Press release

Fluoride monitoring report finds lower levels of tooth decay in fluoridated areas and no evidence of harm to health

Public Health England has published ‘Water fluoridation: health monitoring report for England 2014’.

Smiling teeth

Children in local authorities with water fluoridation schemes (where the level of fluoride is adjusted to 1 part per million) have less tooth decay than those in local authorities without such schemes, says a new report by Public Health England (PHE).

As many as 45% fewer children aged one to four in fluoridated areas are admitted to hospital for tooth decay – primarily to have decayed teeth extracted under a general anaesthetic – than in non-fluoridated areas.

The report says there is no evidence of harm to health in fluoridated areas. PHE has found no differences between fluoridated and non-fluoridated areas in their rates of hip fracture, osteosarcoma (a form of bone cancer), cancers overall, Down’s syndrome births or all-cause mortality (all recorded causes of death).

Rates of kidney stones and bladder cancer were lower in fluoridated areas than non-fluoridated areas, the report says. PHE cautions that this should not be interpreted as a ‘protective effect’ from fluoridated water, as the lower rates may be due to other factors and the possibility that they occurred by chance cannot be ruled out.

Professor John Newton, Chief Knowledge Officer at PHE, commented:

This report provides further reassurance that water fluoridation is a safe and effective public health measure. Since PHE came into existence in April 2013, this is our first report on the health of people living in fluoridated areas. We are required by legislation to produce them every four years on behalf of the Secretary of State for Health. We will use this report as a basis for discussions with local authorities on the scope and content of further reports and on the role of fluoridation as a public health measure.

Key findings on the dental health of children were:

  • When deprivation and ethnicity – both important factors for dental health – are taken into account, 5 year olds in fluoridated areas are 28% less likely to have had tooth decay than those in non-fluoridated areas.

  • When deprivation and ethnicity are taken into account, 12 year olds in fluoridated areas are 21% less likely to have had tooth decay than those in non-fluoridated areas.

  • The reduction in tooth decay in children of both ages in fluoridated areas appears to be greatest among those living in the most deprived local authorities.

Sue Gregory, Director of Dental Public Health at PHE, said:

These findings highlight the important contribution that water fluoridation makes to children’s dental health and general well-being. It is notable that the benefits of this public health measure appear to be greatest for children living in the most deprived areas of the country. This is significant for reducing the large differences we see in dental health between deprived and more affluent areas of the country.

The report says a previous study (published in 2012) of fluoridated Newcastle upon Tyne and non-fluoridated Manchester found that the number of 12 year old children with moderate dental fluorosis or more is very low, at around 1% in Newcastle and 0.2% in Manchester. However, children in fluoridated Newcastle have less tooth decay than those in non-fluoridated Manchester.


Notes to editors

  • Dental caries (tooth decay) is a significant public health problem in England. Sizeable inequalities still exist between affluent and deprived communities, and dental caries is a common cause of hospital admissions in children.

  • Fluoride is a naturally occurring mineral found in water in varying amounts. It is also present in some foods. In the early 20th century, lower levels of tooth decay were found to be associated with certain fluoride levels in drinking water. This observation led ultimately to the introduction of water fluoridation schemes to adjust fluoride levels in community water supplies, in an effort to reduce tooth decay in the populations they serve.

  • In some parts of England the level of fluoride in the public water supply has been adjusted to 1mg per litre (1 part per million). Currently, around 6 million people live in areas with fluoridation schemes. Many schemes have been in operation for over 40 years.

  • An original version of this press notice said that, after deprivation and ethnicity are taken into account, 28% fewer 5 year olds and 21% fewer 12 year olds have tooth decay in fluoridated areas than non-fluoridated areas. Statistically, it is clearer and more accurate to say that 5 year olds in fluoridated areas are 28% less likely, and 12 year olds are 21% less likely, to have had tooth decay than children of the same age in non-fluoridated areas. This is known as an ‘odds ratio’.

  • Dental fluorosis is considered to be a cosmetic condition arising from excess fluoride consumption from all sources, including water, when teeth are forming. In the main, it is characterised by white marks on the tooth surfaces. Some studies have found that the marks, especially in the mildest stages of fluorosis, tend to go unnoticed. One study found that teenage children rated the aesthetic appearance of teeth with mild fluorosis no differently from teeth without any fluorosis, and that they rated teeth with decay as worse than teeth with fluorosis.

  • Public Health England’s mission is to protect and improve the nation’s health and to address inequalities through working with national and local government, the NHS, industry and the voluntary and community sector. PHE is an operationally autonomous executive agency of the Department of Health.

  • See the report and executive summary Follow us on Twitter @PHE_uk

Photo by B Zedan. Used under Flickr Creative Commons

Press office

Only for use by journalists and the media

Published 25 March 2014
Last updated 3 April 2014 + show all updates
  1. Change to odds ratio, as described in notes to editors.
  2. First published.