Public Water Fluoridation Research Articles

Impact of dental fluorosis on the oral health-related quality of life: a systematic review.

The aim of this systematic review is to investigate the literature to assess the effect of dental fluorosis on the Oral Health-Related Quality of Life (OHRQoL). Included studies were epidemiological investigations, clinical trials, or human studies that directly compared the impact on OHRQoL between individuals with dental fluorosis and those without, utilizing valid OHRQoL assessment tools. The searches were conducted up to March 2024 in databases, including PubMed, Scielo, LILACS, Scopus, Web of Science, Embase, and the Virtual Health Library. Additionally, gray literature sources such as Google Scholar, OpenGrey, Ibict/BDTD, and ProQuest were searched. Reference lists were also manually reviewed for potential eligible studies. The risk of bias in cohort studies was assessed using the Newcastle-Ottawa Scale (NOS), while its modified version was employed for cross-sectional studies. A narrative synthesis of the results was conducted. 16 studies were included in this Systematic Review. In total, 16,314 participants, aged 8 to 18, were assessed across the studies. Most of the included studies were cross-sectional, except for one cohort study. In assessing OHRQoL across different age groups and severities of dental fluorosis, the impact varied. A negative association between dental fluorosis and OHRQoL was found in 9 of the included studies, a positive association was found in 1 study, and no significative association was identified in 6 studies. Limitations in the included studies primarily pertained to cross-sectional designs, with significant issues such as the absence of sample size calculations, lack of non-response rate reporting, limited consideration of confounding factors, and substantial heterogeneity stemming from diverse diagnostic methods and assessment tools. The findings of the systematic review demonstrate a complex and varied relationship between dental fluorosis and OHRQoL in children and adolescents. These conclusions may have limitations in scientific evidence. The findings emphasize the need for further investigations to explore the intricate aspects of this relationship and identify contributing factors to varying outcomes. Dental caries preventive fluoridated measures might be indicated even if there would be a risk for mild dental fluorosis as the fluoridated public water. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number: CRD42020186552.

Biomarkers of Orthodontic Patients After Use of 1% Brazilian Red Propolis Toothpaste: A Randomized Clinical Study.

To evaluate the salivary biomarkers and plaque index after a treatment with a propolis-contained toothpaste. This is a longitudinal, randomized, double-blind study where 76 participants were randomized into two groups: Group I: Fluoridated Red Propolis toothpaste; Group II: Fluoridated toothpaste. The participants were selected in a municipality without fluoridated public water. All participants received standardized oral hygiene instructions from the same instructor for 3 daily brushings (after breakfast, after lunch, and before bed) for a period of 2 min; Saliva samples were collected before (D0) and after 28 days (D28) of treatment for analysis of pH and total protein, amylase, and IL-10. Saliva was collected in the initial consultation and on return, totaling two collections. All samples were collected under the same conditions, by the same operator and between 9:00 AM and 11:00 AM in order to minimize the influence of circadian rhythm on salivary flow. On D0 and D28, the various treatments had no effect on total salivary proteins (G1: P = 0.0746; G2: P = 0.2144), and the pH stayed about the same. Additionally, there was no change in the amylase activity in G1 (P = 0.1877) or G2 (P = 0.4674). Significant decreases in G1 (P < 0.0001) and G2 (P = 0.03) were observed with IL-10. There was no statistically significant difference in the salivary flow between the BRP toothpaste-treated group (P = 0.172) and the commercial fluoridated toothpaste-treated group (P = 0.329). Compared to G2 (P = 0.03), G1 showed a superior decline in the plaque index (P = <0.0001). After 28 days of using the toothpastes, there were no changes in the amylase, pH, or total protein indicators. After 28 days, there was a decrease in the propolis group's IL-10 dose and plaque index.

Effect of bottled fluoridated water to prevent dental caries in primary teeth: study protocol for a phase 2 parallel-group 3.5-year randomized controlled clinical trial (waterBEST)

BackgroundFluoridation of public water systems is known as a safe and effective strategy for preventing dental caries based on evidence from non-randomized studies. Yet 110 million Americans do not have access to a fluoridated public water system and many others do not drink tap water. This article describes the study protocol for the first randomized controlled trial (RCT) of fluoridated water that assesses its potential dental caries preventive efficacy when delivered in bottles.MethodswaterBEST is a phase 2b proof-of-concept, randomized, quadruple-masked, placebo-controlled, parallel-group trial designed to estimate the potential efficacy of fluoridated versus non-fluoridated bottled water to prevent dental caries incidence in the first 4 years of life. Two hundred children living in eastern North Carolina, USA, and aged 2–6 months at screening are being allocated at random in a 1:1 ratio to receive fluoridated (0.7 mg/L F) or non-fluoridated bottled water sourced from two local public water systems. Throughout the 3.5-year intervention, study water is delivered monthly in 5-gallon bottles to each child’s home with instructions to use it whenever the child consumes water as a beverage or in food preparation. Parents are interviewed quarterly to monitor children’s water consumption and health. At annual visits, the presence of dental caries is evaluated with a dental screening examination. Clippings from fingernails and toenails are collected to quantify fluoride content as a biomarker of total fluoride intake. The primary endpoint is the number of primary tooth surfaces decayed, missing, or filled due to dental caries measured by the study dentist near the time of the child’s fourth birthday. Tooth decay is assessed at the threshold of macroscopic enamel loss. For the primary aim, a least-squares, generalized linear model will estimate efficacy and its one-tailed, upper 80% confidence limit.DiscussionwaterBEST is the first evaluation of a randomized intervention of fluoridated drinking water in bottles to prevent dental caries in the primary dentition. This innovative method of delivering fluoridated water has the potential to prevent early childhood caries in a large segment of the US population that currently does not benefit from fluoridated public water.Trial registration ClinicalTrials.gov NCT04893681. Registered on March 2022. Last update posted on 10 October 2023. https://clinicaltrials.gov/study/NCT04893681?cond=Dental%20Caries%20in%20Children&term=fluoride&locStr=North%20Carolina,%20USA&country=United%20States&state=North%20Carolina&distance=50&rank=1

