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The debate around whether fluoride should be added to tap water is not new.

The practice, which is aimed at reducing tooth decay, has been ongoing for 60 years.

But since fluoride toothpaste became more widely available around the 1970s, more questions have been raised about whether adding it to the drinking supply is still necessary.

And with Donald Trump’s health secretary pick Robert F Kennedy Jr saying he would ban it, the issue has entered public debate yet again.

Despite RFK being well known for his outlandish views on public health, it seems the fluoridation issue isn’t one that can be totally dismissed.

One study in the US has linked fluoride to a lowering of children’s IQs, while another in the UK has questioned its overall effectiveness when added to water.

So what is fluoride, what do experts say – and what’s the story in the UK?

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What is fluoride and what does it do?

It’s a natural mineral found in rocks, which leaches into soil, rivers and lakes.

It helps dental health by strengthening the tooth enamel, making it more resistant to tooth decay, and also reduces the amount of acid the bacteria on your teeth produce, according to the Oral Health Foundation.

Fluoride is known to be particularly beneficial for children’s teeth, as past studies have suggested ingesting it during the period of tooth development makes the enamel more resistant to later acid attacks and subsequent development of tooth decay.

Dr Kunal Patel, who has been a private and NHS dentist for 15 years, told Sky News the benefit of fluoride is “drilled into” dental students, adding there are “scientifically proven benefits of having fluoride within your oral hygiene regime”.

Fluoride is essentially a passive way of protecting your teeth, he says.

“If you decide not to use fluoride then the technique of brushing your teeth, your flossing and other methods of cleaning have to be that much better,” he adds.

How do we get fluoride?

Almost all water contains some naturally occurring fluoride, but it’s normally not enough to prevent tooth decay.

Some areas do have water supplies where the amount of fluoride is naturally at a high level – a point that will be covered later.

We get trace amounts of fluoride from much of our food and drink, but brewed tea in particular proves a big source because tea plants take up fluoride from soil.

Most toothpastes now contain fluoride to give you extra protection from decay.

When did adding it to the water supply become a thing?

Many oral health experts believe adding fluoride to water – an act known as fluoridation – is the most effective way to widely reduce dental problems, particularly in underprivileged regions.

The practice began in 1945 in Grand Rapids, Michigan, after scientists noticed that people had less tooth decay in areas with naturally higher fluoride levels in the tap water.

It was first added to the water supply in England in 1964, when a pilot scheme was launched in Birmingham.

Over the years it’s been rolled out to about 75% of America’s population, compared to about 10% of England.

The World Health Organization (WHO) estimates some 400 million people in 25 countries are getting artificially fluoridated water, while about 50 million have naturally occurring fluoride at the same level as the artificial schemes.

What is the ideal amount of fluoride in water?

The WHO recommends a maximum level of 1.5mg per litre.

In its guidelines, it says the level is aimed at creating a middle ground where tooth decay is minimised, but the risk of dental fluorosis and skeletal fluorosis is too.

Dental fluorosis is a common cosmetic condition caused by ingesting too much fluoride during tooth development, and can leave white flecks, spots or lines on teeth.

Skeletal fluorosis, a much rarer occurrence, is a chronic metabolic bone and joint disease caused by ingesting large amounts of fluoride.

The UK government aims for fluoride levels of 1mg per litre in drinking water, while the level of fluoride is kept at about 0.7mg per litre in the US.

Potential danger to children’s IQs

Fluoridation has been a contentious subject in the US, with more than 100 lawsuits over the years trying to get rid of it without success, according to the American Fluoridation Society, an advocacy group.

And the anti-fluoride group Fluoride Action Network says more than 150 towns and counties across the US have voted to keep fluoride out of public water systems or to stop adding it.

But the movement against it really gained momentum earlier this year when a US government report concluded that fluoride in drinking water at twice the recommended limit was linked with lower IQ in children.

The report, based on an analysis of previously published research, said it reached its conclusion “with moderate confidence”.

It cited a 2019 study, published in the well-respected journal JAMA Pediatrics, which found that IQ levels were slightly lower in three and four-year-old children whose mothers had higher measures of fluoride in their urine when they were pregnant.

A federal judge in California used the report to order the nation’s Environmental Protection Agency (EPA) to strengthen its regulations on fluoridation in September, saying the current levels were posing an unreasonable risk to children.

The judge stressed that he was not concluding with certainty that fluoridated water endangered public health, but rather that it poses a risk.

