COMMUNITY DENTISTRY
PREVENTION OF DENTAL CARIES THROUGH THE EFFECTIVE USE OF FLUORIDE – THE PUBLIC HEALTH APPROACH
Poul Erik Petersen 1a *
1
Department for Global Oral Health and Community Dentistry School of Dentistry , Centre for Health and Society , Copenhagen , Denmark
a
DDS , Dr Odont Sci , MSc ( Sociology ), BA , Professor
Received : July 08 , 2016 Accepted : July 11 , 2016
Available online : August 17 , 2016
Cite this article : Petersen PE . Prevention of dental caries through the effective use of fluoride – the public health approach . Stoma Edu J . 2016 ; 3 ( 2 ): 130-140 .
ABSTRACT
Background : The World Health Organization ( WHO ) emphasizes that dental caries is a severe public health problem across the world . The current global and regional patterns of dental caries reflect distinct risk profiles of countries which relate to the structure of the society , living conditions , lifestyles , and the existence of preventive oral health programmes . Research conducted in high income countries documents that systematic use of fluoride reduces the burden of dental caries ; such research is scarce in low and middle income countries . Objectives : This article reviews the evidence on effective use of fluoride , highlights the public health approach to fluoridation , and clarifies how automatic fluoridation contributes to breaking social inequities in dental caries . Data collection : Scientific publications on fluoride administration stored in PubMed / Medline and caries data from the WHO databank . Outcome : Dental caries identified from national surveys or country relevant data ; extraction of scientific reports is based on their public health relevance . Conclusions : The article outlines the history of fluoridation programmes and describes the sound evidence on automatic fluoridation through water , salt and milk , or from the use of high quality fluoridated toothpastes ( 1000-1500 ppm F ). The experiences from the implementation of programmes in various countries are discussed and the potential for breaking the social inequalities in the burden of dental caries is clarified . Finally , the role of WHO in the development and implementation of fluoridation schemes is explained ; WHO technical assistance in the outcome evaluation and assessment of fluoride exposure is enlightened . Keywords : burden of dental caries , social inequalities , population-based disease prevention , automatic fluoridation , WHO .
1 . Introduction Dental caries continues to pose an important public health problem across the world . The World Health Organization ( WHO ) emphasizes that the disease affects about 60 – 90 % of schoolchildren and the vast majority of adults ; moreover , dental caries contributes to an extensive loss of natural teeth in older people globally . 1 , 2 Meanwhile , in most westernized high income countries , dental health has improved over the past three decades in parallel to the introduction of prevention-oriented oral health systems . A decline in the prevalence and the severity of dental caries is particularly observed in children and younger adults in countries having established public health programmes using fluoride for dental caries prevention , coupled with changing living conditions , healthier lifestyles , and improved self-care practices . In Eastern Europe and Central Asia dental caries levels are high and with health systems in transition the exposure of the population to fluoride for disease prevention has diminished dramatically . In low and middle income countries of Asia , Latin America , and certain areas of Africa , the prevalence of dental caries is growing considerably . The lack of preventive programmes is further complicated by the fact that these countries have a shortage of oral health personnel and the capacity of oral health systems is mostly limited to treatment of symptoms or emergency care . In children and adults suffering from severe tooth decay , teeth are often left untreated or they are extracted to relieve oral pain or discomfort . In the future , tooth loss and impaired quality of life are therefore expected to increase as a public health problem in many developing
* Corresponding author :
Professor Poul Erik Petersen , DDS , Dr Odont Sci , MSc ( Sociology ), BA Department for Global Oral Health and Community Dentistry , Centre for Health and Society , School of Dentistry , Oester Farimagsgade 5 , P . O . Box 2099 , DK-1014 Copenhagen K , Denmark Tel .: + 45 29 61 14 86 , Fax : + 45 35 32 67 80 , e-mail : poep @ sund . ku . dk
130 STOMA . EDUJ ( 2016 ) 3 ( 2 )