University of Chester researchers call for more action

University of Chester researchers call for more action to tackle root causes of children’s tooth decay.

Posted on 10th May 2016

This comes after they published research finding that the biggest influence on children’s tooth decay is inequality, which can be improved by addressing social determinants of health (in other words, the conditions in which people are born, grow, work, live, and age, and the wider influences shaping our daily lives) rather than by mass fluoridation of water. Despite the ambiguous evidence around fluoridation of our tap water supplies in some parts of the UK, historically it has been used as a strategy for protecting against dental caries.

Karen Tocque, Professor of Health Intelligence, andProfessor Lynne Kennedy, Associate Dean of the Faculty of Medicine, Dentistry and Clinical Sciences, both from the University of Chester, have studied the links between dental decay, social deprivation and local water fluoridation – and their research has shown that social deprivation has a far greater negative influence on dental health than local fluoridation of tap water has a positive one.
Professor Kennedy said: “We know that people living in affluent societies such as the UK have high intakes of sugar in their diet, including sugary drinks. National Smile Month is the largest and longest-running campaign to promote good oral health, so we felt that this was a good time to raise issues of dental hygiene and good diet in preventing cavities, especially in our children.
“Despite the fact that fluoridated drinking water can help moderate dental caries, in reality human behaviour, such as eating a lot of sweets and chocolate, sugary beverage consumption, dental hygiene, other nutritional factors and access to dental services are more likely to influence overall dental health.”
Water fluoridation (both adding fluoride to water and naturally fluoridated water) is supported by Public Health England and the NHS (www.nhs.uk/news/2015/08August/Pages/Water-fluoridation-a-safe-way-of-stopping-tooth-decay.aspx), but it also has its critics (egwww.theguardian.com/society/2015/dec/25/fluoride-water-supply-benefit-unproved-tooth-decay).
While much research has been carried out on fluoridation and levels of tooth decay, Tocque and Kennedy’s research is distinctive by analysing variations in dental decay in five-year-old children across the whole of England in relation to social deprivation, in areas with and without local water fluoridation. Both professors recognise that water fluoridation results in an overall lower average of tooth decay in children, but their findings show that the independent effects of social deprivation are much greater than this benefit.
Their work focused on the National Dental Epidemiology Programme’s survey of five-year old-children in England (and has been published by the Journal of Public Health and Epidemiology), which, in an analysis of over 142,000 dental examinations, found that 31% of 5-year old children had at least one decayed, missing or filled tooth (dmft).
Children living in the most deprived areas were three times more likely to experience tooth decay than those living in more affluent areas, but Professor Tocque and Professor Kennedy concluded that there was no evidence that water fluoridation reduces inequalities in children’s dental health; because the difference across the social gradient remains the same whether children live in fluoridated areas or not.
Professor Tocque said: “We discovered that there was a very strong association between good dental health and social advantage, with 80% of children living in the most affluent areas being decay-free and only 56% of those living in the most deprived areas. But there was only a small difference in being decay-free between fluoridated (73%) and non-fluoridated areas (68%).
“However, children living in deprived areas that are fluoridated do have significantly loweraverage dental decay than those living in equivalent deprivation with no water fluoridation. Our study concluded that fluoridated drinking water does moderate dental caries, but socio-economic deprivation has a stronger influence on dental decay than local fluoridation of water does in preventing/mitigating it.”
Professor Kennedy added: “Children are at greater risk of developing caries if they have poor dental hygiene (including infrequent brushing), use non-fluoride toothpaste and are more likely to have a diet high in sugar and sugary drinks. Other research also suggests that, nationally, fewer children are consuming tap water, fluoridated or not.
“That’s why we believe that reducing the disparities in health is key to the future of our children’s teeth. We feel that this would be better achieved by focusing resources on reducing the effects of socioeconomic deprivation on overall health and wellbeing – with strategies tailored to needs.”
With the latest data from the National Dental Survey, also released today, confirming the persistent relationship between dental caries in 5-year olds and social deprivation – Professor Tocque added: “The challenge for the Government and public health authorities is to successfully address the social and behavioural influences on poor health in general. This would achieve a greater overall improvement in health and wellbeing – rather than trying to tackle one single disease at a time.”