Agenda item

Briefing Report from NHS England (North East and Yorkshire) and presentation by Amanda Healy, Director of Public Health, County Durham and Chair of the North East Directors of Public Health Network.

The Committee considered the briefing report from NHS England (North East and Yorkshire) on water fluoridation that provided the following information:

·      Summary of the evidence base of the benefits of fluoridation.

·      Local epidemiology data detailing the clinical impact of water fluoridation on North East communities.

·      Summary of the evidence base on potential adverse health outcomes linked to fluoridation.

·      Summary of the evidence base on dental side-effects e.g., fluorosis.

·      Cost effectiveness evidence.

·      Local support for fluoridation including quotes of support from system leaders.

A Healy, Director of Public Health was in attendance to present the report and deliver a presentation that provided information on the Department of Health and Social Care (DHSC) consultation process to expand community water fluoridation schemes across the North East of England, to update on the current position in relation to oral health, to provide advice on next steps and to seek multiple responses to the consultation (for copy of report and presentation, see file of minutes).

K Shah, Consultant in Dental Public Health North East and J Evans, Public Health Team were in attendance to answer any questions.

Councillor Reed indicated that she could see the positives of fluoridation due to tooth decay and knew a child who had 13 teeth removed in one day that was concerning. She continued that she had read that there was an impact on people’s health in terms of high levels of fluoride in the system that can cause problems such as bone damage, osteoporosis and arthritis. In Europe some countries had rejected the fluoridation programme due to the health issues and asked the officer for her advice on this.

The Consultant in Dental Public Health North East responded that the concentration of fluoride levels in England was monitored by an independent mandatory monitoring report on the health effects of fluoridation that was undertaken every four years. She stated that the last report was published in 2022 that examines other health effects that could be associated with fluoridation. Consistently there was no evidence to suggest that fluoridation at the levels in England had any adverse effect on the population.

Councillor Stubbs referred to fluorosis and asked how this occurred. Was it too much fluoride in the water which would be monitored but also the fact that some people brushed their teeth with fluoride toothpaste on multiple occasions per day?.

He then referred to the Stockton on Tees programme of fluoride varnish that was paused during COVID and asked if there was a reason why Durham County Council never adopted that programme and was there any evidence that this was affective and if it was whether this approach should be considered.

The Director of Public Health responded in terms of varnishing and referred to the Oral Health Strategy and fluoride was one of the many interventions. She continued that the evidence base was clear that in terms of all the interventions putting fluoride into the water was the most protective and the most preventative way to reduce tooth decay in the population, particularly for children. She referenced the targeted toothbrushing scheme in County Durham and they were looking at other actions in the plan to see if they can potentially extend the scheme and look at other interventions including varnishing. However other schemes would come at a cost to the local authority and she stated that from a return in investment none of these are as cost effective as fluoridation. The local authority already had some equalities as some parts of the county had fluoride in the water and the consultation was around extending the scheme. The Director of Public Health indicated that she was happy to bring back updates to the committee on the strategy.

The Consultant in Dental Public Health North East indicated that fluorosis occurs due to too much fluoride at a particular point in life when teeth are developing primarily amongst young children. They monitor these every four years when they conduct 12 year old surveys, they monitor the level of fluorosis that was done through dental surveys and not the water companies in terms of fluorosis. She continued that severe fluorosis occurred where fluoridation could lead to brown staining on the teeth. Research carried out in Newcastle with children with fluorosis showed that it was not a concern to them the reason as it made their teeth look whiter. In terms of over brushing leading to fluorosis this was not the case and the way to reduce fluorosis was by the amount of toothpaste put onto the toothbrush so that children did not swallow the toothpaste. With regard to fluoride varnish, she indicated that she had set up the scheme in Stockton and Teesside and they were really important but were complimentary as no one intervention would give the reduction in tooth decay what they were looking for. She commented that varnish was also for older people in care homes who had high levels of decay due to the inability to clean their own teeth and wanting more sweet things to eat as their taste buds changed.

Councillor Earley stated that anything that could be done to reduce tooth decay and improve oral hygiene should be supported particularly given the evidence that the Director of Public Health had presented. He remembered teeth being a class issue due to the expense of dental health care and we were now back in that situation with the health inequalities increasing through diet and insufficient public health interventions in schools. He stated the more that could be done to improve children’s dental health the better as it was heartbreaking to see children having multiple teeth removed. He considered that the Committee should give 100% backing to the proposals and would recommend to everyone as he had water fluoridation in his area.

Councillor Hovvels indicated that this was about health inequalities and fluoridation was in some parts of the county and not others. If the Council is serious about giving young children the best start in life what better way to do it than supporting the proposals. She continued that fluoridation was cost effective and the outcomes would be better for young people this was about prevention, and they had to improve the health of children, and this was a measure to do this that was supported by the evidence, and she fully supported it and agreed with Councillor Earley.

Mrs Gott indicated that she was concerned at the cost of dental treatment for poorer families as no dentists were currently taking on NHS patients. She agreed with fluoridation but how did they follow it through with education for poorer children on advice of what food to give to children to save their teeth.

The Director of Public Health responded that the Oral Health Strategy identifies clear links to other strategies and as a local authority we were responsible for that oral health promotion and colleagues within the Integrated Care Board were responsible for commissioning dental services. In terms of fluoridation this would make a huge difference in terms of inequalities, particularly from the beginning of life and the benefit to the older population and was part of the overall approach.

The Consultant in Dental Public Health North East indicated that they were currently in the procurement process of obtaining new dental practices in the Durham area. She continued that dental treatment was free for children on the NHS and indicated that the benefits of fluoridation would be instead of a child requiring five fillings might only need to have one or two so the volume of treatment that was needed would be reduced over time with the fluoridation.

Councillor Howey stated that she agreed with fluoridation in water and would be good for everyone not just children. She indicated that tooth decay was not always down to a poor diet and asked if they still attended schools to teach children about how to look after their teeth as they may help going forward.

The Consultant in Dental Public Health North East indicated that they have an NHS Oral Health Promotion Team that was jointly commissioned on behalf of the local authorities who go into schools, and they have a training model. As part of the school curriculum there was education built in and they train the teachers to give the key messages to children. They also have a supervised teeth brushing scheme so nursery, reception and year one the children brush their teeth on a daily basis and part of that there are conversations around oral health.

Councillor Howey referred to the training of teachers and indicated that it was a bigger impact if someone came into the school rather than put it onto teachers.

The Director of Public Health responded that this could be included in the action plan for the Oral Health Strategy and indicated that they also have school nurses as the oral health promotion was a small team and was targeting in the right way and needs to be part of the broader strategy so will pick this up and take it forward.

Resolved: (i)That the information detailed in the report and presentation be noted.

(ii) That the comments raised be formulated into a response to the Department of Health and Social Care consultation supporting the expansion of the Community Water Fluoridation scheme.