False confidence

What’s the greatest dental public health measure we could implement? This question might elicit some interesting responses, but many I might imagine would say water fluoridation. As we are all aware, fluoridation has a big anti-lobby that usually acts vociferously to any introduction to a new area and even challenges the continued use in areas already fluoridated. When I was a humble dental student, I remember having it drilled into me (pardon the pun) that water fluoridation would be the single best thing to happen in dentistry since the introduction of fluoride toothpaste. We were told that those who stood against it were philistines and ignorant, ill-informed and looking to make issue. There was also the irritating fact that those who objected to the use of fluoridation are also those who are likely to have good oral health and they wouldn’t be the ones who would primarily benefit.

We as dentists and dental care professionals are slightly guilty of going along with this; we blindly sign-up to the belief that is given to us early in our careers. Has anyone ever questioned whether this is right? Have we been conned to some extent? Where is the evidence that fluoridation is the answer to our problems? This must seem sacrilegious - a dentist questioning the benefits of fluoridation! Have no fear, I am just as much a convert to the idea of fluoridation as the next GDC registrant, my reason for writing this article is that I have always been disconcerted about the idea of being challenged about fluoridation and having to defend it. The issue is that when challenged, the burden of proof is placed upon the expert (us) and those that challenge us have relatively little to defend or prove in return. “The studies show that fluoridation (swap for amalgam and any other dental material/ intervention you may need to defend) is perfectly safe and effective.” Does that sound familiar? If I’ve said this once, then I’ve said it a thousand times. In the case of fluoridation then what is the evidence?