Water fluoridation – stopping the spread of misinformation

Barry Cockcroft, the interim chair of the British Fluoridation Society (BFS), discusses the benefits of water fluoridation and stopping the spread of misinformation.

What would you say to somebody who doesn’t know much about water fluoridation?

There is no water in England that doesn’t contain some fluoride. It’s just that it doesn’t reach the level at which it actually reduces caries. Often, the opponent talks about it being a medication. But a naturally-occurring substance cannot be a medication.

The Royal Society of Chemistry said once you dissolve it in water, there is no difference between artificial fluoridation and natural fluoridation.

People talk about fluoride reducing the prevalence of caries in children. But the benefits of fluoridation are for life. Dentists now spend more time replacing existing restorations than they do treating new carious restorations.

Now, elderly people have a better quality of life and are easier to look after because they don’t have as many restorations, nor are they as big or as expensive. People tend to think of it as only benefiting children but it’s for life.

What are some of the benefits of water fluoridation?

It makes the point that the beneficial effect of water fluoridation hasn’t fallen away. It reinforces the point that one of the great advantages of water fluoridation is it requires no compliance or change in behaviour. It’s not just drinking water either – it’s also used for things like cooking too.

The COVID-19 pandemic has focused people’s minds on prevention. I’m involved in a local health forum, which is basically a retired group of healthcare workers across the spectrum. One of the GPs in it said that 80% of health and wellbeing is not actually based on the provision of service.

It instead comes down to lifestyle, deprivation, diet etc. I think COVID has made people more aware of that. That said, people have also been at home snacking, meaning they may have a higher sugar consumption.

You can also never take money out of people’s thinking. If you’ve got a lower prevalence of caries, I’m not saying the government will save money but they can provide more care for more people. For me, it’s just a complete win-win.

What are your thoughts on the latest white paper that revealed government plans to progress water fluoridation in England?

I was really concerned that among all of the COVID-19 information that the focus on prevention – especially around oral health – might get lost. But in actual fact, the white paper that came out is almost beyond my wildest dreams. Somebody in Public Health England (PHE) has done an amazing job – it must have taken a lot of work.

It’s a huge boost for water fluoridation. We will be incredibly supportive of the government if they do take it forward as they’ve indicated that they’re going to. We will be watching the legislation as it’s published. People have tried to do this before and it’s taken years to put things right.

Politics tend to interfere and the redistribution of responsibility to local authorities, for example, meant certain areas missed out. After all, local authorities do not have much funding and are constantly under financial pressure. As a result, we feel really encouraged by the latest paper. But we are going to keep an eye on it to make sure it really does happen.

Why do you think it’s important that dentists are well informed?

Dentists like to be certain in what they say. We’ve been working with dentists so that they have the right information to hand when they come under pressure from opposition. They can be very effective. But if you’re not knowledgeable it can be difficult to navigate.

There is no evidence of harm and there is regular health monitoring in fluoridated areas. In America, for example, they’ve just celebrated 75 years of water fluoridation.

People trust their dentist. When fluoridation starts to happen, people will ask their dentist about it. We want to get the right information out there so they can be confident in what they say. We’ve done a lot of work improving the BFS website and making free membership available.

We hope more people join, log on and read some of the stuff on there. You’ve got to get the honest information out there. On the whole, I think a lot of the evidence shows that people trust their dentists. We want dentists to log on and find out the truth for themselves and how well it works.

Why are you so passionate about fluoridated water as a way to reduce caries?

My interest in fluoridation started while I was at university in Birmingham. I was told by the dental public health teachers there that the whole country will be fluoridated in 10 years because the evidence is so strong.

They were right that the evidence was strong but they were wrong that the whole country would be fluoridated. I think bringing it back into people’s consciousness is a really, really good thing.

The other thing is that the rate of caries has dropped. When I was at university, about 70% of children had caries – not the 23% now. But what’s not really improved since then are the inequalities. Children from more deprived backgrounds still get more caries than those from less deprived backgrounds.

What do you hope the future holds for the BFS?

I hope that the society grows and develops a more diverse membership. We want anybody who has an interest in oral health to carry the information forward. Anybody who is involved in fluoridation knows this can take a little bit of time.

As a result, we will need people there who are knowledgeable who can attend consultations, for example, and give out the right information.

I’m hoping we can grow the membership and bring on the next generation. The world works on people.

Barry did his best to inflict fluoridation on the people of Southampton and failed.

He is as smooth as a politician in putting forward his  case.