Fluoride fear condemns children to tooth decay

A government Green Paper on public health published today will ignore one of the simplest, most effective ways of tackling health inequalities: adding fluoride to drinking water. Jeremy Laurance, Health Editor, reports.

Fears of a public backlash have forced ministers to change their minds over plans to extend fluoridation of Britain's water supplies to prevent tooth decay.

Tessa Jowell, the minister for public health, has bowed to pressure from cabinet colleagues worried about the civil liberties implications of requiring water companies to introduce a chemical additive to their supplies.

Jack Straw, the Home Secretary, wrote to Frank Dobson, the Secretary of State for Health, last October urging him to meet anti-fluoridation campaigners. "Having looked carefully and objectively at both sides, I do feel that theirs is a valid point of view," he wrote.

Ms Jowell favours further fluoridation and has described as "unacceptable" the refusal of some private water companies to consult with health authorities on the issue.

The National Alliance against Dental Health Inequalities, representing 31 medical, dental and voluntary organisations, has called for legislation to give the final say on fluoridation to publicly accountable health authorities, rather than privatised water companies.

Dr Sandy Macara, chairman of the British Medical Association, said: "Fluoridation of water supplies in deprived areas would halve tooth decay rates in five-year-olds within five years. This could be achieved at very low cost."

John Hunt, British Dental Association chief executive, said: "The Government has a real opportunity to reduce dental health inequalities. It is unacceptable that water suppliers are dictating public health policy."

In a Commons written answer last November, Ms Jowell said the Government was reviewing fluoridation, and cited extensive scientific literature in support of its safety. No serious side-effects had been identified, she said.

Today's Green Paper, which will set out the Government's plans for tackling the health gap between rich and poor, is expected to disappoint pro-fluoride campaigners by recommending further consultation. Ms Jowell is understood to have told colleagues she is anxious to "go with the grain of public opinion" and avoid "needlessly intrusive, bossy government".

Fluoride exists naturally in all water supplies. In some areas, such as Hartlepool, the concentration is high enough to reduce tooth decay by about a half. In other areas, the natural level can be topped up.

About 5.5 million people in Britain drink artificially fluoridated water, mainly in the West Midlands and the North-east. In Sandwell, west Midlands, where fluoride was added in 1988, tooth decay in five-year-olds has fallen by half. In Blackburn, a less deprived area without fluoridation, it has remained unchanged.

Fears that children using fluoride toothpaste who live in areas with high levels of fluoride in the water may overdose are unfounded, says John Hunt, of the BDA: "The only possible side effect is a minor flecking of tooth enamel."

painful lesson

Seven-year-old Kieran Morris and his five-year-old brother, Dylan, are painfully familiar with their dental surgery. At the age of three, both boys had virtually every tooth extracted under because they were so badly decayed. Kieran and Dylan have the misfortune to live near Bolton, in the North West Water region, where supplies are not fluoridated. A recent survey said the area has the worst dental health in England.

The boys' mother, Joanne Morris, said she had always made sure that they brushed their teeth properly, had few sweets and sugary drinks and visited the dentist regularly. "Despite all that, Kieran's top teeth were like black stumps in his mouth," she said. "He started getting abscesses and he was in a lot of pain. After Kieran's problems, I took extra care with Dylan, but his went bad too."

Mrs Morris is considering joining a group legal action against North West Water, which has resisted fluoridating water supplies although regional health authorities have offered to fund it. "I want to help prevent other children from suffering like mine," she said.

perfect teeth

Julie Newell admits that her two children, Charlotte, eight, and Matthew, six, are not conscientious about cleaning their teeth. Nevertheless, both of them have perfect teeth, and they have never visited the dentist for anything more than a check-up.

"I feel very fortunate to live where I do," said Mrs Newell, who lives in Solihull, in the West Midlands. "A lot of my friends have got children of the same age, and none of them have any problems with their teeth either."

A recent survey, by the British Association for the Study of Community Dentistry, found that residents of the West Midlands enjoyed the best dental health in England. The water in the region has been fluoridated for many years.

Mrs Newell's husband, John, said: "The children eat a lot of sweets and we always warn them that they'll ruin their teeth, but when they go to the dentist, they never need to have anything done. The only thing I can put it down to is the fluoride. I feel very sorry for families in unfluoridated areas. Children deserve the right to have decent teeth."