C&C DHB supports water fluoridation

Submission – Draft Annual Plan 2010/11

The Capital and Coast District Health Board Dental Service (Dental Service) is extremely concerned that the Kapiti Coast District Council (Council) is considering ceasing the addition of fluoride to water in the Waikanae, Paraparaumu and Raumati water supplies as part of this annual plan.

The Dental Service urges the Council to continue water fluoridation, as it is an integral part of the Dental Service’s management of dental decay for children and adults in these communities.

The Capital and Coast District Health Board Dental Service is the provider hospital based dental services for the population on the Kapiti Coast. We provide dental services at Kenepuru and Wellington Hospitals and manage the dental care needs of some of the most vulnerable children, adolescents and adults in the community.

We currently employ 34 staff and provide 900 in-patient sessions and 14,000 out-patient appointments per annum to 5000 patients per year.

If water fluoridation were to cease we estimate that treatment needs would increase by at least 20-30 percent in the Kapiti Coast population that we care for. These additional treatment needs will involve extra fillings, extractions and surgical procedures that will add to the staff needs, facility needs and costs for the service.

Expansion of the service to cope with the withdrawal of fluoridation is not a realistic option at this point. As you will be aware central government, health agencies and local government are all under fiscal pressure at this time. The District Health Board is not in a position to add further capital or operational funding to the service to cover an increase in service needs that would result from a decision of the Council to cease fluoridation.

We presume the Kapiti Coast District Council would also not be in a position to fund the additional costs arising for the Dental Service as a result of the withdrawal of water fluoridation.

The policy for water fluoridation and community benefit

The Ministry of Health recommends the adjustment of fluoride to between 0.7 ppm and 1.0 ppm in drinking water as the most effective and efficient way of preventing dental caries in communities receiving a reticulated water supply, and strongly recommends the continuation and extension of water fluoridation programmes where technically feasible.

This policy is also supported by The Drinking Water Standards for New Zealand 2005 which recommend the adjustment of water fluoride to between 0.7 mg/L and 1.0 mg/L for oral health reasons.

These policies are supported by the Capital and Coast District Health Board and underpin the District Health Board’s approach to funding and delivering dental services.

A significant portion of the vulnerable patients we see in our service are from the growing, older population on the Kapiti Coast who retain some or all of their own natural teeth. These people would be disadvantaged by the loss of fluoride from the water supply as there is evidence that water fluoridation at optimal levels provides an ongoing benefit to natural teeth throughout the lifespan.

Recent dental research has shown that older adulthood is a time of increased risk of dental decay. In fact, as older adults become increasingly affected by medical and disability problems the disease activity appears to return to similar or higher levels to that in childhood and adolescence. The majority of this adult dental care is privately funded as an out of pocket expense, and so ceasing of water fluoridation could be expected to add to the health costs of older adults, who are in many cases on fixed incomes.

However, when their needs cannot be managed in a private community-based dental practice they are referred to our hospital dental units. Management can involve the provision of a general anaesthetic to remove extensive and grossly carious teeth from disabled and older adults. We are very concerned at an avoidable increase in the need for this treatment, with significant increased risks to the patients if fluoridation is ceased.

Statistics New Zealand data indicates that there are approximately 40,000 residents in the Waikanae, Paraparaumu and Raumati areas. Based on a 1999 review of the cost effectiveness of water fluoridation undertaken by ESR: Kenepuru Science Centre for the Ministry of Health the 30-year fluoridation costs will be about $270,000, but the avoided dental costs across the community will be $6.5million. In annual terms that is a cost of about $9000 to the council. However, the avoided dental costs for your community would be about $216,000, based on very conservative assumptions in this paper. These analyses are all undertaken in 1999 dollars and so both costs would be proportionately higher today.

A decision by the Council to cease fluoridation would make absolutely no sense on a financial or a health basis, when the interests of the whole community are considered.

Water fluoridation is an important public health measure. Hutt Valley District Health Board staff in both the Regional Public Health Service and the Community Dental Service are well qualified to advise the Council and the staff are willing to provide advice and information to the Council if required.

Capital and Coast District Health Board Dental Service are also available to provide advice to Council on this issue as required and urge the Council not to discontinue water fluoridation in the Kapiti district.

We understand that the Ministry of Health also remains available to assist with information if required.

Read a letter from our CEO in support of water fluoridation [PDF] >