PREVENTION OF DENTAL CARIES THROUGH THE EFFECTIVE USE OF FLUORIDE – THE PUBLIC HEALTH APPROACH
World map on dental caries( DMFT), 35-44 years
Figure 2. Levels of dental caries in 35-44-year-olds in countries as measured by the DMFT index, WHO Global Oral Health Data Bank 3
experiences from fluoridation programmes 11 and a workshop on the effective use of fluoride in Asia was held in Thailand in March 2011, which analyzed the opportunities and barriers in establishing sustainable fluoride programmes. 7, 8 Most industrialized countries have demonstrated a substantial decline of dental caries among children and growing proportions of adults tend to preserve their natural teeth. Several years ago high income countries in Europe, USA, New Zealand, and Australia 12 introduced several years ago comprehensive fluoride administration programmes based on water fluoridation, salt fluoridation, or milk fluoridation. The Scandinavian countries and Japan introduced systematic use of effective fluoridated toothpaste and this appears to be significant population-directed prevention as tooth brushing with fluoridated toothpastes is highly frequent.
2.1. Effective use of fluoride Fluoride is a key agent in reducing the prevalence of dental caries, which it achieves in at least three ways 12, 13:
• by encouraging repair( re-mineralization) of early damage to enamel caused by acid produced by the breakdown of sugars by plaque bacteria;
• by improving the chemical structure of the enamel, making it more resistant to acid attack; and
• by reducing the ability of the plaque bacteria to produce acid. WHO 1 emphasizes that the prevalence and incidence of dental caries can be controlled by the joint action of communities, professionals and individuals. In many low and middle income countries, however, access to oral health services is
limited, while in high income countries significant numbers of the underprivileged population groups are underserved. For these reasons, professionally applied fluorides such as fluoride varnish or fluoride gel are considered less relevant to public health programmes. Thus, according to WHO 14 the public health approaches to effective use of fluoride include:
• water fluoridation
• salt fluoridation
• milk fluoridation; and
• development of affordable fluoride-containing toothpastes. Government agencies and the private industry sector in charge of operation of water facilities, salt processing plants, dairies and toothpaste manufacturers have a very important role to collaborate on the development and implementation of community dental caries prevention programmes in which water, salt or milk alone or in combination with toothpaste are considered as vehicles for making fluoride available to the population.
3. Research on population-based prevention through fluoride Research on the effects of fluoride on oral health started slightly over 100 years ago. 15 During the first third of the century research focused on studying causes of mottled enamel. The next twelve to fifteen years researchers studied the relationship between fluoride, dental caries and enamel fluorosis. In the second half of the 20th century research aimed at adding fluoride to community water supplies and later to salt for human consumption; it gradually shifted to the development and evaluation of fluoride-containing toothpastes and mouth rinses
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