Question to the Department of Health and Social Care:

To ask Her Majesty’s Government, further to the Written Answers by Earl Howe on 28 October 2013 (WA 213) and 5 December 2013 (WA 60–1), whether they will now answer the question why Public Health England, in comparing the percentages with dental fluorosis in fluoridated populations published by McGrady et al in 2012 with those from the York systematic review, cited small categories of fluorosis which were not found in the York review, but omitted the statistically comparable total-fluorosis figures of 55 per cent in fluoridated Newcastle against 48 per cent worldwide in the York review in 2000.

Most dental fluorosis in England is mild and unlikely to be of any concern from a cosmetic perspective. When discussing the public health impact of this condition, it is useful to distinguish between mild to moderate dental fluorosis and more severe fluorosis which is likely to be of concern from a cosmetic perspective, rather than overall levels.

The study described in the paper by McGrady et al in 2012 photographed teeth in order to reducing potential examiner bias, a key recommendation of the York Review. The results might therefore not be directly comparable to the results of studies using older methodology.

Public Health England’s 2014 water fluoridation health monitoring report was published subsequent to the responses given on 28 October 2013 and 5 December 2013 and included a section on dental fluorosis, drawing upon the 2012 report by McGrady et al. A copy of Water Fluoridation Health Monitoring Report for England 2014 is attached.

The report displayed the individual categories of dental fluorosis that were used in the 2012 report by McGrady et al, including the proportion who showed no signs of dental fluorosis in the two cities studied. This is shown in the following table.

Descriptive data for fluorosis total-fluorosis (TF) scores by city

The probability values show that levels of dental fluorosis overall in fluoridated Newcastle were higher than in non-fluoridated Manchester. The proportion of children with dental fluorosis (TF score >0) was 55% in Newcastle compared to 27% in Manchester. Fluorosis recorded at a level of TF3, considered to be mild or mild to moderate, was 6% in Newcastle and 1% in Manchester. The prevalence of higher scores (TF4 or greater) was very low in both cities.

The methodology described in the 2012 paper by McGrady et al may give higher estimates of dental fluorosis compared to the direct examination by a dentist used in other surveys. The results give further assurance that there are low levels of dental fluorosis which might be of concern from a cosmetic perspective in both fluoridated and non-fluoridated areas.