Questions over fluoride’s effectiveness

In the UK, while the government is reviewing plans to raise fluoride levels for millions and roll it out into more areas of England, a major review has suggested fluoridation may only have a “modest” benefit.

Academics at Manchester, Dundee and Aberdeen universities compared 157 studies looking at the effect of fluoridation on the dental health of communities.

When the government began adding fluoride to tap water, it reduced the number of decayed, missing or filled teeth by two whole teeth on average among children with their baby teeth, researchers said.

However, once fluoride toothpaste became widely available, that number declined.

Now, it is equivalent to a reduction of a “quarter of a tooth” that is decayed, missing or filled, on average.

“Water fluoridation is only having a modest benefit on dental caries, and those benefits may take years to be realised,” said Professor Anne-Marie Glenny, of the University of Manchester, who co-authored the paper.

Could it actually be scrapped in the US?

Mr Kennedy Jr has claimed Mr Trump will push to remove fluoride from drinking water on his first day in office, referring to it as “industrial waste” in a statement on X.

He also claimed fluoride was associated with arthritis, bone fractures, bone cancer, neurodevelopmental disorders and thyroid disease.

While there have been studies regarding some of those claims, none of them have been conclusive.

After the comments, Mr Trump told Sky News’ US partner NBC News that while he had not spoken to his health secretary pick about trying to scrap fluoride yet, “it sounds OK to me. You know it’s possible”.

The decision on whether or not add fluoride to water is ultimately made by state and local health authorities, so Mr Trump’s government can only advise them to stop it.

‘It’s about risk vs benefit’

Stephen Peckham, professor of health policy at the University of Kent, previously led a study on fluoridation’s potential links to hypothyroidism – an underactive thyroid – and is now part of a research team investigating whether it could be causing IQ issues within the UK’s population.

He tells Sky News he accepts fluoride can be beneficial, but adds it is not a necessity, especially in water.

“We know that ingested fluoride is not an effective way of preventing tooth decay,” he says. “If you want to have fluoride, put it on your toothbrush and clean your teeth with it. It needs to be applied to the tooth and not swallowed.”

He says that while the benefit is limited, the children’s IQ study carried out in the US highlights a need for caution.

“What we do know is that ingesting fluoride does have a neurologic, neurotoxic effect. What’s less certain is at what level of fluoride that begins.

“The judge is saying, well, in that case, shouldn’t we be more careful? And limit in particular pregnant women’s access to fluoridated water or consumption of fluoridated water.

“And your maximum of fluoride depends on how much you drink. So if you drink more, you get more.”

It’s about the “balance of risk and benefit”, he says.

“But if there’s not much benefit, should you have any risk? The answer is no, you shouldn’t.”

‘Stick to the most deprived regions’

Dr Kunal Patel, who owns six private dental clinics in Surrey, including one for children only, says fluoridation was “great in a time where there was less education and less access to fluoride in toothpaste”.

He adds that before the IQ study came out, he would have been happy to see fluoride being added to any area in the UK because he’d have thought “anyone could benefit” without there being any negative effects.

Now, he says, he thinks it’s best to be “selective” and limit fluoridating water “to the areas that are suffering, where it’s more rural or more deprived”.

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He gives the North West as an example, saying he recently did a charity event there to promote dental health among young people, and it was “shocking” to see how many of them did not even own a toothbrush.

He says it’s a “good idea” to expand to similar areas of the UK where dental health is low – but thinks it would be an even better idea to provide toothpaste to schools in such areas and increase their education regarding how best to look after their teeth.

“I think education is the way forward more so than fluoridated water.”

A Department of Health and Social Care spokesperson told Sky News: “The number one reason children aged six to 10 end up in hospital is to have their rotting teeth pulled out.

“Water fluoridation at levels permitted in this country is a safe and effective public health measure that reduces tooth decay.

“Prevention is always better than cure, and this government is committed to helping people stay healthy and keeping kids out of hospital.”

Is your water being fluoridated?

About 330,000 people live in areas of England with naturally occurring fluoride in drinking water, while around 5.8 million people get an artificial supply put in theirs.

It means some 10% of people in England live in areas where fluoride is added to the water, mainly in the West Midlands and the North East.

There is no fluoridation in Wales, Scotland or Northern Ireland.

