Abstract
Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.
*Original abstract online at https://journals.sagepub.com/doi/10.1177/0022034519843495
References
ase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.
*Original abstract online at https://journals.sagepub.com/doi/10.1177/0022034519843495
References
| American Academy of Pediatrics, Committee on Nutrition . 1995. Fluoride supplementation for children: interim policy recommendations. Pediatrics. 95(5):777. Google Scholar | Medline |
|
| American Dental Association Council on Dental Therapeutics . Reclassification of Crest toothpaste. JADA. 1964;69:195. Google Scholar | Crossref | Medline | ISI |
|
| Anderson, RJ . 1981. The changes in the dental health of 12-year-old school children in two Somerset schools: a review after an interval of 15 years. Br Dent J. 150(8):218–221. Google Scholar | Crossref | Medline |
|
| Aoba, T, Fejerskov, O. 2002. Dental fluorosis: chemistry and biology. Crit Rev Oral Biol Med. 13(2):155–170. Google Scholar | SAGE Journals | ISI |
|
| Arnold, FA, Dean, HT, Jay, P, Knutson, JW. 1956. Effect of fluoridated public water supplies on dental caries prevalence. Public Health Rep. 71(7):652–658. Google Scholar | Crossref | Medline |
|
| Arnold, FA, Likins, RC, Russell, AL, Scott, DB. 1962. Fifteenth year of the Grand Rapids fluoridation study. J Am Dent Assoc. 65(6):780–785. Google Scholar | Crossref |
|
| Ast, DB . 1943. The caries-fluorine hypothesis and a suggested study to test its application. Public Health Rep. 58(23):857–879. Google Scholar | Crossref | Medline |
|
| Bardsen, A . 1999. “Risk periods” associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis. Acta Odontol Scand. 57(5):247–256. Google Scholar | Crossref | Medline | ISI |
|
| Barnard, PD . 1956. Dental survey of state school children in New South Wales, Jan. 1954–June, 1955. Canberra, Australia: Government Press. Google Scholar |
|
| Bibby, BG . 1945. A test of the effect of fluoride-containing dentifrices on dental caries. J Dent Res. 24:297–303. Google Scholar | SAGE Journals | ISI |
|
| Bibby, BG, Wilkins, E, Witol, E. 1955. A preliminary study of the effects of fluoride lozenges and pills on dental caries. Oral Surg Oral Med Oral Pathol. 8(2):213–216. Google Scholar | Crossref | Medline |
|
| Blayney, JR, Hill, IN. 1967. Fluorine and dental caries. J Am Dent Assoc. 74(2):225–302. Google Scholar | Medline |
|
| Bratthall, D, Hansel-Petersson, G, Sundberg, H. 1996. Reasons for the caries decline: what do the experts believe? Eur J Oral Sci. 104(4, Pt 2): 416–422. Google Scholar | Crossref | Medline | ISI |
|
| British Fluoridation Society . 2012. One in a million [accessed 2019 Mar 19]. https://www.bfsweb.org/one-in-a-million. Google Scholar |
|
| Brown, HK, Poplove, M. 1965. The Brantford-Sarnia-Stratford fluoridation caries study: final survey, 1963. Can J Public Health. 56:319–324. Google Scholar | Medline |
|
| Chankanka, O, Levy, SM, Warren, JJ, Chalmers, JM. 2010. A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health-related quality of life. Community Dent Oral Epidemiol. 38(2):97–109. Google Scholar | Crossref | Medline | ISI |
|
| Dean, H . 1946. Epidemiological studies in the United States. In:Moulton, FR , editor. Dental caries and fluorine. Lancaster, PA: American Association for the Advancement of Science. Google Scholar |
|
| Dean, H, Arnold, FJ, Elvove, E. 1942. Domestic water and dental caries. V. Additional studies of the relation of fluoride domestic waters to dental caries experience in 4,425 white children, aged 12 to 14 years, of 13 cities in 4 States. Public Health Rep. 57:1155–1179. Google Scholar | Crossref | Medline |
