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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