Here is the full list of areas receiving artificial fluoridation in England, according to the British Fluoridation Society:

  • Cumbria – 120,000
  • Cheshire – 137,000
  • Tyneside – 643,000
  • Northumbria – 101,000
  • County Durham – 85,000
  • Humberside – 136,000
  • Lincolnshire – 250,000
  • Nottinghamshire – 287,000
  • Derbyshire – 43,000
  • Birmingham – 1,000,000
  • Solihull – 200,000
  • Coventry – 300,000
  • Sandwell – 300,000
  • Dudley – 305,000
  • Walsall – 253,000
  • Wolverhampton – 236,000
  • Staffordshire – 497,000
  • Shropshire – 22,000
  • Warwickshire – 431,000
  • Worcestershire – 253,000
  • Bedfordshire – 198,000

And here is the list of areas getting the “optimal” amount of fluoride naturally:

  • Hartlepool, County Durham – 89,000
  • Easington, County Durham – 47,000
  • Uttoxeter, Staffordshire – 13,000
  • Redbridge, London Borough – 180,000

Where else could fluoride be added to water?

The Conservative government introduced proposals to expand fluoridation schemes across the North East “because of the significant and long-standing inequalities in the region” when it comes to dental health.

A public consultation on the plans was launched in June and closed in July. Since Sir Keir Starmer’s Labour government won the election, it has not been clear whether the plans are still being pursued.

These are the areas the government proposed extending the fluoride supply to:

  • Darlington
  • Durham
  • Gateshead
  • Hartlepool
  • Middlesbrough
  • Newcastle
  • Northumberland
  • North Tyneside
  • Redcar and Cleveland
  • South Tyneside
  • Stockton
  • Sunderland

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In dramatic move, UK to buy F-35 stealth jets that can carry US nuclear warheads

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In dramatic move, UK to buy F-35 stealth jets that can carry US nuclear warheads

The UK will buy at least 12 F-35 stealth jets that can carry nuclear warheads in the most significant strengthening of its nuclear capability in a generation, the government has said.

Today, Sir Keir Starmer will tell a summit of NATO allies in The Hague that the new squadron will join an alliance mission that can be armed with US nuclear weapons.

The dramatic move will doubtless draw condemnation and concern from Russia and China.

But it comes at a time of growing global insecurity – and as the prime minister and his European and Canadian counterparts scramble to convince Donald Trump they are serious about bolstering their ability to defend Europe, instead of overly relying on the United States.

The US president, a long-standing NATO sceptic, raised questions about whether he would uphold the alliance’s founding Article 5 principle – that an attack on one is an attack on all – before he even arrived in the Dutch city last night.

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‘There’s numerous definitions of Article 5’

An urgent need to keep Mr Trump on side has prompted NATO allies to agree to increase spending on defence and national resilience to a new target of 5% of GDP by 2035.

As part of this push to rearm, Sir Keir will give the Royal Air Force the ability to carry airborne nuclear warheads for the first time since the 1990s.

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“In an era of radical uncertainty we can no longer take peace for granted,” he said.

“These F-35 dual capable aircraft will herald a new era for our world-leading Royal Air Force and deter hostile threats that threaten the UK and our allies.

“The UK’s commitment to NATO is unquestionable, as is the alliance’s contribution to keeping the UK safe and secure, but we must all step up to protect the Euro-Atlantic area for generations to come.”

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What is NATO’s 5% defence spending goal?

It was not immediately clear when the F-35 jets would be bought or how much they will cost, but the new squadron will be part of a NATO-led nuclear deterrence mission.

That is in contrast to the UK’s national nuclear deterrence, based on a fleet of four nuclear-armed submarines, though they too are used to defend the whole of the alliance.

Mark Rutte, the head of NATO, applauded the plan – saying: “The UK has declared its nuclear deterrent to NATO for many decades, ​and I strongly welcome today’s announcement that the UK will now also join NATO’s nuclear mission and procure the F-35A.

“This is yet another robust British contribution to NATO.”

Keir Starmer watches a demonstration by troops as he visits the Netherlands marines training base.
Pic: AP
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Sir Keir watches a demonstration by troops as he visits the Netherlands marines training base. Pic: AP

Aircraft operated by a small number of NATO countries, including Belgium, Germany and the Netherlands, are cleared to carry US-provided nuclear weapons in a war.

The RAF and the Royal Navy already operate F-35B jets that can fly off Britain’s two aircraft carriers, but they are not equipped to drop nuclear warheads.

The new planes will be the F-35A variant, operated by the air force, that take off from land but can fly further and be armed with nuclear or conventional weapons.

The government said they would all be based together at RAF Marham in Norfolk.

The government has long planned to purchase a total of 138 F-35 aircraft, but has so far only acquired around three dozen – seven years since the first jets entered service.