|
| Dean, H, Elvove, E. 1936. Some epidemiological aspects of chronic endemic dental fluorosis. Am J Public Health Nations Health. 26(6):567–575. Google Scholar | Crossref | Medline |
|
| Dean, H, Elvove, E. 1937. Further studies on the minimal threshold of chronic endemic dental fluorosis. Public Health Rep. 52(37):1249–1264. Google Scholar | Crossref | Medline |
|
| Dean, HT . 1934. Classification of mottled enamel diagnosis. J Am Dent Assoc. 21:1421–1426. Google Scholar |
|
| Dean, HT . 1935. Studies on the minimal threshold of the dental sign of chronic endemic fluorosis (mottled enamel). Public Health Rep. 50(49):1719–1729. Google Scholar | Crossref | Medline |
|
| Dean, HT . 1944. Post-war implications of fluorine and dental health: epidemiological aspects. Am J Public Health Nations Health. 34(2):133–143. Google Scholar | Crossref | Medline |
|
| Dean, HT, Arnold, FA, Jay, P, Knutson, JW. 1950. Studies on mass control of dental caries through fluoridation of the public water supply. Public Health Rep. 65(43):1403–1408. Google Scholar | Crossref | Medline |
|
| Dean, T, Jay, P, Arnold, F, Elvove, E. 1941. Domestic water and dental caries. Public Health Rep. 56:365–381. Google Scholar | Crossref | Medline |
|
| Den Besten, PK . 1999. Mechanism and timing of fluoride effects on developing enamel. J Public Health Dent. 59(4):247–251. Google Scholar | Crossref | Medline |
|
| Department of Health and Social Security . 1969. The fluoridation studies in the United Kingdom and the results achieved after eleven years; a report of the committee on research into fluoridation. DHSS Reports on Public Health and Medical Subjects No. 122. London: Department of Health and Social Security. Google Scholar |
|
| Do, L, Spencer, A. 2016. Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide, Australia: University of Adelaide Press. Google Scholar | Crossref |
|
| Do, L, Spencer, A, Ha, D. 2016. Natural history and impact of dental fluorosis: a prospective cohort study. Med J Aust. 204(1):25. Google Scholar | Crossref | Medline | ISI |
|
| Do, LG, Levy, SM, Spencer, AJ. 2012. Association between infant formula feeding and dental fluorosis and caries in Australian children. J Public Health Dent. 72(2):112–121. Google Scholar | Crossref | Medline |
|
| Do, LG, Spencer, A. 2007a. Oral health-related quality of life of children by dental caries and fluorosis experience. J Public Health Dent. 67(3):132–139. Google Scholar | Crossref | Medline | ISI |
|
| Do, LG, Spencer, AJ. 2007b. Decline in the prevalence of dental fluorosis among South Australian children. Community Dent Oral Epidemiol. 35(4):282–291. Google Scholar | Crossref | Medline | ISI |
|
| Driscoll, WS, Heifetz, SB, Korts, DC. 1974. Effect of acidulated phosphate-fluoride chewable tablets on dental caries in schoolchildren: results after 30 months. J Am Dent Assoc. 89(1):115–120. Google Scholar | Crossref | Medline |
|
| Driscoll, WS, Horowitz, HS, Meyers, RJ, Heifetz, SB, Kingman, A, Zimmerman, ER. 1983. Prevalence of dental caries and dental fluorosis in areas with optimal and above-optimal water fluoride concentrations. J Am Dent Assoc. 107(1):42–47. Google Scholar | Crossref | Medline |
|
| Driscoll, WS, Horowitz, HS, Meyers, RJ, Heifetz, SB, Kingman, A, Zimmerman, ER. 1986. Prevalence of dental caries and dental fluorosis in areas with negligible, optimal, and above-optimal fluoride concentrations in drinking water. J Am Dent Assoc. 113(1):29–33. Google Scholar | Crossref | Medline |
