Agenda item

To consider an update on plans for community water fluoridation for the North East of England.

The Committee received a presentation on updated plans for community water fluoridation for the North East of England. Led by the Office for Health Improvement and Disparities (OHID) Regional Director / NHS Regional Director of Public Health (North East & Yorkshire), and supported by the Consultant in Dental Public Health, NHS England (North East & Yorkshire) and the Stockton-on-Tees Borough Council (SBC) Director of Public Health, content included:

Ø  Outline of current status

Ø  Oral health across Tees Valley 2019-2022

Ø  Significant inequalities across Local Authorities

Ø  General Anaesthetic (GA): Numbers and rates (2022-2023)

Ø  Evidence-based interventions to improve oral health

Ø  Consultation narrative

Ø  Achieving consensus across the North East

Ø  Where are we now?

Ø  Recommendations

Summarising the existing position with regards this initiative (which included Government support and funding, the preparation of the statutory 12-week consultation requirement, and communication / decision-making responsibilities), it was noted that Hartlepool and some parts of County Durham already had naturally fluoridated water, and other areas (Newcastle, North Tyneside and parts of Northumberland) had artificial water fluoridation. Significantly, associated capital and revenue costs (which previously sat with Local Authorities under the Public Health grant) for expanding this across the North East would be the responsibility of the Department of Health and Social Care (DHSC).

Outlining the changes in prevalence of dental decay in 5-year-olds across the North East between 2019 and 2022, officers stated that there could be up to 134 teeth being extracted under general anaesthetic in a single day within County Durham for Durham and Darlington children. Reference was made to a table which compared the most and least deprived wards in Teesside (without fluoridated water) with Hartlepool (which already had fluoridated water) – this 2017 data demonstrated the positive impact of fluoridation which was particularly significant for those in the most deprived areas. In terms of inequalities, it was also noted that there can be up to a ten-fold difference in decayed, missing or filled teeth (DMFT) rates between the most and least deprived wards within a single Teesside Local Authority footprint.

The use of general anaesthetic in relation to dental decay during 2022-2023 was highlighted. The wider impacts of this were also emphasised, with children usually requiring at least three days off school, around 38% enduring sleepless nights, and around 70% reporting pain.

Public Health England data was provided which showed the return on investment of oral health improvement programmes for 0-5-year-olds. Targeted supervised toothbrushing and fluoride varnish programmes, as well as the provision of toothbrushes / paste by post and by health visitors, were all found to effectively reduce tooth decay. However, by a very significant margin (nearly three times more than the second most effective), water fluoridation had the greatest impact.

Detail was provided on the rationale, aims and next steps around the proposed expansion of water fluoridation across the North East. Ultimately, this initiative would help everyone (especially those who needed it the most), would lead to positive changes in oral health for young children, and would reduce the number undergoing general anaesthetic (a large majority of which were likely avoidable). Officers welcomed Government support for such a population health measure and noted that the new Secretary of State for Health and Social Care had expressed a desire to launch a consultation in early-2024.

An outline of the broad consultation and engagement plans (including with parents and communities) associated with this scheme was given. It was stated that these proposals were planned prior to the emergence of the COVID-19 pandemic (at which point Health and Wellbeing Boards across the region had endorsed), and that dentists were hugely supportive of them. Consultation was on track to commence before the end of 2023, and a communication plan (involving Local Authority colleagues) was in the final stages of preparation.

Reflecting on the contents of the presentation, the Committee pointed to the somewhat overwhelming nature of the quoted statistics and the adverse impact of the pandemic in inhibiting improvements to dental health. Highlighting that Hartlepool still had apparent issues despite water fluoridation, Members added that there were objections to these proposals out in the community. In response, officers emphasised that water (like other drinks and foods) was already treated to ensure it was safe to consume, and that fluoridation would reduce dental caries by around 25% in the most deprived areas. That said, whilst fluoridation would reduce severity of dental decay, it would not eliminate bad health / dietary decisions – there was, therefore, a significant requirement for education around the benefits and limitations of the initiative. Ultimately, there was always likely to be objections to any proposal, but it was known that parents of those children suffering from dental decay were broadly supportive as they had witnessed the pain their children had endured. Assurance was given that Local Authorities would be encouraged to robustly consult with their communities.

Continuing the theme of unease around introducing fluoridation to the water supply, the Committee asked for clarity on potential side-effects. Officers drew attention to a dental monitoring report which was published every four years and included analysis of general and dental health and the impact of fluoridation – the last report in 2022 showed no differences between fluoridated and non-fluoridated water in terms of adverse health side-effects. Fluorosis was a dental side-effect.

Responding to those who were concerned about side-effects, Members drew attention to the impact of dental caries and the risks faced by children who required treatment under general anaesthetic, the use of which, it was felt, should be minimised as far as was safely possible. Officers reiterated that fluoridation was not a panacea for poor dental health, but would reduce severity.

The Committee was informed that there had been some areas across the country where fluoridation schemes had stopped for technical reasons by water companies. It was subsequently evidenced that this led to a dip in the standard of oral health.

A query was raised around how fluoride was best absorbed into the body and whether people had to drink it for optimum effect (e.g. would brushing teeth still provide benefits?). Officers confirmed that drinking fluoridated water would make the biggest difference and agreed that this message needed to be widely communicated to the public.

This proposed initiative aside, the Committee asked if enough was being done to address what, for many, were avoidable dental issues. Officers acknowledged that there was always more that could be achieved (e.g. increased number of fluoride varnish schemes) and that this was not limited to children and young people – vulnerable adults and older people in care homes could also be targeted further. Local Authority Public Health functions were fully supportive of the drive to improve the existing situation, with oral health packs, healthy school nutrition programmes, and supervised toothbrushing within schools demonstrating this (Members stressed the need to keep pushing the latter as a number of schools were not participating). Ultimately, however, a key message that must be continually emphasised was that sugary drinks should be a rare treat for children, not, as had become for many, the norm.

Concluding the item, the Committee sought clarity around consultation plans. It was confirmed that each Local Authority could decide how it wished to conduct this, but that a significant response was anticipated (including some push-back).

AGREED that the community water fluoridation information be noted, and the stated recommendations be supported.