Community Water Fluoridation: Caveats to Implement Justice in Public Oral Health

Community water fluoridation (CWF), a long-established public health intervention, has been studied for scientific evidence from both of yea and nay standpoints. To justify CWF with scientific evidence inevitably leads to ethical justification, which raises the question of whether oral health is of individual concern or social responsibility. As dental caries is a public health problem, public health ethics should be applied to the topic instead of generic clinical ethics. From both pro- and anti-fluoridationists’ perspectives, CWF is a public health policy requiring a significant level of intervention. Thus, there needs to take further considerations for justifying CWF beyond the simple aspect of utility. For further ethical considerations on CWF, three caveats were suggested: procedural justice, social contexts, and maintenance of trust. The process to justify CWF should also be justified, not simply by majority rule but participatory decision-making with transparency and pluralistic democracy. Social contexts are to be part of the process of resolving conflicting values in public health interventions. Public trust in the dental profession and the oral healthcare system should be maintained over the considerations. This article suggests accountability for reasonableness as a framework to consider infringement by CWF for public justification of its implementation.

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A cost-effectiveness analysis of community water fluoridation for schoolchildren

BMC Oral Health ◽

10.1186/s12903-021-01490-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jodi Cronin ◽

Stephen Moore ◽

Máiréad Harding ◽

Helen Whelton ◽

Noel Woods

Keyword(s):

Public Health ◽

Cost Effectiveness ◽

Water Supply ◽

Public Health Intervention ◽

Water Fluoridation ◽

Community Water ◽

Effectiveness Analysis ◽

Community Water Fluoridation ◽

Effective Public Health ◽

Lifetime Treatment

Abstract Background Community water fluoridation (CWF), the controlled addition of fluoride to the water supply for the prevention of dental caries (tooth decay), is considered a safe and effective public health intervention. The Republic of Ireland (Ireland) is the only country in Europe with a legislative mandate for the fluoridation of the public water supply, a key component of its oral health policy. However, more recently, there has been an increase in public concern around the relevance of the intervention given the current environment of multiple fluoride sources and a reported increase in the prevalence of enamel fluorosis. The aim of this economic analysis is to provide evidence to inform policy decisions on whether the continued public investment in community water fluoridation remains justified under these altered circumstances. Methods Following traditional methods of economic evaluation and using epidemiological data from a representative sample of 5-, 8-, and 12-year-old schoolchildren, this cost-effectiveness analysis, conducted from the health-payer perspective, compared the incremental costs and consequences associated with the CWF intervention to no intervention for schoolchildren living in Ireland in 2017. A probabilistic model was developed to simulate the potential lifetime treatment savings associated with the schoolchildren’s exposure to the intervention for one year. Results In 2017, approximately 71% of people living in Ireland had access to a publicly provided fluoridated water supply at an average per capita cost to the state of €2.15. The total cost of CWF provision to 5-, 8-, and 12-year-old schoolchildren (n = 148,910) was estimated at €320,664, and the incremental cost per decayed, missing, or filled tooth (d3vcmft/D3vcMFT) prevented was calculated at €14.09. The potential annual lifetime treatment savings associated with caries prevented for this cohort was estimated at €2.95 million. When the potential treatment savings were included in the analysis, the incremental cost per d3vcmft/D3vcMFT prevented was -€115.67, representing a cost-saving to the health-payer and a positive return on investment. The results of the analysis were robust to both deterministic and probability sensitivity analyses. Conclusion Despite current access to numerous fluoride sources and a reported increase in the prevalence of enamel fluorosis, CWF remains a cost-effective public health intervention for Irish schoolchildren.

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Water fluoridation: current challenges

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318545 ◽

2020 ◽

pp. archdischild-2019-318545

Author(s):

John Furness ◽

Sam J Oddie ◽

Simon Hearnshaw

Keyword(s):

Public Health ◽

Dental Caries ◽

Water Fluoridation ◽

Public Health Measure ◽

Important Public Health ◽

Community Water ◽

Health Measure ◽

Community Water Fluoridation ◽

And Child Health ◽

Do So

Dental extraction for caries is the most common reason for children aged 6–10 years to be admitted to hospital. Community Water Fluoridation (CWF) is safe and effective at reducing dental caries. It is most effective where there is more deprivation. However, many deprived areas do not have CWF despite Public Health England recommending it. Those who lobby against fluoridation do so using emotionally charged language and misinformation. We discuss the benefits of fluoridation and the specious arguments used against this important public health measure. The National CWF Network is led by dentists and promotes CWF. COVID-19 has led to the suspension of routine dentistry, renewing the urgency of implementation of CWF. Professional bodies such as the Royal College of Paediatrics and Child Health are urged to give their support.

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