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​Dentists: Fluoridation offers ‘theoretical’ benefits without up-front investment

11 February 2021


The British Dental Association has warned that moves spelt out in today’s White Paper to enable greater uptake of water fluoridation must be supported by capital investment, and form part of a joined-up approach to support services and wider public health programmes if England is going to avoid an oral health crisis.


No new schemes have been introduced this century, despite the Water Act in 2003 aiming to remove barriers. Under current laws governing fluoridation councils have been required to carry out drawn-out public consultations and feasibility studies without any support from central government. The public health grant was cut by £200m in the 2015 budget and has seen real-terms cuts of 3.9% each year that followed. Many existing dental programmes implemented by local authorities, including supervised brushing in schools and nurseries, have faced grave uncertainty as a result.


Public Health England modelling indicates £1 spent on fluoridation in more deprived areas can secure £12.71 in savings after just 5 years, through reduction in treatment need. Tooth decay has remained the number one reason for child hospital admissions across the UK. Extractions of decayed teeth in children, which take place in hospital under general anaesthetic, costing the NHS £41.5 million in 2018/19, according to recent analysis by the Local Government Association.


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, and must form part of a strategic approach alongside expansion of schemes like supervised brushing, and measures to maintain the sustainability of high street services. The latest (pre-COVID) Public Health England survey of oral health of five-year-olds showed a ten-fold difference in the severity of tooth decay between those in more and less deprived local authority areas.


The government imposed a target on NHS practices in England on 1 January that is forcing dentists to prioritise volume over need. Practices that do not hit 45% of their pre-pandemic activity levels are set to hit steep financial penalties, with those falling below 36% facing the return of the majority of their NHS funding. Dental services were already in crisis before the pandemic, with an estimated 4 million missing out on access to NHS care, or nearly 1 in 10 of the adult population.


The White Paper has pledged wide-ranging reforms expected to impact on the delivery, commissioning and regulation of dental care. The BDA has stressed the government's ‘build back better’ mantra must be applied to dental services.


British Dental Association Chair Eddie Crouch said:


“Fluoridation could be a game changer, improving health outcomes while saving the NHS millions. Yet until we see up-front investment any benefits to public health or the public purse will remain purely theoretical.


“Any commitment here can’t be at the expense of dental services and wider public health programmes, which have been badly hit by the pandemic. We need a joined-up approach to tackle deep health inequalities that now look set to widen.


“Reforms will shape the way care is delivered, planned and regulated, areas where both patients and practitioners have been let down.


“Ministers say it’s time to 'build back better', and that logic must be applied to dentistry.”