Abstract
Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride would exert its primary preventive effect after being incorporated into the enamel as fluorapatite, making the enamel more resistant to the caries process; however, it is now recognized that the main effect of water fluoridation is local and post eruptive. On the other hand, irrespective of the caries decline reported worldwide, the anticaries benefit of water fluoridation continues to be observed even in developed countries. Regarding the risks, water fluoridation is considered an acceptable community-based method for fluoride delivery, because the risk of developing dental fluorosis lesions due to the ingestion of fluoride during the enamel formation period has been deemed acceptable when contrasted to the anticaries benefits of fluoride. However, the use of fluoride in water to control caries has created a controversy due to data associating water fluoridation as the cause of some systemic diseases. Therefore, the aim of this descriptive review was to discuss the systemic effects (risks) of water fluoridation use.
Highlights
The use of fluoride to control dental caries was classified as systemic or topical, because the lower prevalence of dental caries found in children, who were exposed to fluoridated water during teeth formation, was attributed to fluoride incorporated into enamel during its pre-eruptive mineralization
The adjustment of fluoride concentration during water treatment is still recommended by WHO, because the only systemic side effect associated with optimally fluoridated water ingestion is dental fluorosis, which does not compromise the quality of life of affected people
Fluoride absorbed by the body and circulating in the blood has the potential to manifest side effects, either acute or chronic
Summary
The use of fluoride to control dental caries was classified as systemic or topical, because the lower prevalence of dental caries found in children, who were exposed to fluoridated water during teeth formation, was attributed to fluoride incorporated into enamel during its pre-eruptive mineralization (systemic effect). Considering the current knowledge about the mechanism of action of fluoride on caries control, water fluoridation should be classified as a community-based way of fluoride use and no longer systemic [1]. Given the importance of water fluoridation in terms of public health, if it continues to be considered a systemic method, it is implied that we would have to ingest fluoride to be able to control caries. Supported by RDI, fluoride has been added to dietary products, such as chewing gum
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