The decision to purchase 12 of the A-variant does not mean extra aircraft.

It just means a diversification in the fleet – something the RAF has long been pushing for – though it’s a decision some in the Royal Navy have long pushed back against, believing it would reduce even further the number of the B-version that operate from their carriers.

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Is the UK preparing for war?

The government described the plan to purchase nuclear-capable aircraft as the “biggest strengthening of the UK’s nuclear posture in a generation”.

Defence Secretary John Healey said a major defence review published earlier in the month highlighted new nuclear risks.

“It recommended a new UK role in our collective defence and deterrence through a NATO-first approach,” he said.

However, the public version of the Strategic Defence Review stopped short of making any specific recommendation.

It merely said “the UK must explore how to support the US and its NATO allies in strengthening extended deterrence across the Euro-Atlantic”.

The F-35 aircraft is made by the US defence giant Lockheed Martin, but the British defence company BAE Systems is also a key contributor.

The order will support 20,000 jobs in the F-35 programme in the UK.

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Doctors are using unapproved AI software to record patient meetings, investigation reveals

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Doctors are using unapproved AI software to record patient meetings, investigation reveals

Doctors are using AI software that does not meet minimum standards to record and transcribe patient meetings, according to a Sky News investigation.

NHS bosses have demanded GPs and hospitals stop using artificial intelligence software that could breach data protection rules and put patients at risk.

A warning sent out by NHS England this month came just weeks after the same body wrote to doctors about the benefits of using AI for notetaking – to allow them more time to concentrate on patients – using software known as Ambient Voice Technology, or “AVT”.

Health Secretary Wes Streeting will next week put AI at the heart of the reform plan to save the NHS in the 10-year plan for the health service in England.

But there is growing controversy around software that records, transcribes and summarises patient conversations using AI.

In April, NHS England wrote to doctors to sell the benefits of AVT and set out minimum national standards.

However, in a letter seen by Sky News, NHS bosses wrote to doctors to warn that unapproved software that breached minimum standards could harm patients.

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Text of warning letter with highlighted sections
NHS warning letter with text highlighted
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The version seen in the GP demonstration to Sky News complies with all NHS England standards and guidance

The 9 June letter, from the national chief clinical information officer of NHS England, said: “We are now aware of a number of AVT solutions which, despite being non-compliant … are still being widely used in clinical practice.

“Several AVT suppliers are approaching NHS organisations … many of these vendors have not complied with basic NHS governance standards.

“Proceeding with non-compliant solutions risks clinical safety, data protection breaches, financial exposure, and fragmentation of broader NHS digital strategy.”

Sky News has previously revealed the danger of AI “hallucinations”, where the technology makes up answers then lies about them, which could prove dangerous in a healthcare setting.

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Is ChatGPT reliable despite its ‘hallucinations’?

NHS England sets minimum standards but does not tell NHS trusts and healthcare providers which software providers to use.

Sky News can now reveal there is growing pressure on NHS England and similar bodies to be more proactive.

Dr David Wrigley, deputy chair of the British Medical Association’s GP committee, said: “Undoubtedly, as a GP myself and my 35,000 colleagues, we’ve got responsibilities here – but in such a rapidly developing market when we haven’t got the technical knowledge to look into this.

“We need that help and support from those who can check that the products are safe, check they’re secure, that they’re suitable for use in the consulting room, and NHS England should do that and help and support us.”

Dr Wrigley continued: “We’re absolutely in favour of tech and in favour of taking that forward to help NHS patients, help my colleagues in their surgeries.

“But it’s got to be done in a safe and secure way because otherwise we could have a free for all – and then data could be lost, it could be leaking out, and that just isn’t acceptable.

“So we are not dinosaurs, we’re very pro-AI, but it has to be a safe, secure way.”

Matthew Taylor, chief executive of the NHS Confederation
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The head of the NHS Confederation says the letter is ‘a really significant moment’

The spectre of dozens of little-known but ambitious AI companies lobbying hospitals and surgeries to get their listening products installed worries some healthcare professionals.

There are huge profits to be made in this technological arms race, but the question being asked is whether hundreds of different NHS organisations can really be expected to sift out the sharks.

Matthew Taylor, chief executive of the NHS Confederation, said the letter was “a really significant moment”.

He said it was right for the NHS to experiment, but that it needed to be clearer what technology does and does not work safely.

“My own view is that the government should help in terms of the procurement decisions that trusts make and should advise on which AI systems – as we do with other forms of technology that we use in medicine – which ones are safe,” Mr Taylor said.

