There is no guarantee water fluoridation schemes in England will continue to save money for the NHS, a new study led by the University of Manchester has concluded.
Approximately six million people in England live in areas where fluoride is added to drinking water – the first permanent scheme started in 1964 in Birmingham. Fluoride is known to help with tooth decay hence why it was later added to toothpaste in the 1970s.
The study analysed the effects of water fluoridation between 2010-2020 and found that those receiving optimally fluoridated water experienced a 3% reduction in invasive NHS dental treatments. They also saw a 2% drop in the number of decayed, missing, and filled teeth.
Optimal water fluoridation cost £10.30 per person over the 10-year period and, as a result, NHS treatment costs were £22.26 lower (5.5%) per person, while patients paid £7.64 less (2%) in dental charges.
Using this data, the research team calculated that, if 62% of England’s adults and teenagers attended an NHS dentist at least twice within the 10-year period, the public sector would save £16.9m.
Dr Deborah Moore, lead author of the study and honorary lecturer at the University of Manchester, explained: “This study is the first in the UK to capture health and economic effects of water fluoridation on adults with widespread access to fluorides in toothpastes, mouthwashes and dentist-applied varnishes.
“The patients who received optimal water fluoridation had very small positive health effects.”
She continued: “But as the costs of NHS dentistry are much higher than the costs of water fluoridation, the relatively small observed reductions in visits to the dentist still resulted in a positive return for the public sector.
“This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.”
The University of Manchester says that, if a new scheme was setup to cover a similar number of people today, it would cost around £50m and take 30 years to recover in dental treatment savings.
As children’s teeth are in generally better condition than older people, the scheme may not guarantee a return of investment in the future.
According to Dr Moore, even though “population-level, mass preventive interventions” are still necessary for tooth decay, high income countries could be approaching the “limit of what can be achieved through fluorides” on their own.
Instead, sugar consumption could be an area of public policy that needs addressing.
“The relationship between sugar consumption and tooth decay is very clear: average consumption of sugars in the UK is more than double the recommended level for adolescents, and is almost double for adults,” said Dr Moore.
“Managing sugar consumption is another area of policy that needs to be investigated.”
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