongst children. We believe community water fluoridation schemes represent an opportunity to take a big step forward in not only improving this generation’s oral health, but those for decades to come.

“We wait in anticipation for progress to be made towards that goal but while we do, we would encourage everyone to brush their teeth twice a day with a fluoride toothpaste. This gives your teeth the boost of fluoride that they need.”

Dr Alex Crighton, dental representative to the NHS Greater Glasgow and Clyde Area Drugs and Therapeutics Committee also backed the move.

The honorary clinical senior lecturer and the University of Glasgow's dental school said: "Fluoride in water doesn’t clean your teeth but it does stop tooth decay in deprived areas and so is a good thing."

But James Goolnik, a clinical dentist who is founder of the Rewards Project charity, which fights to reduce public sugar intake, said there has been no evidence of a reduction in tooth decay.

"My concern is parents will then continue to feed their children food/drinks full of sugar thinking the ‘Fluoride will protect them’," he said. "It is all down to diet and sugars and carbohydrates. Nothing can combat a poor diet.

"This won’t stop the growing diabetes problem.

"Shouldn’t we spend the money on education and reducing the added sugars in our foods. Reduce the sugar we don’t need fluoride."

This is refuted by the BDAS which said that Public Health England data shows it leads to a 52% reduction in tooth decay for five-year-olds in deprived areas.

The Scottish Government's oral health improvement plan published in January, 2018, recognised that water fluoridation could make a positive contribution to improvements in oral health.

But it said that he the practicalities of implementing this means "we have taken the view that alternative solutions are more achievable”.

The BDAS said that despite recognising the benefits ministers have "never seriously attempted to look at delivery". It said: "The Scottish Government already recognises that water fluoridation could make a positive contribution to improvements in oral health and while its implementation is a matter for local NHS Boards, the Government needs to provide a clear lead on this issue. This includes supporting NHS Boards to carry out fluoridation feasibility studies, along with investment to help facilitate its introduction where applicable."

It has also called for a new funding model “that reflects modern dentistry” and makes it an attractive profession to pursue.

A recent BDAS survey, found that less than two thirds of PDS dentists said they planned to continue practising as a community dentist in the next five years, with a third intending to retire during this time, raising “significant concerns” about the future capacity of the service, and its ability to treat vulnerable patients.

The Scottish Budget 2021-22 provides £431 million for general dental services, a rise of 0.6% from the year before. And the BDAS says that represents a real-terms “cut” at a time the service faces an “unprecedented backlog”.

The dentists' association has warned the profession “needs to be sufficiently resourced, with appropriate career opportunities, to attract practitioners to the service and ensure that it has enough capacity to meet future challenges”.

The SNP said it has "no plans" to support fluoridation if re-elected.

NHS Greater Glasgow and Clyde declined to comment.