Adding fluoride to Plymouth’s drinking water may be considered as part of a drive to improve oral health.

Currently, one in 10 people in England receive fluoridated tap water, and the scheme could be expanded depending on public support. The government cites strong scientific evidence that fluoridation is safe, effective, and helps reduce tooth decay.

Plymouth City Council is exploring ways to improve oral health, as more than one in five children under five in the city have visible tooth decay.

Although the US Centres for Disease Control lists water fluoridation as one of the ten most important public health advances of the 20th century, it remains a contentious issue because residents cannot opt-out once fluoride is added to the water supply.

The government has the power to require water companies to increase fluoride levels to one milligram per litre—well within the World Health Organisation’s recommended maximum level known to reduce tooth decay. The Health and Care Act 2022 granted the secretary of state authority to introduce fluoridation schemes, a measure supported by both Conservatives and Labour when passed through parliament.

Similar schemes operate worldwide, including in the USA, Canada, and Ireland, covering an estimated 400 million people. In England, around six million people already receive fluoridated water, while some areas have naturally occurring fluoride at similar levels.

A plan for the northeast is currently awaiting evaluation, according to public health consultant Robert Nelder, who addressed Plymouth City Council’s health and wellbeing board.

Plymouth City Council established a dental task force 18 months ago in response to a local crisis, where 23,000 people—including more than 4,000 children—are waiting to see an NHS dentist. A new city centre dental practice, run by the Peninsula Dental School at the University of Plymouth, is set to open later this year. The ‘education practice’ will offer general, urgent, and oral surgery care, staffed by undergraduate and qualified dentists, therapists, and trainees.

Additionally, £900,000 from the Integrated Care Board (ICB) will fund oral health initiatives, such as toothbrushing schemes in Plymouth schools and across Devon. Free dental care is also being provided to children through a partnership with PDSE, the dental school’s social enterprise.

Mr Nelder said young people in deprived areas with fluoridated water had “really good oral health” but noted that no new fluoridation schemes have been introduced in the UK for 40 years. While fluoridation does not eliminate tooth decay, he said, it significantly reduces its severity and impact.

However, he acknowledged that opposition to fluoridation is “well-organised and very vocal.”

Plymouth lacks the recommended level of naturally occurring fluoride, and the most suitable site for fluoridation would be the Mayflower water treatment works. However, this facility does not supply all of Plymouth and also serves parts of the South Hams and Cornwall.

“The views of neighbouring areas, and indeed those across the South West, are still unknown and would need to be sought,” Mr Nelder said.

It could be many months before detailed regulations on water fluoridation are available.