PREVENTION OF DENTAL CARIES THROUGH THE EFFECTIVE USE OF FLUORIDE – THE PUBLIC HEALTH APPROACH
Decayed , Missing and Filled permanent Teeth Very low : < 1.2 Low : 1.2-2.6 Moderate : 2.7-4.4 High : 4.5 + No data available
Figure 1 . Levels of dental caries experience among 12-year-old across the world as measured by the DMFT index according to the WHO Global Oral Health Data Bank 3
countries unless prevention is introduced . Figures 1-2 summarize the epidemiological information depicting the burden of dental caries across the world . The figures show the country scores of Decayed , Missing due to caries , and Filled index at ages 12 and 35-44-years . 1 , 3 Figure 3 demonstrates the high DMFT index among older people within the six WHO regions . The number of teeth missing due to caries is remarkably prominent . The current global and regional patterns of dental caries largely reflect distinct risk profiles of countries which relate to structure of society , living conditions , lifestyles , and the existence of preventive oral health systems . 4 The socio-behavioural risk factors in dental caries are found universally and they play significant roles in children , adults as well as older people . The disease level is relatively high among the underprivileged population groups , i . e . people with a low education background , poor living conditions , people with poor dietary habits and high consumption of sugars , and people with limited tradition of dental care . 5 Unless serious efforts are made to tackle the social inequity by modifying risk factors and by establishing effective caries prevention programmes , the level of dental caries in disadvantaged populations and countries will unduly increase . 4 Evidently , substantial population groups in low and middle income countries have not yet obtained the health benefit from fluoride in community prevention programmes . The reasons for not having been able to implement such prevention programmes varies in nature ranging from lack of national policy and systems for oral health to low awareness of the importance of oral health .
The purpose of this article is to review the evidence for using fluoride for prevention of dental caries and to summarize the public health benefit from usage of automatic fluoridation as recommended by WHO . In addition , the intention is to discuss one of the major public health advantages of automatic fluoridation in that the approach may break the prevailing oral health diversities between population groups .
2 . Existing fluoridation programmes Few low and middle income countries have largescale fluoridation programmes in operation . Some countries in Latin America have introduced water and salt fluoridation , and remarkable caries reduction has been observed in the populations of those countries . However , effective exposure to fluoride is still fairly limited in other regions . In the African region , for example , salt fluoridation has been implemented in Madagascar with the support of UNICEF and WHO . In Asia , Thailand introduced high-quality fluoride-containing toothpaste and milk fluoridation in school programmes ; 6-8 in parallel , WHO facilitated the implementation of salt fluoridation in Laos and Viet Nam . While the use of fluoride-containing toothpaste is becoming more common in low and middle income countries , its use is not the norm even among those who brush their teeth twice a day , and it is more likely to be used in urban rather than in rural communities . 9 , 10 Locally produced fluoride-containing toothpastes often have insufficient levels of fluoride . Two important events have analyzed the use of fluoride in Asia . In 2006 , a WHO symposium reviewed the Chinese
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