Archived decisions

Item 3

Hampshire County Council Health Overview and Scrutiny Committee

Proposals to fluoridate drinking water in Southampton and south west Hampshire. Themes for discussion at formal evidence days- 25 September 2008 and 6 October 2008.

Members of the Review Group have highlighted a number of key themes to stakeholders covering a range of different issues raised by this complex issue. The questions set out below are suggested as possible lines of inquiry but members may wish to explore other areas of interest. Stakeholders have been invited to focus the views they wish to present in relation to the following points:

1. Improving oral health:

_ What are the main causes of poor oral health and what can be done to address these?

_ What are the national trends in oral health- is there a difference between fluoridated and non-fluoridated countries?

_ How does fluoride improve oral health and is there any difference between the topical and systemic application.

_ What is the action of fluoride on teeth- is it equally effective on all surfaces.

_ How does fluoride reduce health inequalities? Is there evidence to show that fluoride- from water alone- has benefited disadvantaged communities?

_ What are the effects of fluoride in water on the health of infants, children, adolescents and adults.

_ There are conflicting views about the incidence and impact of fluorosis on oral health- is there any evidence to suggest that fluorosis can have a detrimental impact on the oral health of a population.

2. Ethics:

_ What are your views on the ethical considerations of adding fluoride to water?

_ Do the potential benefits support this level of intervention?

_ Have the potential dis-benefits been appropriately assessed?

_ Why do you think this issue arouses such strongly held articulate but diametrically opposed opinion?

_ How can lay people and the public come to an informed view about this proposal given the conflicting information and research presented?

3. Impact on health:

_ There is a substantial body of literature that indicates that there is at least a plausible impact of fluoride on bone and other systems but research in a number of areas is not of suitable quality to allow conclusions to be drawn about the effect of fluoride on the human body. Hip fractures and osteosarcoma are particular areas highlighted in some literature, but others relate to I.Q., the endocrine system and Downs syndrome. These concerns are disputed in other research. Given this conflicting information, what is your professional view on the impact of the addition of fluoride to drinking water on the general health and well being of the population affected?

_ Is there any evidence to suggest that some individuals may be allergic to, or could suffer an adverse reaction to fluoride?

_ Is there any evidence to suggest that some individuals may be more sensitive to fluoride because of a medical or other condition?

4. Alternatives to fluoride in water:

_ The literature indicates that there are a number of alternatives to adding fluoride to water which can have a beneficial impact on oral health- what is your understanding of the benefits and constraints of these alternatives.

_ Can the effectiveness of these alternative be demonstrated?

_ Are there any cost implications that need to be taken into account?

_ What are the available alternatives for SCPCT to consider.

5. Exposure to fluoride:

_ The current recommended levels of 1ppm of fluoride in water were set at a time when there was less availability of fluoride in diet and oral health products. What is the evidence to support this level being added to drinking water and how has the efficacy of this dose been evaluated.

_ Given the reduction in fluoride in drinking water in Ireland (down to 0.7 ppm) is there evidence that a similar level should now be considered in England.

_ There is conflicting information about the impact that changing life styles and exposure to fluoride has had on populations particularly in a tea drinking nation such as ours. What is the estimated exposure to fluoride in adults and children in the UK. How does this vary across fluoridated and non fluoridated areas.

_ What impact does the total exposure of an individual to fluoride have on the suggested efficacy of fluoride in drinking water

_ What is the threshold at which exposure to fluoride ceases to be therapeutic. How is individual exposure assessed

6. The nature of fluoride:

_ The SHA document says the fluoride added to drinking water is `specifically manufactured to meet very high quality standards' how is it manufactured and by whom.

_ Who regulates the production of fluoride and how is its safety quality assured

_ Do people absorb fluoride in a uniform/predictable way, what difference does hard water make to the way in which people absorb fluoride?

_ Do people retain different amounts of fluoride in their bodies, where is this deposited and does it have any health implications for individuals

7. Legal and technical considerations:

_ Are there any legal or technical issues that the bodies proposing to add fluoride to water need to take into account.

_ We would be particularly interested in your views on the expectation that the NHS will indemnify the water companies should this proceed and any implication this has for the NHS in the future.

_ Is there an impact on manufacturing industries that use high levels of water to produce their goods.

_ Is it feasible to add fluoride to water supplies in smaller areas than the distribution zones identified.