The history of water fluoridation in Scotland

Objectives: To examine the history of water fluoridation in Scotland, assessing its implementation, cessation, and impact on dental caries, and to evaluate whether water fluoridation should be reconsidered in future public health strategies. Basic research design: A historical review of water fluoridation in Scotland conducted using peer-reviewed studies, government reports, and legal documents. Data was synthesised chronologically on fluoridation's impact, legislative challenges, policy shifts, and public attitudes. Main outcome measures: Dental caries prevalence and treatment costs, public and political attitudes toward fluoridation, and legislative and policy developments affecting the implementation or cessation of fluoridation in Scotland. Results: Scottish fluoridation schemes significantly reduced caries prevalence and treatment costs. Fluoridation was discontinued following legal challenges. Post-cessation studies reported rising caries rates and treatment costs. Recent public attitude surveys indicate majority support for fluoridation. While Childsmile has improved oral health, fluoridation remains the most effective passive intervention. Conclusion: Scotland's fluoridation history highlights the tension between scientific evidence, legal constraints, and public perception. While current policy prioritises individual choice, integrating fluoridation into Childsmile could enhance caries prevention across Scotland. Renewed policy discussions and public engagement are essential for reconsidering fluoridation as part of Scotland's long-term oral health strategy.