Health and Disease

Arya Bhatt: Water Fluoridation

Water fluoridation is the adjustment of fluoride ions within the public water supply. Through extensive research, water fluoridation has been evidenced to improve the oral health of the wider population, especially in areas of lower deprivation where levels of oral health are seen to be much worse. This article will look into how water fluoridation is implemented into society and evaluate whether the use of such systems is justified. Despite the initial benefits which may be visible in public water fluoridation, there are some potential drawbacks which a government would consider.

Water fluoridation does not change the taste, appearance or smell of drinking water and is completed by adding either sodium fluoride, fluorosilicic acid, or sodium fluorosilicate. These compounds are used to stimulate remineralisation of enamel on teeth. Sodium fluoride is more expensive than the other two and was the first compound used. Fluorosilicic acid is the most commonly used additive in the United States for fluoridation but the costs are high in transportation as it exists in liquid form. Sodium fluorosilicate is the sodium salt of fluorosilicic acid and is easier to ship than fluorosilicic acid. Even though water fluoridation schemes are utilised, natural sources of fluoride include seafood, potatoes, coffee and many fruits such as apples and peaches.

The first artificial water fluoridation for caries control was first introduced in 1945 in the US and a large fall in caries prevalence occurred. This not only presented the prospect of water mineralisation but also allowed for more dental products to include fluoride such as toothpaste and mouthwash. An increase in overall fluoride intake stimulates mineralisation of teeth while reducing likelihood of demineralising. The most appealing prospect of water fluoridation is that the general public does not have to take an active role in ensuring they receive fluoridated water. The American Dental Association stated that fluoride in water reduced tooth decay by around 20 to 40%. Whilst the World Health Organisation recommends a maximum level of 1.5mg/L of fluoride, areas of the UK with access to water fluoridation have around 1mg/L. Within the UK one large motivator for an increase in water fluoridation schemes is the large number of children with tooth decay. Within 2019 to 2020, 37,000 children were admitted to hospital to extract decayed teeth and the overall estimated annual cost to the National Health Service (NHS) for all tooth extractions in children is £50 million. A cultural change in children having sugary food and drink has exacerbated this effect but alongside dental education, water fluoridation will improve the oral health of certain communities.

Images reference:

a)       Regional difference in the prevalence of tooth decay in 5-year-old children in 2019

b)      Areas of fluoridation schemes and naturally occurring

These inequalities in oral health are driven by socio-economic status and deprived groups are more likely to have worse dental health. This is the reason why hospital-based tooth extractions are also more common in these areas of low socio-economic status. As seen in the comparisons of images (a) and (b), the areas in which water fluoridation schemes are put in place are closely linked to areas with high decay experience. Some areas are also fortunate to have naturally occurring fluoride due to the environment.

Despite these systems for improvement in oral health taking place, there are some limitations to water fluoridation. During childhood, a large exposure to high concentrations of fluoride during childhood can cause dental fluorosis, which results in white streaks and spots on the enamel which affects the aesthetic of the teeth. However, this is mainly for very young children. Skeletal fluorosis is another side effect of high concentrations of fluoride which leads to pain and damage to bones. This may lead to impaired joint mobility and an increased risk of fractures. There has been some research taken place to suggest neurological damage to unborn babies.

Even though some side effects to high fluoride exposure are visible, the overall oral health of the population would be improved with controlled amounts of fluoride which not only reduces NHS costs but avoids the need for patients, especially children, to undergo surgery for extractions due to decay. These fluoridation schemes being introduced alongside dental education on diet and care will improve the oral health of a population.

References: Water fluoridation – Wikipedia. [online] Available at:,and%20is%20the%20reference%20standard.

Arbor Oaks Dental. 2021. Natural Sources of Fluoride. [online] Available at:

Aoun, A., Darwiche, F., Hayek, S. and Doumit, J., 2018. The Fluoride Debate: The Pros and Cons of Fluoridation. [online] National Library of Medicine. Available at:

UK Parliament. 2021. Water fluoridation and dental health. [online] Available at: 2018. Why do we have fluoride in our water?.[online] Available at:

By Arya Bhatt

Arya Bhatt is a student in London, UK.

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