Fluoride or fillings?

Fluoride. It’s always been a controversial subject. As a dentist, it’s one of the questions I’m asked most. “Do you think it’s right to have it in drinking water?”

Well, as it happens I do. When you take a good look at the facts I think you’ll see why.

Fluoride is a mineral that occurs naturally. It is actually an entirely natural component of bone. It’s found in certain foods such as tea and fish, as well as in water. The amount varies according to where you live.

In the early 20th century, it was discovered that lower levels of tooth decay corresponded with certain levels of fluoride in drinking water. This led to fluoride being added to toothpastes.

The dentist’s view

From a dental point of view, fluoride’s a really good weapon to fight tooth decay. Even now, tooth decay is one of the most common reasons children are admitted to hospital. Decay occurs when acid, produced by bacteria in plaque when you eat sugary foods, attacks the surface of your teeth. Fluoride disrupts this process. It changes the structure of developing enamel to make it more resistant and reducing plaque’s ability to produce acid.

There are other ways to use fluoride against decay. For example, mouthwash, gel, and tablets. there is even a varnish that can be painted onto teeth to help protect them. But it was the introduction of fluoridation schemes – adding fluoride to local drinking water to bring it up to the optimum level to prevent decay of about 1 ppm (parts per million) – that has caused most controversy.

Origins of use

Birmingham was first area to add fluoride in the 1960s. Other parts of  the Midlands, the North West, North East, Yorkshire and The Humber quickly followed on. Abroad, fluoridation is popular in the US and Australia, but less so in Europe.

Mass fluoridation has always attracted controversy. Many people don’t like the idea of ‘health by stealth’, seeing it as a little bit ‘Big Brother’; and I can totally understand that. Others claim fluoride is harmful. And like many substances it can be dangerous, but not in the miniscule quantities we’re talking about here.

In fact, there’s no medical evidence of it having any harmful side effects, and this is after more than 60 years of research. But there’s plenty of evidence for its benefits. According to the British Dental Health Foundation, adding fluoride to water has been proven to reduce decay by 40 to 60%, while fluoride in toothpaste has reduced it by up to 50%. And as recently as 2014, Public Health England (PHE) found that in fluoridated areas, 45% fewer children were admitted to hospital with dental problems while levels of general tooth decay were 15% lower for five-year-olds and 11% lower for 12-year-olds.

Also, as part of that report, PHE (the Government’s public health advisory body) advised that councils should consider adding fluoride to water more widely – a call I wholeheartedly support for the good of our, and our children’s, dental health.