Adding fluoride to water supplies

doi:10.1136/bmj.39318.562951.BE

BMJ 2007;335:699-702 (6 October), doi:10.1136/bmj.39318.562951.BE

Analysis

Controversy

Adding fluoride to water supplies

K K Cheng, professor of epidemiology¹, Iain Chalmers, editor², Trevor A Sheldon, professor and pro-vice chancellor³

¹ Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT , ² James Lind Library, Oxford OX2 7LG , ³ Health Services Research, University of York, York YO10 5DD

Correspondence to: K K Cheng k.k.cheng@bham.ac.uk

Adding fluoride to water supplies to prevent dental caries iscontroversial. K K Cheng, Iain Chalmers, and Trevor A Sheldonidentify the issues it raises in the hope of furthering constructivepublic consultation and debate

The first 150 words of the full text of this article appear below.

Several countries add fluoride to water supplies to preventdental caries (boxes 1 and 2). Since the 2003 Water Act, watercompanies are required to add fluoride to supplies when requested—afterpublic consultation—by a health authority in England orthe Welsh Assembly in Wales.¹

Summary points

Water fluoridation is highly controversial

Evidenceis often misused or misinterpreted and uncertainties glossedover in polarised debates

Problems include identifying benefitsand harms, whether fluoride is a medicine, and the ethical implications

Thisarticle provides professionals and the public with a frameworkfor constructive public consultations

Box 1 Dental caries

What is dental caries?
Dental caries isa process of demineralisation of dental hard tissue caused byacids formed from bacterial fermentation of sugars in the diet.Demineralisation is countered by the deposit of minerals inthe saliva—remineralisation. Remineralisation is a slowprocess, however, which has to compete with factors that causedemineralisation. If remineralisation can effectively competethe enamel is repaired. If . . . [Full text of this article]

How common is caries?

Box 2 Exposure to fluoride

How common are water supplies containingfluoride?
What are the sourcesof fluoride exposure?

Known benefits of adding fluoride to water

Potential harms of fluoridation

Box 3 Key recommendations for future research on water fluoridation

Alternative ways to prevent caries

Is fluoride added to water supplies a medicine?

Box 4 Effect of fluoride on the association between sugar andcaries

Ethical implications

Trust in the dissemination of evidence

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This article has been cited by other articles:

Cockcroft, B., Donaldson, L. (2007). The Department of Health's view. BMJ 335: 840-840 [Full text]
Bewdley, B. o. (2007). Addressing the arguments. BMJ 335: 841-841 [Full text]
Holgate, S. T, Sheldon, T. A (2007). Interpreting the Newcastle fluoride bioavailability study. BMJ 335: 840-841 [Full text]

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