HEREFORDSHIRE may have one of the worst records for tooth decay among five-year-olds across the West Midlands but health bosses could learn a trick or two from Hereford’s American namesake.

The Texan city of Hereford is known as the ‘town without a toothache’, with health officials there saying this is due to high levels of naturally occurring fluoride levels in the water.

Drinking water fluoridation is a highly divisive issue and continues to attract vocal opposition from some groups.

Herefordshire does not have a fluoridation scheme but a recent Public Health England report found that five-year-olds in areas with one were much less likely to suffer tooth decay.

Lara Anton, press officer at Texas Department of State Health Services, said jurisdictions in Texas also decide whether or not to fluoridate their water.

Hereford in Deaf Smith County has a natural fluoride level in its water supply of 2.6 mg per litre. The optimal amount of fluoride in drinking water should be 0.7 mg per litre, according to Centers for Disease Control and Prevention, the leading national public health institute of the United States.

“When fluoride levels are this high, fluorosis begins to form on children’s teeth when they are developing. People with fluorosis on their teeth are more resistant to tooth decay,” Ms Anton said.

Nuala Woodman, NHS England West Midlands deputy head of commissioning, said roughly a quarter of five-year-olds have tooth decay in the county with on average three or four teeth affected.

She presented a children’s dental health report as part of a county spotlight review to children and young people scrutiny committee last month and said most child tooth decay under six is untreated and less than 12% of children attend a dentist before their second birthday.

Many local children do not visit a dental practice until dental disease is well established, or they are in pain and require admission to hospital.