by Robert Donald,
Chairman of the British Dental Association’s Scottish Council
It's election time, so expect to hear candidates banging on about ‘prevention’, ‘value for money’ and ‘evidence-based policy making’ until the cows come home.
Sadly, one phrase that’s unlikely to follow - that delivers on all three - is ‘water fluoridation’.
As a dentist it’s baffling why Scotland still seems no closer to taking forward a policy that’s safe, effective and could save our NHS a fortune.
On safety the science is clear cut, for anyone not wearing a tin foil hat. Drinking water fluoridated to the optimal level is safe for all ages, be they toddlers, pregnant women or care home residents. It clearly reduces decay in children - and with it wholly preventable pain and misery - and may also benefit adults.
READ MORE: Tap solution: Scots dentists' move for fluoride in the water supply to combat children's oral health crisis
And on cost, it's the same story. Wonks have established that a £1 spent on water fluoridation in more deprived areas can secure £12.71 in savings after just 5 years.
Fewer fillings, fewer extractions: it’s simple maths. And it’s an argument that’s been won the world over, for the 370 million who currently benefit.
This isn’t some throwback policy from the 1950s. In the last 15 years an additional 50 million people have been covered, and if recent messages from Westminster are anything to go by England is now set to follow.
Covid means oral health inequality in Scotland - already a source of national shame - is set to skyrocket. And so we need to think about joining the queue when it comes to our water.
This gap between rich and poor is not inevitable, but millions of missed appointments, the suspension of public health programmes, and sugar laden lockdown diets will only widen that divide.
Some 30% of P1 kids experienced decay in 2018. So if you're looking for reasons then why Scotland hasn't moved forward with a tried and tested policy, then it lies in political wrangling that saw plans shelved back in the early 2000s.
One big positive emerged. Recognising the necessity to get fluoride in contact with kid’s teeth Childsmile was born, the pioneering programme of supervised brushing and fluoride varnish application for young children that’s now been exported across the globe.
For Scotland today it’s not an either/or. Current disruption means action on water fluoridation would be a complement, not replacement for Childsmile, and one that could benefit the dental health of all – from teenage kids through to their grandparents.
But the political impasse is still with us. The Scottish Government’s 2018 Oral Health Improvement Plan recognised that water fluoridation could make a real contribution to improving health, but at the same time argued the “practicalities of implementing this means we have taken the view that alternative solutions are more achievable.”
Yet the Scottish Government has never seriously attempted to look at delivery. Yes, there could be potential issues. No one can pretend a programme in the Western Isles would look like one in the West of Scotland.
What’s missing is willingness in Holyrood to look at what is actually achievable. That starts by funding feasibility studies to show where the policy would work, factoring in both geography and patient need.
It’s not rocket science. As we emerge from COVID we can save millions and improve the oral health of all Scots. The question is are the next generation of MSPs willing to sign up?
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