Public Meeting - Water Fluoridation

[Ushtey]

I think this thread does illustrate one thing, that looking at an issue at a very fine level of detail can distract from the bigger picture.

 

Irrespective of the relative health issues surrounding flouride, be they postive or negative, surely the bigger questions is, what problem is the flouride intended to resolve.

 

Surely if it is to resolve poor dental standards on the Island, then it might be more sensible to put effort into looking at the causes for that poor standard and the possbile commin links that may lead to that result (i.e. diet, location, education, income). When it's clear what the cause of the problem is, then it is possible to look at all the potential solutions (such as better education, improved diet in schools, increased investment in free dental healthcare, flouridation of the water).

 

Once you know what the problem is, you know what the possible solutions are, you can then look to implement a tiered solution that acts as a programme to maximise the effects of each part.

 

With regard to flouridation my concerns lie around the cost of adapting the water treatment works to cater for the dosing plants and the associated chmical storage. Having worked for the water authority as a project manager in designing and building the largest of these plants I know there will be costs associated with this, that they won't be cheap and that it wasn't a core requirement of the original design (but it was included as an option, there are areas that can be converted to house the equipment albeit at considerable cost).

 

Having discussed flouridation with Paul Emerson, we both agreed that providing free fruit to schools would have a big impact on dental standards amongst kids. Flouridation does have some benficial effects, but only if you actually drink the water. For those kids who don't drink tap water, don't have home cooked meals and who don't eat a lot of fruit, then it's not going to have any effect.

 

Hence the suggestion that the solution to the problem of poor dental standards has to be a multi strand approach.

 

Steve

 

p.s. I've yet to meet anyone who doesn't think more free dentists and regular dental check ups in schools would have the biggest impact. Unfortunately it's also one of the most expensive options long term.

[Skeddan]

Steve - I wholeheartedly agree with you - and think what you say makes complete sense - identify problems, look at segmentation and clusters, determine possible solutions and points of leverage, but also look at cost, risks and benefits of the various options in a programme. It is basic project and programme management approach.

 

The first thing of course is getting accurate and detailed evaluation - a comprehensive situational analysis if you like - that does not seem to have been done, hence isn't it a bit jumping the gun to be seeking to implement water fluoridation?

 

I am also wary about thinking only 'conventional' solutions ought to be considered. There may be innovative ways of addressing the problem. More dentists might be expensive, but what about oral hygienists? There does not have to be the 'bells and whistles' or nothing - one can have an in between - much like barefoot doctors in China. What about individual fluoridation dispensers? If the problem is limited to 100 or 1000 children maybe that would offer the optimal solution - one that would work in the scale of IoM - which itself is quite unique. However to design optimal solutions one must first not only evaluate the actual problem as you highlight, but also determine constraints, priorities and so forth. Again there does not seem to have been full proper evaluation of these.

 

I'm not saying this to be peverse, but I'm not convinced that more free dentists and regular check ups would have the biggest impact, nor that it would be the most expensive in the long term (water fluoridation could be significantly more expensive given potential harm it might cause). A ban on sweets in schools could have a big impact, education initiatives could be the biggest leverage. Maybe in primary and secondary schools there ought to be tooth brushing in the morning and after lunch as a norm - that could help drive a huge impact in habits and improvement in oral hygiene. I can't say that I don't have more fillings because I had regular check ups with a dentist - I was always clear and ok (I do need teeth descaled sometimes though - but that is often done by an oral hygienist). In one sense dentists are the ambulance at the bottom of the cliff - the biggest leverage is likely to be at the top of the cliff.

 

If I remember something like 80-95% of project risk is in the 'design of the design' - i.e. the initial stages in evaluating and determining the strategy. I have no idea if there is a project plan or methodology being followed by the Govt in the issue of dental health or water fluoridation - it strikes me that maybe there is not. Shouldn't that be a bit of a worry?

[Ushtey]

Steve - I wholeheartedly agree with you - and think what you say makes complete sense -

 

..............

 

That's a first for this thread....umm...any thread now I come to think about it.

 

Now then, where's the print button gone.......

[Ushtey]

More seriously though, i completely agree with your point about oral hygienists. A very good friend of mine is a dentist in the UK and she is often frustrated at her work load being filled up with people who's issues could quite easily be resolved by seeing an oral hygienist more regularly but who insist on seeing a dentist because they have it seemingly stuck in their heads that if it's an issue with their teeth then only a dentist will do.

