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Adult dental health treatment costs reduced by water fluoridation

Lookup NU author(s): Dr Ray Lowry, Emeritus Professor Jimmy Steele CBE


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We examined National Health Service (NHS) treatment spending in primary care using routinely-collected data. The Dental Practice Board, the United Kingdom NHS primary dental care administrative organisation, to analyse treatment data for 1984 and 1985. Treatments for damage arising mainly from dental caries (fillings, crowns and extractions) were selected. The study was limited to 21-29 year olds living in two fluoridated (Birmingham and Newcastle on Tyne) and two non-fluoridated areas (Birmingham and Wolverhampton). Only treatments to permanent teeth counted. The cohorts were chosen deliberately because these age groups were related to the onset of fluoridation in their respective areas: Birmingham started water fluoridation in 1964, Newcastle in 1969, so in 1985 both cohorts were born into non-fluoridated areas, but of the 1995 cohorts, the Birmingham residents had been born in a fluoridated area whereas only half the Newcastle ones were. For both years of the study, all four areas would have benifited from improvements in dental health due to better diet, fluoridated toothpaste etcetera. So if there was a benefit from the introduction of fluoridted water on top of this, it should show up most in Birmingham, and to an extent in Newcastle. Both non-fluoridated areas showed a similar drop in total caries-related treatments between 1984 and 1994 (Table 1), but Birmingham showed a significantly increased drop, with Newcastle in between. The declines were Wolverhampton %, Cleveland %, Newcastle % and Birmingham (p) (Figure 1). We have looked for reasons other than water fluoridation to account for the difference. The populations in all areas showed little import change in the resident population over the study period. The catchment areas for the dental schools in Birmingham and Newcastle include the other two areas is the study, so the prescriibing patterns of dental graduates (many of whom practice close to their alma mater) might not be expected to differ markedly. Treatments provided outside the NHS primary care system recorded by the DPB are unlikely to be important: especially in 1994, people in this age group experiencing dental decay are likely to be in the lowest social classes, so be less likely to use the private sector; or attent a dental school for lengthy student-provided treatment; and are ineligible for the community dental service on age grounds, unless they are a special needs patient or pregnant or a nursing mother. So the inevitable conclusion is that being born into a fluoridated area confers a unique, additional benefit above and beyond others that may accrue due to other measures, and that these benefits last into adulthood. We also costed up the savings in the fluoridated areas, using present day fees for the items of treatment recorded. it is a staggering A3 ($). If this is for just two UK cities, we estimate that, if every major city were fluoridated, A3 would be saved in tretment costs for this age group alone. Or alternatively, no to fluoridate adds millions of pounds of unnecessary spending on top of the avoidable pain, misery and disfigurement.

Publication metadata

Author(s): Steele J; Lowry R

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: UKPHA Annual Public Health Forum

Year of Conference: 2003