Sir, we (two dentists and two paediatricians) would like to bring to your readers' attention the recent American Academy of Pediatrics (AAP) Section on Oral Health guidance on Fluoride use in caries prevention in the primary care setting.1

AAP state that 'fluoride varnish application is now considered the standard of care in pediatric primary care'. They recommend paediatricians and dentists in USA apply fluoride varnish, recommend the use of fluoride toothpaste, know how to determine the concentration of fluoride in a child's primary drinking water and determine the need for systemic supplements and advocate for water fluoridation in their local community.

Of course, American healthcare provision is different from that in the UK where paediatricians cannot apply fluoride varnish. But the other recommendations are relevant in a British context. AAP argue that community water fluoridation (CWF) continues to be 'a controversial and highly emotional issue' even though the concerns of those opposed to CWF have been shown to have no reliable scientific basis. Scientifically undertaken opinion polls carried out in the UK for the last 40 years, using samples properly representative of the population, have consistently shown that the majority of the population support CWF. Opponents are good at 'getting their vote out' during formal public consultation on implementing new schemes. Proponents of fluoridation need to be more effective in getting the silent majority to register their support.

In the UK, as a result of the COVID-19 pandemic, access to dental care has become difficult and NHS hospitals are postponing routine operations. The most common routine operation for children is dental extraction due to dental caries.2 These extractions under GA are being delayed and children are suffering prolonged toothache. Reducing the need for carious teeth to be extracted would not only benefit the children involved but also release capacity for other hospital care.

The UK government was elected on a policy of 'levelling up' the North and South of England. Dental caries prevalence is highest among deprived children in the North. We should be pushing at an open door to implement CWF in these areas. Is it not time that dentists speak out more vociferously on this issue and enlist the support of our paediatrician colleagues? Should we not jointly be stressing that the science is overwhelming, and there is a safe and effective public health intervention? Controversy and emotion are not acceptable excuses for failure to implement CWF to protect the public health of all and especially vulnerable children.