 

Personally, only having visited a dentist once in the last 8 years, I'm not totally sold on the idea that unless you see a dentist you will have bad teeth. Education and good personal hygiene can go a long way by themselves (note: I am not recommending people don't visit dentists, my family all see dentists twice a year and not seeing one is my personal choice)

 

I am worried that the Government seem to have suggested looking at one possible solution and have talked themselves into a corner by defending that decision so vigourously. Equally, people passionately against flouridation make it difficult for the Government to step back from flouridation for fear of seemign to back down in the face of public protest.

 

I'm not sure it's possible this far into things, but it seems both sides need to find a means of compromise without either side seeming to win or lose. Perhaps a co-ordinated review by the DHSS and DoE of service provision might be one option. There definitely needs to be some thought into how to get out of this corner though, before the Island commits to something for the wrong reasons.

 

On a slightly different note, Ballakermeen has an excellent system of payment for school meals and snacks via a swipe card instead of cash, which parents can top up online. The only change it needs is to provide a weekly summary of everything bought on that card for parents to see first hand what their kids are eating during the week. It doesn't prevent the sweets from shops outside school hours, but it would certainly help. If something like this could be rolled out amongst all the schools on the Island, then parents could have a greater participation in their diet.

[Skeddan]

Once you know what the problem is, you know what the possible solutions are, you can then look to implement a tiered solution that acts as a programme to maximise the effects of each part.

 

This makes complete sense - but actually putting these kind of principles into practice is a lot harder.

 

Often there are all sorts of preconceptions and unfounded assumptions - e.g. more free dentists (or free fruit) without proper analysis and evaluation. It seems you now agree that more free dentists will not be the biggest impact ("only having visited a dentist once in the last 8 years, I'm not totally sold on the idea that unless you see a dentist you will have bad teeth") - and perhaps more oral hygienists could provide an alternative.

 

What is a basic though in any project management is taking proper account of risk. As I've said, water fluoridation presents a possible risk which hasn't been properly assessed or evaluated (e.g. possible incidence of neurocognitive disorders, auto-immune disorders etc.). Those have to be assessed and costed.

 

As I mentioned also the constraints have to be considered properly - including legal and ethical ones - which to me seem a very important issue that hasn't been fully considered.

 

It strikes me that the assessment so far seems very ad hoc.

 

p.s. you might find this gives some insight into the sort of issues that might be considered: http://www.paconsulting.com/industries/hea...e_management.ht

[%age]

Manx Radio Report

 

From this Tuesday's Tynwald Question paper

20. The Hon Member for Rushen (Mr Gill) to ask the Minister for Health and

Social Security -

(1) When were the findings of the dental survey reported in the Manx

Independent of 1st February 2008 under the banner headline “Tooth

decay shock”, relating to Manx school childrens’ dental problems, first

published; and

(2) why has your Department chosen to re-release the findings of this

survey at this time?

[ballaughbiker]

Skeddan - replying to your question on the 15th, I think those at risk could be identified pre school if they attend one of the many nurseries around the island. I don't think it is policy to routinely check this age group though. Afaik it is only school children who get checked (ie reception age group upwards. Despite this I know that the nursery teacher at Manor Park asks for their children to be checked but it only occasionally gets done. In my opinion, the sooner the at risk kids are identified the better.

 

I'm sure the Community Dental service offer treatment to these children but in real life getting something done is another matter.

[Schiele1]

Hi All,

Am new to the forums. The reason I checked them out today was that I was hoping I might read something encouraging on the topic of fluoridation. As some have touched upon, the matter really is about freedom. For a small minority of children the IOM Gov is considering mass medicating the entire population. How about those with osteoporosis - almost certainly a larger section of the community - are they going to add Fosamax to the water for them? Or perhaps iodine for the thyroidally challenged ...Shouldn't give them ideas...

 

Recent studies show that topical application is most effective. Toothpaste for example. The proposed approach is laughable. Introduce poison into everyone's system to target a few teeth in a small minority of the population. Please can you explain what is intelligent about that?

 

Definitely agreed with those who have suggested better prophylactic care. (Are we allowed to agree with people on this thread?). But that's too easy I guess.

 

What about farmland etc etc? I thought the island was trying to market produce on the basis of low pollution or was considering going organic? An impossibility if this legislation goes through.

 

And talking about legislation. As fluoride is not classed as an essential nutrient nor is it necessary to improve water quality then perhaps we are talking new legislation to allow other things to be added to the water. Is this really the way we want to go?

 

The whole thing is ridiculous and guess what - not all European countries do this. Despite the fact that some have a far superior health service. So I wonder why they don't want it. Think about it. Maybe we need to read ALL the evidence objectively.

[nipper]

....The proposed approach is laughable. Introduce poison into everyone's system to target a few teeth in a small minority of the population. Please can you explain what is intelligent about that?

 

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