Hansard

I am pleased that the workings of the Scottish Parliament have allowed a small party to contribute to the debate through an amendment.

I have no problem with the Executive's motion, apart from its complete endorsement of the action plan for dental services and the increase in fluoridation.

I support the Scottish National Party's amendment, which proposes the abolition of charges for dental check-ups, and I completely support Nicola Sturgeon's comments on the provision of sugary foods and drinks in schools.

Members will forgive me if I concentrate on speaking to my own amendment. Much of the Executive's document, "An Action Plan for Dental Services in Scotland", is commendable, but in paragraph 22, under the heading "Contributing to Public Health", it says:

"Fluoridation of the water supply, where practicable, offers the most effective means of improving dental health".

In the "Proposed actions" section that follows, the plan says:

"proposals will be developed with Health Boards for consultation on fluoridation of the water supply."

My amendment seeks to alter the Parliament's endorsement of the action plan by suggesting that the commitment to the fluoridation of Scotland's water supplies be withdrawn.

There has been a change since the publication of the action plan in August 2000: three weeks ago, the long-awaited report "A Systematic Review of Public Water Fluoridation" was published by a Government commission. It was carried out by the NHS Centre for Reviews and Dissemination at the University of York.

Given the controversy over fluoridation and the constant debate about its risks, that review was to be something of a final say on fluoridation, although I very much doubt that it will be. It states:

"This review presents a summary of the best available and most reliable evidence on the safety and efficacy of water fluoridation."

In answer to a recent oral question, the Minister for Health and Community Care told the chamber:

"I have examined the evidence closely and believe that there is very strong evidence to suggest that fluoridation can have a dramatic impact on the health of our children's teeth."—[Official Report, 7 September 2000; Vol 8, c 138.]

What did the review find? Is fluoridation effective in reducing dental caries? To quote the review directly:

"Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken."

In other words, there is little evidence of any quality to answer the question whether fluoridation is as effective as is claimed in reducing dental caries.

The reviewers went on to say:

"Any future research into the safety and efficacy of water fluoridation should be carried out with appropriate methodology to improve the quality of the existing evidence base."

That clearly suggests that the minister and her advisers based their intention to fluoridate the water supply on scientific evidence of poor quality. I am not saying that that was deliberate; it is just that that has now been established. In other words, the idea that fluoridation has been proved to be effective beyond all reasonable doubt is false.

What does the little high-quality research on fluoridation, which we can trust, show? That fluoridation might help to prevent dental caries. Significantly, however, it also shows that the level of improvement is far lower than the figures that the advocates of fluoridation have been bandying about. Far from fluoridation being a miracle cure, the evidence shows that in only about 15 per cent of cases is it likely to bring about an improvement in dental health and the prevention of caries. A reasonable extrapolation from the figures is that if we add fluoride to the entire Scottish water supply, we will prevent one filling in six.

I draw members' attention to the effectiveness of other methods of reducing the incidence of dental caries. They have been carefully explained, I am happy to note, by the Deputy Minister for Community Care, with a list of thoroughly good ideas. Recent research from Tayside and Glasgow shows the effectiveness of school-based toothbrushing schemes, under which children are provided with their own tray and toothbrush and toothpaste at school and are supervised during the school day during their brushing.

The money that the Executive proposes or, perhaps, might spend, on fluoridation plant and chemicals would go a long way to cover the extension of such a scheme to all children up to the age of 11 years.

What about the possible harmful effects of fluoridation? On that, the reviewers said:

"The research evidence is of insufficient quality to allow confident statements about other potential harms or whether there is an impact on social inequalities."

That means not that there are no other harmful effects to health, but that no quality research on that has been done. It is perhaps of insufficient quality, but a lot of evidence suggests harmful health effects. We cannot just ignore it. If there is a suggestion that some of the population's health will suffer, we have to be sure and we must take a precautionary approach.