The benefits of fluoridating drinking water for dental health may be less than what was possible before the widespread use of fluoride toothpaste (1^✔ ✔Trusted Source
Water fluoridation for the prevention of dental caries

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A team of researchers from the Universities of Manchester, Dundee, and Aberdeen examined information from 157 studies that compared towns with fluoride added to their water supply to communities without fluoride. They discovered that since fluoride toothpaste became more readily accessible in the 1970s, the advantages of fluoridation have decreased.

Most of the recent research was carried out in wealthy nations. Because there has not been any recent research, it’s unclear how community water fluoridation affects low- and middle-income nations.

Tooth decay can be minimized by using fluoride, which is present in a lot of commercial toothpaste and varnishes. In an effort to promote dental health among people worldwide, governments in many countries have infused drinking water with fluoride; however, opinions on this matter are divided.

“When interpreting the evidence, it is important to think about the wider context and how society and health have changed over time,” says co-author Anne-Marie Glenny, Professor of Health Sciences Research at the University of Manchester.

“Most of the studies on water fluoridation are over 50 years old, before the availability of fluoride toothpaste. Contemporary studies give us a more relevant picture of what the benefits are now.”

Results from studies conducted after 1975 suggest that the initiation of water fluoridation schemes may lead to slightly less tooth decay in children’s baby teeth.

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Analysis of these studies, covering a total of 2,908 children in the UK and Australia, estimates that fluoridation may lead to an average of 0.24 fewer decayed baby teeth per child.

However, the estimate of effect comes with uncertainty, meaning the more recent schemes may have no benefit. By comparison, an analysis of studies with 5,708 children conducted in 1975 or earlier estimated that fluoridation reduced the number of decayed baby teeth, on average by 2.1 per child.

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The same contemporary studies (conducted after 1975) also looked at the number of children with no decay in their baby teeth. The analysis found that fluoridation may increase the number of children with no tooth decay by 3 percentage points, again with the possibility of no benefit.

The review was only able to conclude the impact on children’s teeth, with similar findings across both baby and permanent teeth. There were no studies with adults that met the review’s criteria.

“The evidence suggests that water fluoridation may slightly reduce tooth decay in children,” says co-author Dr Lucy O’Malley, Senior Lecturer in Health Services Research at the University of Manchester.

“Given that the benefit has reduced over time, before introducing a new fluoridation scheme, careful thought needs to be given to costs, acceptability, feasibility and ongoing monitoring.”

Advocates have suggested that one of the key benefits of water fluoridation is that it reduces oral health inequalities. This updated review sought to examine this question and did not find enough evidence to support this claim, although this doesn’t necessarily mean there is no effect.

The review’s findings accord with recent observational studies including the LOTUS study, which compared anonymised dental health records with water fluoridation status for 6.4 million adults and adolescents in England between 2010 and 2020. People in fluoridated areas needed slightly fewer invasive dental treatments, with no significant impact on inequalities.

“Contemporary evidence using different research methodologies suggest that the benefits of fluoridating water have declined in recent decades,” says Tanya Walsh, Professor of Healthcare Evaluation at the University of Manchester.

“Oral health inequalities are an urgent public health issue that demands action. Water fluoridation is only one option and not necessarily the most appropriate for all populations.”

“Whilst water fluoridation can lead to small improvements in oral health, it does not address the underlying issues such as high sugar consumption and inadequate oral health behaviors,” says co-author Janet Clarkson, Professor of Clinical Effectiveness, University of Dundee. “It is likely that any oral health preventive programme needs to take a multi-faceted, multi-agency approach.”

Reference:

1. Water fluoridation for the prevention of dental caries – (https:www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010856.pub3/full)

Source-Eurekalert