A Cross-Sectional Analysis of Community Water Fluoridation and Prevalence of Pediatric Dental Surgery Among Medicaid Enrollees

Dental surgery under general anesthesia (DGA) is an ineffective, costly treatment for caries. Interventions to reduce the need for DGA are challenging because children's parents may not seek care until surgery is required. Community water fluoridation (CWF) effectively prevents early childhood caries, but its effectiveness in reducing severe early childhood caries is unknown. To determine whether access to CWF is associated with the prevalence of DGA. This is a cross-sectional analysis of Medicaid claims data from 2011 to 2012. Deidentified data were derived from Medicaid claims and enrollee files for Massachusetts, Texas, Connecticut, Illinois, and Florida for children aged 9 years and younger enrolled in either a fee-for-service or managed care plan through their state's Medicaid program. Linear regression models tested for associations between CWF and covariates. Multivariable linear regression models tested for associations between CWF and outcomes. Regression models included clustered SEs at the county level. Data analysis was performed from December 2018 to March 2020. Access to CWF was determined by estimating the proportion of a county's total population that had access to a fluoridated public water system. The main outcome was county-level DGA prevalence. Other outcomes were caries-related visit prevalence and patient quality indicators (asthma and diabetes). Covariates included county-level demographic, socioeconomic, and dental practitioner variables. A total of 436 counties within 5 states per year (872 county-year observations), were included in the analysis. Adjusted analysis revealed that a 10% increase in the proportion of county's population access to CWF was associated with lower caries-related visit prevalence (-0.45 percentage points; 95% CI, -0.59 to -0.31 percentage points; P < .001). Increasing CWF access in 10% increments was associated with decreased DGA prevalence in unadjusted analysis (-0.39 percentage points; 95% CI, -0.67 to -0.12 percentage points; P = .006) but not in adjusted analysis (-0.23 percentage points; 95% CI, -0.49 to 0.02 percentage points; P = .07). Increasing the proportion of county's access to CWF by 10% was not associated with the prevalence of asthma-related exacerbations (-0.02 percentage points; 95% CI, -0.10 to 0.05 percentage points; P = .53) or diabetes-related exacerbations (-0.0003 percentage points; 95% CI, -0.0014 to 0.0009 percentage points; P = .66). This study extends our understanding of CWF's benefits for children's oral health. Specifically, these findings suggest that increasing a population's access to CWF's is associated with decreased caries-related visits and may also be associated with use of dental surgical services within high-risk populations.

Contextual and individual determinants of tooth loss in adults: a multilevel study

BackgroundTooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35–44 years of age), in accordance with individual and contextual social characteristics.MethodsThis was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated.ResultsBrazilian adults lost a mean of 7.57 (95% CI 7.1–8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males.ConclusionsThe number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

Evaluation of contaminants in fluorosilicic acid used for public water fluoridation in the Santos region, Brazil

Fluorosilicic acid is one of the main products used in water fluoridation. As a by-product of the phosphate fertilizer industry, it may contain contaminants that are harmful to human health. The aims of this study were to assess the quality control analysis of fluorosilicic acid; to detect the presence of contaminants, such as arsenic, lead, cadmium, aluminum, barium, strontium, cobalt, iron, and sulfur in fluorosilicic acid samples by using inductively coupled plasma–optical emission spectrometry; and to collect data for water analysis performed at a water treatment plant. The results show the presence of all contaminants mentioned previously, except for lead, in fluorosilicic acid samples from all sources. No quality control was carried out or required for this product at any time. Although the water analyses indicate the water is potable, there are no minimum safe limits for human consumption regarding carcinogenic elements such as cadmium and arsenic and both were detected and released in the water. Therefore, the purity of fluorosilicic acid used for water fluoridation should be required and monitored by public administrations to avoid long-term public health problems.

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation.

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.

Fluoride varnish applications and caries incidence in pre-schoolers.

