European citizens' opinions on water fluoridation

To understand European citizens' opinions on water fluoridation, as part of research on their attitudes to the tensions between private and public interest.

Sixty-eight focus groups held (with an average of eight people per group) in September and October 2003 in 16 countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Poland, Portugal, Spain, Sweden and the UK).

Most participants were against water fluoridation, although groups in Greece, Ireland, Poland and Sweden were more in favour. Many felt dental health was an issue to be dealt with at the level of the individual, rather than a solution to be imposed en masse. While people accepted that some children were not encouraged to brush their teeth, they proposed other solutions to addressing these needs rather than having a solution of unproved safety imposed on them by public health authorities whom they did not fully trust. They did not see why they should accept potential side effects in order that a minority may benefit. In particular, water was something that should be kept as pure as possible, even though it was recognized that it already contains many additives.

While the vast majority of people opposed water fluoridation, this may be indicative of shifts away from public support of population interventions towards private interventions, as well as reduced trust in public agencies. Thus if research were to demonstrate more clear benefits of water fluoridation over and above that which can be achieved by use of fluoride toothpaste, then the public may become more supportive. However, lobby groups are likely to remain influential.