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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