Is tooth decay in 5-year-olds related to fluoridation and social deprivation?

Key Points

• Dental caries in 5-year-old children is strongly associated with poverty.

• Water fluoridation produced a 43% reduction in dmft in England in 1993/94.

• Water fluoridation reduces dental caries more effectively in areas of social deprivation and so reduces dental health inequalities.

Abstract

Aim

To examine the relationship between water fluoridation, socioeconomic deprivation and tooth decay in 5-year-olds.

Setting

10,004 children: 1,051 in naturally fluoridated Hartlepool in 1991/92, 3,816 in fluoridated Newcastle & North Tyneside and 5,137 in non-fluoridated Salford & Trafford in 1993/94.

Outcome measures

Correlations between mean electoral ward dmft and ward Townsend Scores from the 1991 census.

Results

Regardless of the level of water fluoridation significant correlations were found between deprivation and tooth decay. Multiple linear regression models for dmft showed a statistically significant interaction between ward Townsend score, and both types of water fluoridation, confirming the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 43% reduction in decay in 5-year-olds in fluoridated areas.

Conclusions

Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has halved tooth decay in 5-year-old children and that the dental caries divide between rich and poor is reduced.

Main

The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children Jones C M and Worthington H Br Dent J 1999; 186: 397–400

Comment

This elegant ecological statistical study demonstrates yet again, if further evidence were needed, the effectiveness of water fluoridation. It also confirms, at electoral ward level, the link between dental decay and social deprivation, and the greater reduction in dental decay produced by fluoridation in socially deprived communities. Similar evidence led the Acheson Report to recommend fluoridation as one of the most effective interventions to reduce inequalities in health.¹

The authors correlate previous survey results with the Townsend score of wards, which is a more appropriate indication of social deprivation than the Jarman scores used in earlier studies. It is encouraging to those far seeing individuals in BASCD who promoted standardised comparable surveys, and those who carry out and co-ordinate these surveys² to see the results used to contribute to the scientific evidence base for dental public health policy making.

Five-year-old children in non-fluoridated areas have nearly twice as much tooth decay as those who benefit from water fluoridation. The authors state that water fluoridation is a well accepted public health measure, but one has to ask, by whom? As they point out, few of the British population currently benefit from fluoridation, and no new fluoridation schemes have been introduced since the Water (Fluoridation) Act of 1985. The opponents of fluoridation have managed, with a diligence and commitment that all members of the dental team would do well to emulate, to exert an influence out of all proportion to their numbers. The Consumers' Union of the USA published a report on the fluoridation controversy over 20 years ago and concluded that 'the survival of this fake controversy represents, in the Consumers' Union's opinion, one of the major triumphs of quackery over science in our generation'.³

The publication of this paper is very timely as we await the Healthier Nation White Paper from a government committed to reducing inequalities in health. Will they propose an amendment to the legislation, which the Minister for Public Health has described as a mess, and which a judicial review has found to be ineffective? Will they find yet another reason to delay the implementation of the one dental public health strategy which has been demonstrated to reduce inequalities in dental health?