An unhappy consequence of the perennial wrangling over the funding of frontline health provision is that public health appears to be the Cinderella service. Its crises creep up surreptitiously and often go unaddressed. Such appears to have been the case with the health of the nation’s teeth.
A study of 50,000 three-year-olds by Public Health England finds they are having large numbers of teeth extracted because of decay caused by drinking fruit juice and squash from bottles and feeding cups. A disturbing 12% have some tooth decay, but Public Health England also found that in some parts of the UK the proportion rises to a third. PHE, quite sensibly, warns parents against giving children sugary drinks or sweetening baby meals to make them more palatable. It also advocates vigilance against sugary medicines and adherence to the most effective practices for tooth-brushing.
PHE can raise the alarm and evangelise best practice but inevitably parents must take the lead. The state’s relationship with the citizen in matters of health will always depend on partnership. Still, one can reasonably question whether the state is playing its proper part in the debate about our dental health. In its response to the study, the British Dental Health Foundation focused on sugary drinks, but more pointedly on the question of fluoridation.
Dr Nigel Carter, the association’s chief executive, said fluoride in toothpaste has reduced tooth decay in England by up to 50%, but the detail is important. “Levels of dental decay have fallen in both fluoridated and non-fluoridated areas in the UK, with the greatest reductions seen in fluoridated areas, yet only 12% of the population have fluoridated water.” The association speaks of a “clear need for water fluoridation”. But there is nothing approaching that clarity in the government’s approach to the issue. Under the Water Act 2003, local authorities decide whether or not to add fluoride to the water. Many are reluctant to push ahead in the face of claims, wholly unproven, linking fluoridation to cancer, Down’s syndrome, infant mortality and, less seriously, mottled teeth. There are strong passions, with fluoridation condemned by opponents as “indiscriminate mass medication”.
And yet the government’s stance, on an issue it has been wrestling with since the first significant UK fluoridation scheme was launched in Birmingham half a century ago, is that the proven benefits clearly outweigh unsubstantiated risks. “Reviews have found that water fluoridation contributes to reduced decay levels,” says the Department of Health. Willingness to shift responsibility to local authorities could be seen as virtuous devolution. But if the result is a lottery of regional standards, ministers need to think in terms of a consistent national health policy. Time for them to grip the credible science and present a coherent case to the country.