Water fluoridation is beneficial for reducing tooth decay in children, particularly those living in more-deprived areas, and poses ‘no convincing evidence’ of detrimental effect on cognitive ability or hip fracture risk.
The findings were recently published by the UK Health Security Agency (UKHSA), which monitors and reports on the health effects of fluoride for people living in areas covered by water fluoridation schemes.
The probe analysed data on the health of people living in areas of England with differing levels of fluoride in their drinking water supply.
Fluoride occurs naturally and can be present in water and some foods in varying amounts.
However, in some areas with lower natural fluoride levels, fluoride is added to public drinking water in line with regulatory limits as a measure to reduce tooth decay, which is a significant public health problem in England and most common in more-deprived communities.
The report assesses three dental health outcomes: the prevalence of five and 10/11-year-old children with tooth decay, the average number of teeth per child with tooth decay in the same age groups, and hospital admissions for removal of teeth due to tooth decay in children and young people.
Two non-dental health outcomes were also studied: emergency hospital admissions for hip fracture in people of any age and cognitive ability in children aged five to seven years old.
Exposure to fluoride in the area where people in the study lived was measured in two ways: whether a water fluoridation scheme was operating in an area, and the average amount of fluoride in the drinking water.
The frequency of each health outcome was compared for people living in areas with different fluoride levels and with and without fluoridation schemes.
The analysis also took into account other factors that could differ between areas or people in the study, such as age, sex, ethnicity and deprivation.
Between 2017-2024, the range of fluoride concentrations found in local areas ranged from 0.01 milligrams per litre of water (0.01 mg/L) to 1.3 mg/L.
About 85% of the English population lived in areas with an average fluoride concentration below 0.40 mg/L.
And 23% of five-year-old children had experienced tooth decay, with an average of about 0.8 teeth per child affected in both 2022 and 2024.
Five year olds living in areas with fluoridation schemes compared to without were less likely to experience tooth decay and less likely to experience severe tooth decay (decay affecting about three or more teeth), and 0-19 year olds were less likely be admitted to hospital to have a tooth removed due to tooth decay.
Five year olds living in areas with higher compared to lower fluoride concentrations were less likely to experience tooth decay and less likely to experience severe tooth decay, and 0-19 year olds living in areas with higher fluoride concentrations were less likely be admitted to hospital to have a tooth removed.
Higher levels of fluoride in drinking water contributed to reducing these measures of tooth decay in children in both the more-deprived and the less-deprived areas.
However, these dental health benefits were largest for children living in the more-deprived areas.
And, taken alongside the wider international evidence and limitations of this study, the findings in the report provided ‘no convincing evidence of a relationship between emergency admissions for hip fractures and living in areas with higher fluoride levels in drinking water, or in areas with fluoridation schemes’.
It also reported ‘no evidence of a relationship between fluoride levels in drinking water and cognitive ability test scores in five or seven-year-old children’.
Because no relationship with levels of fluoride in water was found, the report did not assess a relationship with living in areas with or without fluoridation schemes.
The report concludes: “In line with previous HMRs, the findings of the 2026 HMR are consistent with the view that water fluoridation at levels within the regulatory limit for England (1.5 mg/L) is a beneficial public health intervention for reducing tooth decay in children, with no convincing evidence of harm to non-dental health.
“The dental health benefits were largest for those living in the more-deprived areas.”
The Water Fluoridation Health Monitoring Working Group continues to review evidence and will publish a further report within the next four years.