Fluoride study fails to spark major changes

Junior health minister Philip Hunt said the NHS Centre for Reviews and Dissemination report, published in the British Medical Journal last week, showed fluoridation improved dental health and found no evidence of a link with cancer, bone fracture or Down's Syndrome.

However, the government has drawn back from making major policy changes on the back of the research. Lord Hunt said it would be asking the Medical Research Council to look at areas where further research was needed.

He also said it would be holding further talks with water companies and local authorities, while encouraging health authorities 'with particular health problems'to consider fluoridation.

Professor Mike Lennon, professor of preventive dentistry at Liverpool University and chair of the British Fluoridation Society, said ministers had acknowledged that current legislation, which leaves a final decision on fluoridation to water companies, was a mess. 'We want the government to stand by its public health white paper pledge, which was something along the lines of: if the York review finds it safe and effective we will pass legislation to force the water companies to fluoridate where local people support that, 'he said. 'The government is sitting on the fence at the moment. They are talking about HAs taking action. But HAs would say they have gone as far as they can. '

The National Alliance for Equity in Dental Health also renewed its call for government action.

The alliance was formed in 1996 after a National Association of Health Authorities and Trusts survey found HA decisions on water fluoridation were being blocked by water companies.

Lord Hunt was director of NAHAT at the time.

Then, he said legislation needed to be 'urgently reviewed' to deal with the problem.

The alliance, which includes the British medical and dental associations, congratulated the York team on the 'thorough and meticulous' review and the 'open and inclusive way in which it had been conducted'.

It noted that both the then-president and two vice-presidents of the National Pure Water Association, which vehemently opposes fluoridation, were represented on its advisory panel.

But the NPWA said the York study had concentrated only on water fluoridation, rather than the cumulative effect of fluoride from a number of sources, and that it had been 'highly selective' in the papers chosen for review. It also emphasised its continued opposition to 'mass medication'.

The York study was launched by then-health secretary Frank Dobson, a known supporter of fluoridation, following the publication of Our Healthier Nation last year.

Its report says there is clear evidence that fluoridation reduces tooth decay, although the reduction is 'smaller than previously reported'.

However, it says the reduction comes at the expense of an increase in dental fluorosis - mottling of teeth.

The British Dental Association says the problem has been known about for 70 years and can be overcome by helping children to use small amounts of low-fluoride toothpaste. The NPWA insists fluorosis is a symptom of fluoride poisoning.

NHS Centre for Reviews and Dissemination Report 18.

Publications Office, NHSCRD, University of York, York, YO10 5DD.£20. Links to the report and pressure group websites: www.hsj.co.uk