Short summary
Published 20 March 2026
Applies to England
© Crown copyright 2026
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Introduction
In England, about one in 10 people live in areas where fluoride has been added to public water supplies to improve dental public health. This Health Monitoring Report assessed whether there are dental health benefits to water fluoridation, and whether there are any potential non-dental health harms. This report found that water fluoridation is beneficial for reducing tooth decay in children and these benefits were largest for those living in more deprived areas. This report found no evidence of an effect on cognitive ability in children and no convincing evidence of an effect on hip fracture risk.
Background
This monitoring report was prepared by the Water Fluoridation and Health Monitoring Working Group, on behalf of the Secretary of State for Health and Social Care. It analyses data on the health of people living in areas of England with differing levels of fluoride in their drinking water supply.
Fluoride occurs naturally and can be present in water and some foods in varying amounts. In some areas with lower natural fluoride levels, fluoride is added to public drinking water in line with regulatory limits as a measure to improve dental health. Tooth decay (dental caries) is a significant public health problem in England, with more than a fifth of 5 year olds experiencing tooth decay. It is most common in more deprived communities.
Around one in 10 people in England currently have fluoride added to their drinking water supplies. To monitor the effects of this intervention, this report assesses whether dental benefits from water fluoridation shown in previous health monitoring reports continue to be seen, and whether there are any potential non-dental health effects.
Methods
Three dental health outcomes were studied: the prevalence of 5 and 10 or 11 year old children with tooth decay, the average number of teeth per child with tooth decay in 5 and 10 or 11 year olds, and hospital admissions for removal of teeth (due to tooth decay) in children and young people. These were chosen to continue monitoring the impact of fluoride on dental health. Two non-dental health outcomes were studied: emergency hospital admissions for hip fracture in people of any age and cognitive ability in children aged 5 and 7 years old.
Exposure to fluoride in the area where people in the study lived was measured in 2 ways: whether a water fluoridation scheme was operating in an area, and the average amount of fluoride in the drinking water. The frequency of each health outcome was compared for people living in areas with different fluoride levels and with and without fluoridation schemes. The analysis also took into account other factors that could differ between areas or people in the study, such as age, sex, ethnicity and deprivation.
Results
Between 2017 and 2024, the range of fluoride concentrations found in local areas ranged from 0.01 milligrams per litre of water (0.01 mg/L) to 1.3 mg/L. About 85% of the English population lived in areas with an average fluoride concentration below 0.40 mg/L.
About 23% of 5 year old children had experienced tooth decay, with an average of about 0.8 teeth per child affected in both 2022 and 2024.
Five year olds living in areas with fluoridation schemes compared to without were less likely to experience tooth decay and less likely to experience severe tooth decay (decay affecting about 3 or more teeth), and 0 to 19 year olds were less likely be admitted to hospital to have a tooth removed due to tooth decay.
Five year olds living in areas with higher compared to lower fluoride concentrations were less likely to experience tooth decay and less likely to experience severe tooth decay, and 0 to 19 year olds living in areas with higher compared to lower fluoride concentrations were less likely be admitted to hospital to have a tooth removed due to tooth decay.
Higher levels of fluoride in drinking water contributed to reducing these measures of tooth decay in children in both the more deprived and the less deprived areas. However, these dental health benefits were largest for children living in the more deprived areas.
Taken alongside the wider international evidence and limitations of this study, the findings in this report provided no convincing evidence of a relationship between emergency admissions for hip fractures and living in areas with higher fluoride levels in drinking water, or in areas with fluoridation schemes.
There was no evidence of a relationship between fluoride levels in drinking water and cognitive ability test scores in 5 or 7 year old children. Because no relationship with levels of fluoride in water was found, this report did not assess a relationship with living in areas with or without fluoridation schemes.
Conclusion
In line with previous HMRs, the findings of the 2026 HMR are consistent with the view that water fluoridation at levels within the regulatory limit for England (1.5 mg/L) is a beneficial public health intervention for reducing tooth decay in children, with no convincing evidence of harm to non-dental health. The dental health benefits were largest for those living in the more deprived areas. This report found no evidence of an effect on cognitive ability in children and no convincing evidence of an effect on hip fracture risk. These findings are in line with the wider international evidence at similar water fluoride concentrations.
The Water Fluoridation Health Monitoring Working Group continues to review evidence and will publish a further report within the next 4 years.