“We’ll need [government] to do a bit more to guide the NHS in the best way to use this.”

When pressed whether in the short term that actually makes it sound like it could be quite dangerous, Mr Taylor replied: “What you’ve seen with ambient voice technology is that kind of ‘let a thousand flowers bloom’ approach has got its limits.”

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Godfather of AI warns of its dangers

Earlier this year, the health secretary appeared to suggest unapproved technology was being used – but celebrated it as a sign doctors were enthusiastic for change.

Mr Streeting said: “I’ve heard anecdotally down the pub, genuinely down the pub, that some clinicians are getting ahead of the game and are already using ambient AI to kind of record notes and things, even where their practice or their trust haven’t yet caught up with them.

“Now, lots of issues there – not encouraging it – but it does tell me that contrary to this, ‘Oh, people don’t want to change, staff are very happy and they are really resistant to change’, it’s the opposite. People are crying out for this stuff.”

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GP Anil Mehta
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GP Anil Mehta says AI software helps cut paperwork and patients are ‘extremely reassured’

Doctors who use AI that complies with national standards already say there are big benefits.

Anil Mehta, a doctor in the health secretary’s Ilford constituency, told Sky News he backed his MP’s drive for more AI technology in healthcare.

Dr Mehta demonstrated the version of Ambient Voice Technology that he uses.

This software, Accurx Scribe, has been developed and deployed in line with all current NHS England requirements for AVT, and there is no suggestion this product breaches any rules, standards or guidance.

Indeed, the company which developed it meets weekly with NHS England on creating a standardised approach to scale the benefits across the NHS.

“I spend 30% of my week doing paperwork,” Dr Mehta said.

“So I think once I’ve explained all of those features of what we’re doing, patients are extremely reassured. And I haven’t faced anybody that’s not wanted to have me do this.

He added: “(I) think that consultation with your doctor is extremely confidential, so that’s not changed at all.

“That remains confidential – so whether it’s a vulnerable adult, a vulnerable child, teenager, young child with a parent, I think the concept of that confidentiality remains.”

An NHS spokesperson said: “Ambient Voice Technology has the potential to transform care and improve efficiency and in April, the NHS issued guidance to support its use in a safe and secure way.

“We are working with NHS organisations and suppliers to ensure that all Ambient Voice Technology products used across the health service continue to be compliant with NHS standards on clinical safety and data security.”

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UK weather: Another heatwave could be on the way this weekend, forecasters say

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UK weather: Another heatwave could be on the way this weekend, forecasters say

Another heatwave could be on the way this weekend, forecasters say.

Temperatures could reach 30C, but some showers are expected before then amid more changeable weather.

Some parts of the UK will experience highs of 29C on Saturday, with the potential for 30C on Sunday and 31C on Monday, according to the Met Office.

Last Saturday was the hottest day of the year so far, with a provisional temperature of 33.2C recorded in Charlwood, Surrey.

The Met Office confirmed “many places” in England and “one or two areas” in Wales, including Cardiff, entered a heatwave last Friday.

A heatwave is recorded when an area reaches a certain temperature – the level of which varies across the UK – for three consecutive days.

Music fans can expect a mixture of sunshine and rain at this week’s Glastonbury Festival, where more than 200,000 people are expected to attend.

A person sunbathes in Furnivall Gardens, Hammersmith, west London. Pic: PA
Image:
Some parts of the UK entered a heatwave last week. Pic: PA

‘Risk of showers and thunderstorms’

Oli Claydon, from the Met Office, said Wednesday would be “warmer” with “an increasing risk of showers and thunderstorms”.

He said temperatures would reach a maximum of 27C on Thursday, with potential for heavy showers in the east and more persistent rain in the northwest of Scotland into the evening.

“Friday will see a maximum of 27C again as the high, the showers will clear away to the northeast, with local drizzle in parts of the South West and Wales through the day,” Mr Claydon added.

The South East of England is expected to experience the highest temperatures, potentially reaching 29C on Saturday and 30C on Sunday.

Temperatures could reach up to 31C on Monday, but there was lower certainty around that, Mr Claydon added.

Mr Claydon said it was possible the South East of England “could be looking at a short-lived localised heatwave”.

“When we had the warm spell last week it was much more widespread, we’re not likely to see that,” he added.

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So far, this month’s average daytime temperature is 19.2C, slightly above the June average of 17.68C.

But the Met Office said that temperatures were expected to fall next week.

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