|
| Dunning, J . 1962. Principles of dental public health. Cambridge, MA: Harvard University Press. Google Scholar |
|
| Environmental Protection Agency . 2010. Fluoride: dose-response analysis for non-cancer effects. Washington, DC: Office of Water, Health and Ecological Criteria Division. Google Scholar |
|
| Evans, RW, Darvell, BW. 1995. Refining the estimate of the critical period for susceptibility to enamel fluorosis in human maxillary central incisors. J Public Health Dent. 55(4):238–249. Google Scholar | Crossref | Medline | ISI |
|
| Farkas, C, Farkas, E. 1974. Potential effect of food processing on the fluoride content of infant foods. Sci Total Environ. 2(4): 399–405. Google Scholar | Crossref | Medline |
|
| Galagan, DJ . 1953. Climate and controlled fluoridation. J Am Dent Assoc. 47(2):159–170. Google Scholar | Crossref | Medline | ISI |
|
| Galagan, DJ, Vermillion, JR. 1957. Determining optimum fluoride concentrations. Public Health Rep. 72(6):491–493. Google Scholar | Crossref | Medline | ISI |
|
| Glass, R . 1982. The first international conference on the declining prevalence of dental caries. J Dent Res. 61:1301–1383. Google Scholar | ISI |
|
| Goldman, AS, Yee, R, Holmgren, CJ, Benzian, H. 2008. Global affordability of fluoride toothpaste. Global Health. 4:7. Google Scholar | Crossref | Medline |
|
| Gray, P, Todd, J, Slack, G, Bulman, J. 1970. Adult dental health in England and Wales in 1968. London: HMSO. Google Scholar |
|
| Griffin, SO, Regnier, E, Griffin, PM, Huntley, V. 2007. Effectiveness of fluoride in preventing caries in adults. J Dent Res. 86(5):410–415. Google Scholar | SAGE Journals | ISI |
|
| Hong, L, Levy, SM, Warren, JJ, Broffitt, B, Cavanaugh, J. 2006. Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars. Caries Res. 40:494–500. Google Scholar | Crossref | Medline | ISI |
|
| Institute of Medicine, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes . 1997. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride, Food and Nutrition Board. Washington, DC: National Academies Press. p. 288–313. Google Scholar |
|
| Jauncey, L . 1983. Opinion of Lord Jauncey {In causa} Mrs Catherine McColl (A.P.) against Strathclyde Regional Council. Edinburgh, UK: The Court of Session. Google Scholar |
|
| Kenny, MJ . 1963. Fluoridation. Judgement delivered by Mr Justice Kenny in the High Court, Dublin, 1963. Dublin, Ireland: Department of Health. Google Scholar |
|
| Kunzel, W . 1996. Trends in caries experience of 12-year-old children in east European countries. Int J Paediatr Dent. 6(4):221–226. Google Scholar | Crossref | Medline |
|
| Kwant, G, Houwink, B, Backer Dirks, O, Groeneveld, A, Pot, T. 1973. Artificial fluoridation of drinking water in the Netherlands; results of the Tiel-Culemborg experiment after 16 1/2 years. Netherl Dent J. 80(Suppl 9): 6–27. Google Scholar |
|
| Leverett, D . 1986. Prevalence of dental fluorosis in fluoridated and nonfluoridated communities: a preliminary investigation. J Public Health Dent. 46(4):184–187. Google Scholar | Crossref | Medline | ISI |
|
| Ludwig, TG . 1971. Hastings fluoridation project V1: dental effects between 1954 and 1970. N Z Dent J. 67(309):155–160. Google Scholar | Medline |
|
| Marinho, VC, Higgins, JP, Sheiham, A, Logan, S. 2003. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. (1):CD002278. Google Scholar | Medline |
|
