Money Down the Drain |
Who pays for fluoridation?
BFS suggested answer
The total cost of fluoridation is borne by the NHS, not the water company nor the consumer.
Water fluoridation is a highly cost-effective public health measure. In a recent study of strategies for reducing tooth decay, the University of York Health Economics Consortium concluded that ‘the most cost-effective policy is fluoridation of water supplies’.
BFS suggested answer refuted
The figure given for cost effectiveness is calculated from the per capita expenditure for fluoridation chemicals, the average cost of a filling and a reduction in caries of 40%. Most of which collapses like a deck of cards when it is recognized that the reduction of caries is a ‘statistical illusion’.
Richard G. Foulkes, MD
The BFS’s suggested answer is disingenuous: You, the consumer, pay for fluoridation through your taxes. You pay for the fluoride that is put in the water, you pay for the equipment needed to meter it into the water, and you also pay for the British Fluoridation Society’s propaganda machine, as it is funded by the Department of Health. The British Fluoridation Society received £117,000 from a hard-pressed NHS in 1997. In Ireland, too, water fluoridation is paid for by the taxpayer.
In 1974 the World Health Organization based its recommendations on fluoridation on an expectation that a fluoride-based preventative programme could result in a more than thirtyfold saving of money on dental care.1 But far from saving money, fluoridation has been shown to be, in effect, a case of throwing money down the drain.
It is recognised by both sides of the argument, that the only people to benefit from water fluoridation are children up to the age of about twelve. But it is estimated that less than one-tenth of 1 per cent of all tap water is drunk by children of this age group. The rest is used by industry, for washing people, dishes, clothes and cars, for watering gardens, or is drunk by adults. Thus, for every £100 spent on water fluoridation, less than 10p reaches its target.
Added to this waste are the extra dental costs necessitated by the more complicated and expensive dental work that fluoride-damaged teeth require. Dentists may deny this, but it is easy to demonstrate the truth, merely by analysing regional trends in dental health expenditures in Britain (see Table 1). Doing so shows clearly that not only are there more dentists in fluoridated areas, but the amount spent per head of population is greater.
The most critical way to assess the effectiveness of fluoridation is to examine how much money is spent within regional Health Authority boundaries. For the purpose of this exercise, three UK regions, which have both fluoridated and unfluoridated communities within their areas, have been chosen for close examination of dental health costs. The picture that emerges from artificially fluoridated districts is that more fluoridation results in higher expenditure by the patient and, as most dentists today operate privately outside the NHS, more profit for the dentists.
Note: Art., artificial; Nat., natural; Opt., optimal. ‘Fluoride level’ shows the percentage of the population affected and the level of fluoride received; ‘Opt.’ means the fluoride concentration in water was greater than 0.7 ppm. ‘Expenditure’ is the sum of all receipts received for 1997 divided by the size of the population, thus giving the average cost of dentistry per person. ‘Dentists’ are those who were practising at the end of 1996; the ratio is based on the size of the total population divided by the number of dentists. The population levels are estimated at mid-1996 levels.
Table 1. Comparison of dental expenditure in selected fluoridated and unfluoridated districts of the United Kingdom
•East Anglia has no artificial fluoridation schemes in place, but some water contains a noticeable amount of naturally occurring fluoride. It is important to consider the impact of natural fluoride on a population because of the claim that natural fluoride is better than artificial fluoride. Observations in this region do not support that claim. Unfluoridated north-west Anglia has 23.5 per cent fewer dentists per head, and dental costs are down by almost 30 per cent compared with naturally fluoridated Suffolk.
•The northern region is home to two flagships of fluoridation: Newcastle and Gateshead. Both fluoridated since 1968, this allows us to compare adult expenditure. Both have the most dentists and the highest expenditure per head of population anywhere in the region. The only other major industrial town is Sunderland, which is also the only genuinely unfluoridated part of the region. Sunderland wins on all counts: dentistry is less expensive, and there are fewer dentists per head. Why is it that Newcastle and Gateshead have so many extra dentists if, as they claim, fluoridation reduces the need for them?
•West Midlands: Districts in this region are the ‘shining’ examples of the benefits of fluoridation, with Birmingham as the jewel in the crown. But expenditure in Birmingham is significantly higher than in less fluoridated Wolverhampton (all areas have some fluoridation). Wolverhampton is now 100 per cent fluoridated. It will be interesting to see how expenditure levels change and how many more dentists are drafted into the city to improve dental health.
•The western region: This part of England is significantly richer than the other regions examined. We can expect that teeth will be better and that less money will have to be spent on dental care. This proves to be the case. Again, there is a significant increase in the cost of dental care in the fluoridated part of the region.
Fluoridation is not cost-effective
According to Dr Hardy Limeback, more money is spent on treatment of dental fluorosis than on dental decay.’
It is easy to see why.
•It is accepted, even by the BFS, that a large proportion of children living in fluoridated areas suffer from dental fluorosis. Whether this is merely a cosmetic condition or a symptom of something more serious was discussed in Chapter 15, but either way, it is not aesthetically pleasing. Children with dental fluorosis need veneers to cover and hide their stained teeth – and a veneer is vastly more expensive than having a cavity filled.
•Fluoridation doesn’t stop cavities. Children in fluoridated areas still suffer dental decay. When these cavities need to be repaired, it generally costs more because the fluoride makes teeth brittle – and they have a tendency to shatter.
Put your money where your mouth is
Almost all the fluoride that the taxpayer purchases to put in tap water doesn’t reach its target; it merely pollutes the environment. If we choose to ignore the risks of fluoride and set as our goal the adequate provision of fluoride for children’s teeth, the most sensible way to do it would be to use toothpaste and the numerous fluoride-containing dental products. For families who can’t afford toothpaste, it would be more cost-effective for governments to provide these families with fluoride tablets or toothpaste. A policy of disseminating fluoride to the needy in this way would not only save money, it would have the added ethical advantage that much less toxic waste would enter the environment – and people who didn’t want fluoridated water would not be forced to drink it.
1.Davies GN. Cost and benefit of fluoride in the prevention of dental caries. Offset Publication, No 9. WHO, 1974.