Fluoridation policy and practice: a European story separating myths from reality.

Background. Controversy surrounding the addition of fluoride to water has prevailed in public discourse for the past ~ 20 years but recently an anti-fluoride stance has been gaining more traction in the Republic of Ireland undoubtedly assisted by social media with an ever increasing number of local authorities voting to ban the practice of adding fluoride to the water supply. No previous research has examined fluoridation policy and practices across the EU. The aim of this review was to examine water fluoridation policy and practices across the EU to explore how they had come about and what they are based on. Methods. The Office’s with responsibility for fluoridation policy in all 28 EU members were contacted, seeking information on fluoridation policy and practice. Responses were then grouped into common categories by country. Results. Ireland and the UK are the only EU member states currently adding fluoride to water at a whole population level. Some regions in Spain are also fluoridated. None of the other 25 member states had a specific policy on fluoridation and none add fluoride to water currently, although some had in the past. Some policy makers said fluoride was not added because of naturally high levels arising from volcanic regions, presence in other foodstuffs or alternative sources such as tablets and toothpaste were advised. No policy maker contacted could cite evidence of harm except at exceptionally high doses. The rationale for not adding/discontinuing fluoridation of water was cited by some as resistance from anti-fluoride lobby groups, concerns about mass medication, concerns about it being unethical and unecological. Discussion. it appears that countries across Europe discontinued the practice of water fluoridation for a variety of reasons but none of them were due to evidence of harmful or adverse effects. Conclusion. There is no evidence that any country ceased adding fluoride because of evidence of harm. Politicians/elected representatives should act on evidence before advocating for the removal of fluoride from community water schemes which could have potentially serious personal and economic consequences particularly for disadvantaged children.