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Water fluoridation schemes have been employed for over 50 years. Water fluoridation has been a source of continuous debate between those who advocate its use as a public health measure and those who oppose it. There have been no new fluoridation schemes in the UK for nearly 30 years owing to principally legislative, but also geographic, financial, and political reasons. However, in early 2008, the UK Secretary of State for Health promoted the use of water fluoridation schemes for areas in England with the highest rates of decay. This article, the third and final article of three, aims to discuss the arguments surrounding water fluoridation and its continued relevance as a public health measure.
Clinical Relevance: This article aims to provide an update for general practitioners for the background and the current status of the water fluoridation debate and to enable them to answer non-clinical questions raised by patients.
Article
The first two articles in this series reviewed the history of fluorides in dentistry and of water fluoridation and the background for the evidence base that resulted in water fluoridation schemes. In this final article, we will examine the legal history and the current legislative status. We will discuss the arguments and evidence for those who advocate water fluoridation and those who oppose it as a dental public health measure. We will expand on the issues surrounding risk benefit for water fluoridation beyond dental fluorosis, and how they have altered with time. We will also discuss the continued relevance of water fluoridation as a contemporary public health measure.
Legislation of the water industry in the UK to protect the public and regulate the safety of water supplies has been in place for over 100 years. It appeared as a response to an outbreak of cholera from a public water supply.1 The majority of water companies were in the public sector for many years and were controlled at a governmental or local authority level. It was during this period of public ownership that the fluoridation schemes in the UK were introduced. On the basis that it was in the public's best interest, the water companies, both private and state owned, were persuaded to fluoridate water supplies. The companies were to fluoridate the water supply under a non-profit agreement whereby all appropriate costs were met by the state. However, a series of events in the 1980s changed the picture of water fluoridation with far reaching effects. The first of these events was a ruling given on a case before the Scottish judiciary.
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