PUT back on the agenda in recent weeks by a strong pro-lobby mainly made up of health professionals, the ever-controversial issue of fluoridation of local water supplies to improve dental health was cranked up again today as another East Lancashire health trust was poised to decide whether to back it.

The question is being debated tomorrow by the Burnley, Pendle and Rossendale Primary Care Trust. This follows the Hyndburn and Ribble Valley PCT showing broad acceptance of fluoridation, but calling for more information before signing up with the British Fluoridation Society.

If the primary care trust follows suit tomorrow it will mean that the authorities in charge of much of East Lancashire's primary health care will be lining up with the professionals -- and that the already-vociferous concern of opponents of fluoridation will increase.

What is hardly in dispute, though, is the terrible state of people's teeth in East Lancashire, especially children's. East Lancashire ranks a rotten 94th out of 99 English health authority regions in the dental health league. And advocates of fluoridation believe putting the chemical in water supplies would improve our teeth at a stroke.

But just as they can offer lots of evidence as to the benefits, so, too, can the anti-lobby respond with equal amounts to contradict it. Yet, surely, though the cases for and against fluoridation do need to be debated on medical grounds to the fullest, the ultimate factor in any decision is whether people want fluoride in their water or not.

Who should decide that? The health professionals? The health trusts? No -- they are hardly democratically-elected bodies.

Local authorities, then? Perhaps -- but when they are elected by so few voters, it would be somewhat unethical for such an important decision to be taken by bodies that are not fully representative of the people. It could only be through local referenda that the fairest decision could be made -- and ought to be on an issue as momentous and controversial as mass medication.