Sir, we welcome the 'Statement on water fluoridation' from the UK Chief Medical Officers (CMOs), particularly in light of the proposed changes to legislation in this area.1,2

In order to gain public confidence in water fluoridation, we believe the risks must not be understated and the benefits must not be overstated. With this in mind, we were surprised to read in the statement that 'dental mottling is a small risk'. An authoritative systematic review estimated the risk of dental fluorosis of aesthetic concern to be in the order of 12.5% (where the level of fluoride was at 1.0 ppm), which we regard as substantial and many parents might regard as a high level of risk.3 It is our experience that the current generation of children are highly image-conscious and we see no sign of a reversal in this trend; we postulate that even the minor types of fluorosis might be of aesthetic concern to this future cohort.

The CMOs went on to state 'the cost of hospital admissions for tooth extractions among those aged 0 to 19 years in England was estimated to be £54.6 million, the majority due to preventable tooth decay'. In fact, the report they were quoting states that this figure was £33 million.4

We were also disappointed that the statement did not discuss the implications for dental practices of high numbers of children exhibiting fluorosis. We are convinced there will be an increase in the number of parents seeking advice and treatment for the condition. We would like to see the Department of Health offer training to practitioners in the diagnosis and treatment of fluorosis, particularly to those dentists and therapists currently operating outside of those areas that have fluoridated water supplies. Many of these practitioners will not have been trained in the minimally invasive techniques that are currently recommended to treat the condition.

Finally, we were pleased the CMOs noted the impact water fluoridation is likely to have in reducing dental health inequalities and we partly agree with this. However, without additional financial support, will NHS dental practices be able to offer treatment for dental fluorosis of aesthetic concern? We envisage a potential widening of dental health inequality where those parents who can afford to will pay privately for the treatment of this condition, and for those that cannot, their children will be sadly left untreated.