Community water fluoridation

What we are doing?

We are looking at the possibility of fluoridation in Hull as one way of reducing tooth decay.  No decision to make a formal proposal for water fluoridation has been taken in Hull.  Initial indications are that fluoridating Hull’s water supply would also impact on some neighbouring areas of the East Riding of Yorkshire. We are still at an early stage and need to do further background work before we can begin any formal discussions.

Exploring the possibility of water fluoridation is just one part of our overall approach to improving oral health in Hull.  Our Oral Health Action Plan 2015-2020 contains more information about oral health in Hull and what else we are doing to make it better.


What is water fluoridation?

Fluoridation is when fluoride is added to the water supply by the local water company. Fluoride is a naturally occurring mineral found in water in varying amounts, depending on where in the UK you live. It can help to prevent tooth decay, which is why it's added to many brands of toothpaste. For more information about fluoridation see the NHS choices website.

NHS choices

Why are we looking into fluoridation?

The key to good oral health is regular check-ups at the dentist, brushing twice a day with fluoride toothpaste and limiting sugary food and drinks. However, the poor oral health in Hull shows that this advice is not working for everyone.

In Hull, 38 per cent of five year olds have tooth decay.

Although oral health is getting better, the rates of tooth decay in Hull are still significantly worse than the average regional and national rates and are not improving fast enough to reduce the inequalities. We still need to do more for our children and our population generally.

Find out more information on oral health needs in Hull.



Poor oral health can lead to

  • significant but avoidable suffering and pain
  • days off school
  • time off work
  • low self-esteem and confidence
  • hospital admissions and treatment under general anaesthetic for children
  • costly dental treatment.

What are the benefits of Water Fluoridation

Scientific evidence reviews confirm that fluoride in water at a level of 1ppm (part per million) can safely and effectively lower the risk of dental decay and reduce its severity.  

Public Health England consider there to be ‘strong evidence’ for the effectiveness of water fluoridation and they recommend its consideration in their ‘Toolkit for Local Authorities’, in which they say that ‘reviews of studies conducted around the world confirm that water fluoridation is an effective, safe public health measure suitable for consideration in localities where tooth decay levels are of concern.’

The benefits that these high quality reviews have shown include

  • children in fluoridated communities have fewer decayed, missing and filled teeth than children in non-fluoridated communities
  • a reduction in tooth decay in adults living in fluoridated areas compared to non-fluoridated areas
  • a reduction in hospital admissions and general anaesthetics for children
  • an apparently greater reduction in tooth decay in children in fluoridated areas living in the most deprived local authorities.

Fluoridation support

Fluoridation is widely supported internationally including by the World Health Organisation. Within the UK, water fluoridation is approved as a public health measure by many important organisations, including

  • Public Health England (PHE)
  • British Medical Association Board of Science
  • Faculty of Public Health of the Royal College of Physicians
  • Faculty of Dental Surgery of the Royal College of Surgeons of England
  • British Dental Association
  • British Society for Paediatric Dentistry

Locally, there is a high level of support from dentists and other health partners.

Find out more about the support from Hull Clinical Commissioning Group (CCG), the Local Dental Committee (LDC) and the Local Medical Committee (LMC).


Is there any evidence of unwanted or harmful effects from water fluoridation?

Some fluoride occurs naturally throughout the world in water used for drinking, but the amount is hugely variable.  A very low level of natural fluoride, as found in most parts of England, causes no documented harm to health. 

There is not considered to be any reliable evidence of any adverse impact on general health from fluoride in water at a concentration of 1 ppm (part per million), whether naturally occurring or added.  More detail can be found in the linked document.

In the Toolkit for Local Authorities, Public Health England says ‘the common finding of the reviews looking at dental health is that levels of tooth decay are lower in fluoridated areas and, for reviews which looked at general health effects, that there is no credible scientific evidence that water fluoridation is harmful to health.’

More detail can be found in the linked document.



The only known unwanted  effect from water fluoridation at 1ppm  (part per million) is an increase in mild / moderate dental fluorosis (mottling of teeth). A small minority of children in both non-fluoridated and fluoridated areas of the UK have noticeable dental fluorosis (mottling of the teeth), though severe dental fluorosis is rare.  The rate of fluorosis is higher in fluoridated areas.  Dental fluorosis is entirely cosmetic and does not indicate or result in any harm to general health. 

The 2015 Cochrane Review on water fluoridation for the prevention of dental caries, says "it should be acknowledged that moderate fluorosis may be considered an ’unwanted effect’ rather than an adverse effect. In addition, mild fluorosis may not even be considered an unwanted effect".

More detail can be found in the linked document on dental and skeletal fluorosis.


Other concerns about water fluoridation

Additional concerns that are sometimes raised about water fluoridation include topics such as:

  • fluoridation and water quality
  • water consumption, long term exposure and total fluoride intake
  • impact on specific population groups
  • ethical considerations
  • water fluoridation in other countries

Find out more detailed information for concerns about water fluoridation.


Who pays for community water fluoridation

Public Health England pays for the capital cost of water fluoridation schemes. Local authorities are responsible for the operating costs and the cost of feasibility studies. Local Authorities receive no money for introducing water fluoridation schemes.


What happens next

Parliament has allowed local authorities to make decisions on the introduction of local water fluoridation schemes to improve public health, but has laid down a strict legal process that must be followed. 


Contact us

We will be adding more information to these pages over the coming weeks and months as we go through the legal process and in response to any questions we receive. If you have any questions or feedback please contact us at