---

Water fluoridation and dental health: 2024 update

DOI: https://doi.org/10.58248/PB63

Overview

• Dental health is a significant public health concern with approximately 31,165 hospital admissions of children to extract decayed teeth in 2022-23. The estimated cost to the NHS of all tooth extractions in children is £40.7 million per year, most of which result from avoidable tooth decay.
• Although dental health has improved overall in England in recent decades, this masks substantial inequalities between some groups in the population.
• There is high quality scientific evidence that shows that water fluoridation is a safe and effective public health intervention that can improve overall dental health. Fluoridating water helps to strengthen dental enamel, which prevents dental decay (caries).
• Fluoride occurs naturally at very low levels in most drinking water in England. However, fluoride is also added to the water supplied to approximately ten percent of the population in England through water fluoridation schemes. In most areas with naturally occurring fluoride, fluoride levels are lower than for areas with a water fluoridation scheme.
• The Health and Care Act 2022 gives the Secretary of State for Health and Social Care the power to introduce, vary or terminate water fluoridation schemes. Previously, this was the responsibility of local authorities.
• The latest research shows that water fluoridation continues to have a positive impact on dental health and is associated with fewer dental caries. However, recent studies show reduced effects compared to previous studies, and insufficient evidence to demonstrate a significant reduction indental health inequalities.
• Most evidence for negative health impacts of water fluoridation are based on concentrations above safety limits determined by the World Health Organization. Dental fluorosis (cosmetic changes to the teeth) can sometimes occur if children’s teeth are over-exposed to fluoride when they are developing. Evidence does not suggest this is harmful.
• There has been concern around the potential effects of water fluoridation schemes on children’s neurodevelopment. Multiple systematic reviews have concluded that more high-quality studies are needed to fully understand this risk.
• This evidence can inform government decision making about expanding or introducing new water fluoridation schemes. It may also support government decision making on prioritising other interventions that may be effective in addressing dental health inequalities, such as targeted programmes to ensure all children receive the benefits of fluoride and national policy to reduce the consumption of sugar.

Corrections and clarifications

Some of the content in this briefing was updated in June 2025, following feedback on emerging evidence for negative health impacts of water fluoridation. The overview summary has been updated to reflect these changes. Changes to the original briefing are indicated in footnotes.

Acknowledgements

POST is grateful to Dr Sumayyah Mian for co-researching this briefing, to the Health and Social Care Committee for funding her parliamentary fellowship as part of the Faculty of Medical Leadership and Management’s National Medical Director’s Clinical Fellowship Programme, and to all contributors and reviewers. For further information on this subject, please contact the co-author, Dr Clare Lally.

POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

• Members of the POST Board*
• Professor W David Strain, University of Exeter Medical School and Parliament Thematic Research Lead for Health*
• Dr Michaela Goodwin, Division of Dentistry, University of Manchester*
• Dr Deborah Moore, Division of Dentistry, University of Manchester*
• Dr Lucy O’Malley, Division of Dentistry, University of Manchester*
• Department of Health and Social Care

* denotes people and organisations who acted as external reviewers of the briefing.