PREVENTION OF DENTAL CARIES THROUGH THE EFFECTIVE USE OF FLUORIDE – THE PUBLIC HEALTH APPROACH
Mean DMFT of older people 65 years or more by WHO Region
30
25
20
DMFT
15
10
FT Mean MT Mean DT Mean
5
0 AFRO AMRO EMRO EURO SEARO WPRO TOTAL
Figure 3. Dental caries experience( DMFT) among older people( 65 + years) across WHO regions of the world, as measured by the DMFT index, WHO Global Oral Health Data Bank ³( AFRO = Africa, AMRO = Americas, EMRO = Eastern-Mediterranean, EURO = Europe, SEARO = South East Asia, WPRO = Western Pacific)
and, to studying the use of milk as a vehicle for fluoride as a possible public health alternative to water or salt fluoridation. More recently, efforts have been made to summarize these extensive data sets through systematic reviews, such as those conducted on water fluoridation by the University of York National Health Service Centre for Reviews and Dissemination 16, 17, on fluoride ingestion and bone fractures 18 and on fluoride toothpaste 19 and mouth rinses 20 by the Cochrane Collaboration Oral Health Group.
3.1. Water fluoridation The history of water fluoridation can be divided into three periods. 21 The first period from 1901 to 1933 focused on investigating causes of mottled enamel( Colorado brown stain, first reported by Frederick McKay). The second period between 1933 and 1945 attempted to study the relationship that might exist between fluoride concentrations, fluorosis and dental caries, and established that moderate levels of fluoride prevent dental caries. The third period, from 1945 to the present focused on adding fluoride to community water supplies. In 1945, the first controlled experiment of water fluoridation was initiated by H. Trendley Dean in the city of Grand Rapids, Michigan United States of America. 22 Five years later, Dean reported that there were significant reductions in dental caries. These results were complemented by Arnold et al. in 1953. 23 Other major fluoridation programmes followed the first community programme for water fluoridation instituted at Grand Rapids; in the USA in Newburgh in 1945 24, and in Evanston, Illinois in 1946; 25 in Canada in Brantford and Ontario in 1945; 26 in the Netherlands in 1953; 27 in New Zealand in 1954 28; in the United Kingdom in 1955 29-31, and in the German Democratic Republic in 1959. 32 The outcomes of these programmes were published mainly in the 1950s and 1960s. As a result, many community water fluoridation programmes were introduced in the largest cities of the USA, including Indianapolis( 1951), San Francisco( 1952), Philadelphia( 1954), Chicago( 1956), New York( 1965), Dallas( 1966), and Detroit( 1967). The average cost of water fluoridation in the USA has been estimated at the level of 1US $ per person per year. 33 Worldwide, extensive fluoridation programmes have also been introduced in Australia, Brazil, Chile, Colombia, Canada, Hong Kong Special Administrative Region of China, Ireland, Israel, Malaysia, New Zealand, Singapore, the United Kingdom, and elsewhere. More recently, new programmes have been introduced in large conurbations in the south and west of the USA, including Los Angeles( in 1999), Las Vegas( in 2000), Sacramento( in 2000), and San Antonio( in 2002). Systematic reviews consistently conclude that water fluoridation reduces the prevalence of dental caries, i. e. the percentage of the population with decayed, missing and filled primary teeth( dmft)/ Decayed, Missing due to caries, and Filled permanent Teeth( DMFT) > 0 and reduces the incidence of dental caries. There is no credible evidence that water fluoridation is associated with any adverse health effects. Water fluoridation has benefits in addition to those associated with the use of fluoride toothpastes alone. In order to properly implement water fluoridation programmes a central water distribution system is indispensable. In addition, the full support of the top health authorities and of the government is essential; some countries have secured laws, decrees or regulations. Adequate budget for the initiation and maintenance of programmes is
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