| Marthaler, TM, Mejia, R, Toth, K, Vines, JJ. 1978. Caries-preventive salt fluoridation. Caries Res. 12(Suppl 1):15–21. Google Scholar | Crossref | Medline |
|
| McClure, F . 1943. Ingestion of fluoride and dental caries: quantitative relations based on food and water requirements of children one to twelve years old. Am J Dis Child. 66(4):362–369. Google Scholar | Crossref |
|
| McClure, FJ . 1970. Water fluoridation: the search and the victory. Washington, DC: Government Printing Office, U.S. Department of Health, Education, and Welfare. Google Scholar |
|
| McDonagh, MS, Whiting, PF, Wilson, PM, Sutton, AJ, Chestnutt, I, Cooper, J, Misso, K, Bradley, M, Treasure, E, Kleijnen, J. 2000. Systematic review of water fluoridation. BMJ. 321(7265):855–859. Google Scholar | Crossref | Medline |
|
| Ministry of Health of Malaysia . 2006. Implementation of water fluoridation programme in Malaysia. Division of Health. Putrajaya: Ministry of Health of Malaysia. Google Scholar |
|
| Moore, G . 1960. Water fluoridation practices. Health News. 37(4):12–17. Google Scholar |
|
| Muhler, JC, Radike, AW, Nebergall, WH, Day, HG. 1955. A comparison between the anticariogenic effects of dentifrices containing stannous fluoride and sodium fluoride. J Am Dent Assoc. 51(5):556–559. Google Scholar | Crossref | Medline |
|
| Murray, J . 1986. Appropriate use of fluorides for human health. Geneva, Switzerland: World Health Organization. Google Scholar |
|
| Murray, J, Rugg-Gunn, A, Jenkins, G. 1991. Fluorides in caries prevention. 3rd ed. Oxford, UK: Butterworth-Heinemann. Google Scholar |
|
| O’Mullane, DM, Baez, RJ, Jones, S, Lennon, MA, Petersen, PE, Rugg-Gunn, AJ, Whelton, H, Whitford, GM. 2016. Fluoride and oral health. Community Dent Health. 33(2): 69–99. Google Scholar | Medline | ISI |
|
| O’Mullane, D, Whelton, H. 1994. Caries prevalence in the Republic of Ireland. Int Dent J. 44(4 Suppl 1):387–391. Google Scholar | Medline |
|
| Onoriobe, U, Rozier, RG, Cantrell, J, King, RS. 2014. Effects of enamel fluorosis and dental caries on quality of life. J Dent Res. 93(10):972–979. Google Scholar | SAGE Journals | ISI |
|
| Ophaug, RH, Singer, L, Harland, BF. 1980. Estimated fluoride intake of average two-year-old children in four dietary regions of the United States. J Dent Res. 59(5):777–781. Google Scholar | SAGE Journals | ISI |
|
| Osuji, OO, Nikiforuk, G, Leake, JL. 1988. A review of differential diagnosis of dental fluorosis and non-fluoride enamel defects. J Can Dent Assoc. 54(10):743–747. Google Scholar | Medline |
|
| Palmer, JD . 1980. Dental health in children: an improving picture? Br Dent J. 149(2):48–50. Google Scholar | Crossref | Medline |
|
| Petersen, PE . 2008. World Health Organization global policy for improvement of oral health: World Health Assembly 2007. Int Dent J. 58(3):115–121. Google Scholar | Crossref | Medline | ISI |
|
| Petersen, PE, Baez, RJ, Lennon, MA. 2012. Community-oriented administration of fluoride for the prevention of dental caries: a summary of the current situation in Asia. Adv Dent Res. 24(1):5–10. Google Scholar | SAGE Journals |
|
| Puzio, A, Spencer, A, Brennan, D. 1993. Fluorosis and fluoride exposure in South Australian children. Paper presented at the Consensus Conference: Appropriate Fluoride Exposure for Infants and Children; Perth, Western Australia. Google Scholar |
|
| Riordan, PJ . 1993. Dental fluorosis, dental caries and fluoride exposure among 7-year-olds. Caries Res. 27(1):71–77. Google Scholar | Crossref | Medline |
|
