Water fluoridation: health monitoring report

22 March 2018

On behalf of the Secretary of State for Health and Social Care, Public Health England (PHE) published a report monitoring the health effects of water fluoridation schemes in England – as required by the Water Industry Act 1991.


Fluoride naturally occurs in drinking water in varying concentrations, but water fluoridation schemes involve adding fluoride to public water supplies with a low fluoride concentration with the aim of preventing tooth decay – a significant problem in the UK experienced by 1 in 4 5-year-olds at the time of the report's publication.

This was PHE's second report on this issue – the first was published in 2014 after PHE became the responsible authority for monitoring the impact of water fluoridation on health in 2013.

Upon publishing the 2018 report, PHE confirmed that it would report on this issue at least every 4 years.

Report findings

The report compared data on dental and non-dental health outcomes – selected on the basis of existing evidence – between populations living in areas with different levels of fluoride in their drinking water supplies.

PHE concluded that fluoridation was an effective public health measure for preventing and reducing tooth decay. The report did not find any evidence that those living in water fluoridation areas experienced higher rates of health problems such as hip fractures, kidney stones, Down's syndrome, or cancer.

Other key findings included that:

  • tooth decay was less likely among 5-year-olds in areas with fluoridation schemes compared to those without
  • children living in deprived areas of England benefited the most
  • tooth removal due to decay was much less common in areas with fluoridation schemes than in areas without.  

Public Health England.
Water fluoridation: health monitoring report for England 2018.
Public Health England; 2018.