PREVENTION OF DENTAL CARIES THROUGH THE EFFECTIVE USE OF FLUORIDE – THE PUBLIC HEALTH APPROACH
dollars per child per year . 34 3.4 . Fluoride-containing toothpaste Toothpaste is probably the most widespread and significant vehicle used for fluoride . Introduced in the late 1960s and early 1970s , their rapid increase in market share was remarkable . The consensus view from high income countries was that the introduction of fluoride-containing toothpastes was the single factor most responsible for the massive reduction in dental caries seen in many countries during the 1970s and 1980s . 51 Furthermore , of the various vehicles for fluoride , toothpaste has been the most rigorously evaluated . Marinho et al . 19 included 74 randomized , controlled clinical trials of good quality in their systematic review of fluoride toothpastes . WHO considers a toothpaste containing 1000-1500 ppm F to be an effective toothpaste ; meanwhile , in some low and middle income countries fluoridated toothpaste may contain less fluoride such as 400-500 ppm which is ineffective for the prevention of dental caries . Accordingly , people should be encouraged to brush their teeth daily with effective fluoridecontaining toothpaste , i . e . fluoride recommended at the level of 1000-1500 ppm . It is worth noting that “ topical ” fluorides such as toothpaste can also have a “ systemic ” effect when they are inadvertently ingested by young children . Dispensing a peasized amount of toothpaste , encouraging parents to supervise tooth brushing by their young children , or the use of toothpastes containing less fluoride by young children are approaches to ameliorating this problem . Countries may recommend toothpastes with low concentration of fluoride , i . e . 500 ppm or less specifically for such young age groups ( 1-3 years of age ). An important limitation is that the population value of these toothpastes depends upon the behaviour of the individual and the family in purchasing and regularly using the products . Studies of children 52-55 and adults 4 , 56 have shown that use toothpaste containing fluoride are not uniform and is less likely among underprivileged population groups . In addition , ethnicity plays a significant role in oral hygiene habits . 57 The fall in the incidence of dental caries after the introduction of fluoride into toothpaste formulations , although seen in all social classes , is particularly found in the wealthy social classes ; social-class inequality persists in countries with advanced or less advanced oral health systems . 4 In response to the social inequities found in many parts of the world that are known to impact oral health with consequent disproportional occurrence of dental caries , the WHO Oral Health Programme continue to promote the development and use of “ affordable ” fluoride-containing toothpaste 58 . “ Affordable ” toothpaste is one that is available at a price that allows people on a low income to purchase it . Vital elements in the cost of production are the choice and availability of raw materials . Critically , the abrasive agent and the fluoride source should be compatible over time . Precipitated calcium carbonate is the abrasive agent of choice because of its low cost and ready availability in developing countries . It is experienced companies which can manufacture effective toothpastes that are also of a low cost . However , it remains to be seen whether the marketing of such toothpastes will increase demand and use among low-income groups . In order to encourage use it might be in the interest of countries to exempt these effective fluoride toothpastes from the duties and taxation
1 , 34 , 59 that are imposed on cosmetics .
4 . WHO policy on the use of fluoride for the prevention of dental caries The WHO policy on the effective use of fluoride is reflected in four World Health Assembly Resolutions : WHA22.30 ( 1969 ) and WHA28.64 ( 1975 ) on fluoridation and dental health ; WHA 31.50 ( 1978 ) on fluoride for prevention of dental caries , and the most recent WHA60.17 ( 2007 ): “ Oral Health : Action Plan for Promotion and Integrated Disease Prevention ”. The 2007 Resolution urges Member States to ensure that populations benefit from appropriate use of fluoride 14 and the statement reads as follows : ( 4 ) for those countries without access to optimal levels of fluoride , and which have not yet established systematic fluoridation programmes , to consider the development and implementation of fluoridation programmes , giving priority to equitable strategies such as the automatic administration of fluoride , for example , in drinking-water , salt or milk , and to the provision of affordable fluoride toothpaste ; Today about 450 million people benefit from fluoride 4 . The WHO Oral Health Programme continues to emphasize the importance of public health approaches to the effective use of fluorides for the prevention of dental caries and the Programme is involved with support , guidance , and practical assistance to several countries . Table 1 summarizes the baseline data on dental caries severity at 12 years of age reported to the WHO Global Oral Health Data Bank [ CAPP ] 3 from countries that have implemented automatic fluoridation programmes ( water , salt or milk ). It is recognized that fluoride-containing toothpaste may be available in these countries although , data on demand and regularity of use in all countries are not available .
4.1 . WHO guidance Where the incidence and prevalence of dental caries in the community is high to moderate , or where there are firm indications that the incidence of caries is increasing , an additional source of fluoride ( water , salt or milk ) should be considered . Water fluoridation using fluoride at a concentration of 0.5 – 1 mg / l is the method of choice if the country ( or area of the country ) has a moderate level of economic and technological development . A central water system , a municipal water supply reaching a large population , trained
136 STOMA . EDUJ ( 2016 ) 3 ( 2 )