PREVENTION OF DENTAL CARIES THROUGH THE EFFECTIVE USE OF FLUORIDE – THE PUBLIC HEALTH APPROACH alimentary salt were carried out from around 1965 to 1985 in Colombia , Hungary and Switzerland , with rather similar results to those observed after the introduction of water fluoridation . 34 , 35 These studies also explain that fluoridated salt reaches the consumer through several channels , including domestic salt , meals at schools , large kitchens , and in bread . In Colombia , Costa Rica , Jamaica , and the Canton of Vaud in Switzerland , most , if not all , of these channels are used ; in France and Germany the focus is on fluoridating domestic salt . Jamaica provides another interesting setting , because all salt destined for human consumption in the country has been fluoridated since 1987 . Significant development has occurred in the Americas where Colombia , Costa Rica , Jamaica , Mexico and Uruguay have more than 20 years of documented community experience with population coverage up to 98 %. 36-38 Around the world , the concentration of fluoride in salt used ranges from 200 mg / kg to 350 mg / kg , with
39 , 40
an optimal concentration of around 250 mg / kg . In studies conducted in Hungary the concentration of 350 ppm F was used in all test towns . Caries reduction of 53 % to 68 % was observed in both temporary and permanent dentitions after 15 years of salt fluoridation . 41 If salt ingestion was reduced concentration of fluoride in salt could be increased to provide the corresponding amount of fluoride to maintain comparable cariostatic effect . One concern expressed misleadingly is that the promotion of the dental benefits of fluoridated salt would be unacceptable and contradictory to public health messages that encourage the reduction of consumption of salt and thus decrease the risk of hypertension . However , populations are not encouraged to consume more salt but limit themselves to a minimal consumption to improve their dental health ; rather , the “ automatic ” or passive effect of fluoridated salt is accepted . In other words , people do not need to change their usual behaviour to benefit . Indeed , reduced consumption of salt could and should be encouraged and , where this is successful , the concentration of fluoride in salt could simply be increased appropriately . Iodization of salt has been successfully used to prevent iodine deficiency diseases and is now being promoted in all parts of the world . It is emphasized by WHO that iodization and fluoridation of salt should be combined . 40 Coordination between health agencies , salt producers , marketers , distributors , and the community , with inclusion of appropriate epidemiological surveillance systems , is recommended for effective implementation . The cost of implementing a salt fluoridation program varies with the type of equipment available at the processing plant , the method for adding the fluoride compound , cost of the fluoride compound , necessary training of personnel , quality control equipment , and supplies . The cost of the equipment and other inherent costs for initiating a salt fluoridation programme depend on the size of the processing plants and the amount of salt to be processed . Estimates based on programmes implemented in the Americas indicate that the cost per person per year is approximately US $ 0.06 . 34
3.3 . Milk fluoridation The fluoridation of milk is another example of an attempt by public health administrators to provide the benefits of fluoride without requiring the consumers to take on particular responsibilities or change their behaviour . The potential of milk as an alternative vehicle for fluoride – primarily to children - was first identified in Switzerland in 1962 . Further experience was reported from programmes implemented in Scotland 42 , and in Hungary . 43 Various channels have been used , including programmes distributing milk in kindergartens , 44 and schools , 45 , 46 and powdered milk and milkcereal distributed as part of the National Complementary Feeding Programme in Chile . 47 The results of these programmes as well as other ones targeted at children have been summarized by WHO . 48 All studies have emphasized that it is important to start the programme in early childhood to ensure an optimal effect on the deciduous teeth , and to maintain the consumption of milk for at least 180 days per year . Interesting initiatives such as sending school milk home on a Friday evening for consumption over the weekend have been reported in China , where milk consumption has been maintained for more than 300 days per year . 49 To date no milk fluoridation programmes have been targeted at and evaluated in adult populations . Still today , WHO is involved in comprehensive milk fluoridation programmes in several countries such as Thailand and Bulgaria . In Bulgaria , the first community based scheme was introduced in 1988 including some 15,000 children and it reached more than 30,000 children in 2003 . WHO reported recently the experience gained from milk fluoridation in Bulgaria 50 ; this programme was evaluated through the application of a most advanced study design based on longitudinal surveys and time trend analysis . Fluoridated milk delivered daily in schools in Bulgaria resulted in substantially lower caries development compared with children in schools receiving milk without added fluoride . The enrollment of children in milk fluoridation programmes increased substantially as programmes were introduced in four other countries . More recently there has been further expansion , particularly in Thailand and Chile . In Thailand about 1 million children are now covered by the national programme . In conclusion , fluoridation of milk can be recommended as a caries preventive measure in children , where the fluoride concentration in drinking water is suboptimal , caries experience in children is significant , and there is an existing school milk programme . 48 Generally , the additional cost of providing fluoridated milk , compared with nonfluoridated milk , is approximately two to three US
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