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Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 15 May 2008: National Fluoride Information Centre Conference: “Can we reduce dental inequalities in children?”

Good morning Mr President, ladies and gentlemen.

Thank you very much for inviting me to this conference today.  I am grateful to the University of Manchester for hosting the National Fluoride Information Centre, and indeed, for all their work researching fluoridation and how we can improve dental health in this country.

Fluoridation and the impact it can have on dental disease is of course, especially relevant here in Manchester and the North West because you have some of the worst rates in tooth decay in the country.

I have been interested in this issue for many years – in fact long before I came to the Department of Health – and I am delighted that as Secretary of State, I can give this important public health measure my support.

We all know that tooth decay is preventable through diet and through regular effective tooth brushing.  Over the last thirty years, thanks largely to fluoridated toothpaste, we have seen impressive reductions in the levels of dental decay.  In 1973, 93 per cent of all 12 year olds in England had tooth decay.  Thirty years later, that number had fallen to 38 per cent. In 1968, 37 per cent of adults had no natural teeth at all - we are expecting this figure to be about 6 per cent next year when we undertake the next National Adult Dental Health Survey.

Our older children have the lowest rates of dental decay in Europe, rates comparable with the best in the world.  Over 60 per cent of our children are totally decay free.  But there are still many children with severe tooth decay. We know the factors that lead to poor dental health – poor diet, lack of education and financial deprivation. I know that Fiona Adshead will be talking about some of these determinants in more detail later today.

There is one preventative measure that has a proven track record of closing the gap in this particular health inequality.  It is called fluoride: children here in Manchester, where the water has not been fluoridated, have up to three times as much dental decay as children in areas with a similar social profile, but with fluoridated water, such as Birmingham. 

Artificial fluoridation schemes have existed in this country for over 40 years and in America for over 60 years.  Some 70 per cent of Americans and Australians drink fluoridated water, as well as 40 per cent of Canadians and 45 per cent of Brazilians – the Brazilian government has observed falls in tooth decay of between 40 and 80 percent in areas where water is fluoridated. 

The evidence of the benefits of fluoridation and its safety are overwhelming. The York Review in 2000, identified 700 academic papers, and failed to find any proven evidence of a link to any systemic disease.  All water in this country contains some fluoride. In some areas, naturally occurring fluoride gives levels similar to those in artificial fluoridation schemes, with no evidence of harm over generations.

Fluoridation of water is a key measure in improving dental health amongst those people most at risk of tooth decay.  I am personally convinced of its benefits.  So is Parliament, the Department of Health, the British Medical Association, the British Dental Association, the Royal College of Paediatrics and Child Health, the UK Public Health Association and many others. However, Parliament’s acceptance recognised concerns amongst some people and the need for public consultation.  People must be able to express their opinions and local consultations will not command public confidence unless these issues are debated. People must have all the impartial information that they need in order to make well-informed decisions, which is why the work of the National Fluoride Information Centre, with its focus on evidence-based information, is so important.

In February, I asked PCTs in areas of poor oral health to kick start the consultation process. Parliament set this out in 2005, when it was decided to remove the veto from water authorities and put the initiative in the hands of the NHS.  If, after consultation with patients and the public, fluoridation is approved, financial support of £42 million will be available over the next three years.

I am convinced that water fluoridation provides the best way of improving oral health for the poorest in society. As existing fluoridated areas have shown, it gives poor kids rich kids’ teeth.  I am therefore delighted to give my personal support to SHAs that are determined to tackle health inequalities by conducting public consultations on new fluoridation schemes and thereby making the most of the new opportunities that the amended legislation provides.

So thank you very much for inviting me here today. I’m happy to take a few questions and then will leave you to get on with your important discussions.