1. Despite an overall improvement in dental health over the past 30 years, tooth decay remains a significant public health problem in parts of the UK. Inequalities in dental health remain wide with children living in the poorest communities continuing to suffer unacceptably high levels of tooth decay.

  2. The purpose of the 2006 Dental Reforms was to provide patients with easy access to high-quality and clinically appropriate dental services.

  3. The Health and Social Care (Community Health and Standards) Act 2003 extended PCTs' remit to assessing local oral health needs and commissioning the appropriate services to tackle long standing oral health inequalities.

  4. Furthermore, for the first time NHS General Dental Practitioners were given the opportunity to focus on prevention and health promotion, as well as treatment as part of their NHS contract.

  5. Historically, uptake of dental services has been a classic example of the inverse care law—those in greatest need make least use of the service. Clearly PCTs now need to be very skilful in their commissioning of dental services to redress the balance.

  6. However, even with better provision of primary dental services including the provision of oral health promotion, it is likely that inequalities in oral health will persist for many years to come.

  7. Water fluoridation is the single most effective public health measure available to health authorities to reduce unacceptably high levels of tooth decay, and reduce oral health inequalities.

  8. Importantly, water fluoridation would significantly reduce the need for dental general anaesthetic for tooth extraction in children. (See attached chart comparing general anaesthetics in non-fluoridated Greater Manchester with fluoridated Birmingham and the Black Country.)

  9. In November 2003 Parliament, with substantial majorities in both houses, supported the Government's proposal to correct the legislation (in England & Wales) so that water companies were no longer able to veto NHS decisions about water fluoridation. (Water Act 2003 Section 58(2) http://www.opsi.gov.uk/acts/acts2003/20030037.htm)

  10. Four years after the new legislation no new schemes have been implemented, and only one PCT, Southampton, has requested its SHA to undertake cost and feasibility studies. The SHA and PCTs in Greater Manchester, where dental health is among the worst in the country, originally mapped out a timescale suggesting that in Spring 2007 the PCTs would have sufficient information—in terms of mapping water distribution and caries levels, and cost-effectiveness—to decide whether or not to ask the SHA to undertake a formal fluoridation consultation. However, there is no indication as yet that the NHS in the North West has any firm timetable for a fluoridation consultation.

  11. Elsewhere, there has been little information in the public domain to suggest that other PCTs might be actively considering fluoridation as part of their oral health policies. These delays are unacceptable.

RECOMMENDATION

  12. We strongly urge the Health Select Committee to recommend that where the need has been established—for example in the North West of England and Yorkshire—health authorities will consult communities with a view to implementing new fluoridation schemes without delay.

  Source: Hansard 1 Nov 2004: Column 134W.

Michael A Lennon OBE

Professor of Dental Public Health, University of Sheffield, and

Chairman, British Fluoridation Society

4 December 2007