| Riordan, PJ . 2002. Dental fluorosis decline after changes to supplement and toothpaste regimens. Community Dent Oral Epidemiol. 30(3):233–240. Google Scholar | Crossref | Medline | ISI |
|
| Rozier, RG, Adair, S, Graham, F, Iafolla, T, Kingman, A, Kohn, W, Krol, D, Levy, S, Pollick, H, Whitford, G, et al. 2010. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 141(12):1480–1489. Google Scholar | Crossref | Medline | ISI |
|
| Rugg-Gunn, A . 2001. Preventing the preventable: the enigma of dental caries. Br Dent J. 191(9):478–488. Google Scholar |
|
| Rugg-Gunn, AJ, Nunn, JH. 1999. Nutrition, diet and oral health. Oxford, UK: Oxford University Press. Google Scholar |
|
| Silva, M, Reynolds, EC. 1996. Fluoride content of infant formulae in Australia. Aust Dent J. 41(1):37–42. Google Scholar | Crossref | Medline | ISI |
|
| Spencer, AJ, Do, LG. 2016. Caution needed in altering the ‘optimum’ fluoride concentration in drinking water. Community Dent Oral Epidemiol. 44(2):101–108. Google Scholar | Crossref | Medline | ISI |
|
| Spencer, AJ, Do, LG, Mueller, U, Baines, J, Foley, M, Peres, MA. 2018. Understanding optimum fluoride intake from population-level evidence. Adv Dent Res. 29(2):144–156. Google Scholar | SAGE Journals |
|
| Sutton, P . 1960. Fluoridation: errors and omissions in clinical trials. Melbourne, Australia: Melbourne University Press. Google Scholar |
|
| ten Cate, J, Buzalaf, M. 2019. Fluoride mode of action: once there was an observant dentist… J Dent Res. 98(7):725–730. Google Scholar | SAGE Journals |
|
| UNESCO . 2005. Universal declaration on bioethics and human rights [accessed 2019 Mar 19]. http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201 Google Scholar |
|
| U.S. Department of Health and Human Services . 1943. Public health service drinking water standards. Pub Health Rep. 58(3):69–82. Google Scholar | Medline |
|
| U.S. Department of Health and Human Services . 1960. Health statistics: loss of teeth, United States, July 1957–June 1958. Service UPH. Washington, DC: Government Printing Office. Google Scholar |
|
| U.S. Department of Health and Human Services . 1962. Drinking water standards. Washington, DC: U.S. Department of Public Health Service. Google Scholar |
|
| U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation . 2015. U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Rep. 130(4):318–331. Google Scholar | SAGE Journals | ISI |
|
| U.S. Federal Register . 2018. Regulatory information. Federal Register. 83(135):32563–32758. https://www.govinfo.gov/app/details/FR-2018-07-13 Google Scholar |
|
| Whelton, H, O’Mullane, D. 2012. Monitoring the effectiveness of water fluoridation in the republic of Ireland. J Ir Dent Assoc. 58(3 Suppl):S6–S8. Google Scholar | Medline |
|
| World Health Organization (WHO) . 1958. Expert Committee on water fluoridation: first report of the expert committee on water fluoridation. Geneva, Switzerland: World Health Organization. Google Scholar |
|
| World Health Organization (WHO) . 1969. Fluoridation and dental health. Geneva, Switzerland: World Health Organization. Google Scholar |
|
| World Health Organization (WHO) . 1975. Fluoridation and dental health. Geneva, Switzerland: World Health Organization. Google Scholar |
|
| World Health Organization (WHO)/Federation Dentaire Internationale (FDI) . 1985. Changing patterns of oral health and implications for oral health manpower. Part I. Report of a Working Group convened jointly by the Federation Dentaire Internationale and the World Health Organization. Int Dent J. 35(3):235–251. Google Scholar | Medline |