A two year placebo-controlled, double-blind, randomised control trial in 1-4-year-old children. Children were recruited from low income families in Rio de Janeiro, Brazil, with access to a fluoridated public water supply. Both groups received oral hygiene instruction along with provision of toothbrushes and 1450 ppm F- toothpaste. The control group had a placebo fluoride varnish applied every six months. The intervention group had 22,600 ppm F- varnish applied every six months. Clinical examinations for the presence of caries were conducted at baseline and at each subsequent six monthly visit. The primary outcome was the proportion of children in each group that went on to clinically develop any new carious surfaces using the ICDAS criteria. The number of new carious surfaces was assessed as a secondary outcome, both at the enamel and dentine level. The study also reported on the safety and acceptability of the varnish. Two hundred children participated in the trial, 91% were followed up at two years and adherence to the six-monthly applications was 84% in the intervention and 85% in control groups. The results did not show a significant difference for the development of new lesions between the two groups. In the fluoride varnish group 36% had developed new dentinal lesions compared to 47% in the placebo group, a difference of -10.8% (95% CI -24.9 to 3.3, p = 0.14). In relation to caries increment, at the enamel level, this was a mean of 2.0 teeth in the fluoride varnish group and 2.8 teeth in the placebo group, a difference of -0.8 (95% CI -2.0 to 0.4, p = 0.19). At the dentine level, caries increment was a mean of 1.8 teeth in the fluoride varnish group and 2.5 in the placebo group, a difference of -0.7 (95% CI -1.9 to 0.4, p = 0.23). Two minor complaints related to taste and appearance of the varnish were recorded and no safety events were reported. Whilst no significant difference was found, the authors note that this does not indicate ineffectiveness of fluoride varnish. Re-assessment of the power calculation following study completion demonstrated that a significantly larger sample size would have been indicated, preventing the drawing of any direct conclusions from the results of this study. The use of fluoride varnish amongst this group appears to be safe and overall well tolerated.

Effect of water fluoridation on the development of medial vascular calcification in uremic rats

Public water fluoridation is a common policy for improving dental health. Fluoride replaces the hydroxyls of hydroxyapatite, thereby improving the strength of tooth enamel, but this process can also occur in other active calcifications. This paper studies the effects of water fluoridation during the course of vascular calcification in renal disease.The effect of fluoride was studied in vitro and in vivo. Rat aortic smooth muscle cells were calcified with 2mM Pi for 5 days. Fluoride concentrations of 5–10μM – similar to those found in people who drink fluoridated water – partially prevented calcification, death, and osteogene expression in vitro. The anticalcifying mechanism was independent of cell activity, matrix Gla protein, and fetuin A expressions, and it exhibited an IC50 of 8.7μM fluoride. In vivo, however, fluoridation of drinking water at 1.5mg/L (concentration recommended by the WHO) and 15mg/L dramatically increased the incipient aortic calcification observed in rats with experimental chronic kidney disease (CKD, 5/6-nephrectomy), fed a Pi-rich fodder (1.2% Pi). Fluoride further declined the remaining renal function of the CKD animals, an effect that most likely overwhelmed the positive effect of fluoride on calcification in vitro. Ultrastructural analysis revealed that fluoride did not modify the Ca/P atomic ratio, but it was incorporated into the lattice of in vivo deposits. Fluoride also converted the crystallization pattern from plate to rode-like structures.In conclusion, while fluoride prevents calcification in vitro, the WHO's recommended concentrations in drinking water become nephrotoxic to CKD rats, thereby aggravating renal disease and making media vascular calcification significant.

Water Fluoridation and the Association of Sugar-Sweetened Beverage Consumption and Dental Caries in Australian Children

We examined demographic and socioeconomic differences in the consumption of sugar-sweetened beverages (SSBs), its association with dental caries in children, and whether exposure to water fluoridation modifies this association. In a cross-sectional study, we used a stratified, clustered sampling design to obtain information on 16 508 children aged 5 to 16 years enrolled in Australian school dental services in 2002 to 2005. Dental staff assessed dental caries, and parents completed a questionnaire about their child's residential history, sources of drinking water, toothbrushing frequency, socioeconomic status (SES), and SSB consumption. Children who brushed their teeth less often and were older, male, of low SES, from rural or remote areas consumed significantly more SSBs. Caries was significantly associated with greater SSB consumption after controlling for potential confounders. Finally, greater exposure to fluoridated water significantly reduced the association between children's SSB consumption and dental caries. Consumption of SSBs should be considered a major risk factor for dental caries. However, increased exposure to fluoridated public water helped ameliorate the association between SSB consumption and dental decay. These results reconfirm the benefits of community water fluoridation for oral health.

The dentist's role in promoting community water fluoridation: A call to action for dentists and educators

Community water fluoridation is an important public health intervention that reduces oral health disparities and increases the health of the population. Promotion of its safety and effectiveness is critical to maintaining its widespread acceptance and ensuring its continued use. Dentists are a potentially important source of knowledge regarding the oral health benefits and safety of water fluoridation. However, few dentists regularly discuss fluorides, and water fluoridation in particular, with patients. The authors aim to describe and discuss the role and importance of dentists' promotion of public water fluoridation, barriers to dentists' involvement and some approaches that might influence dentists to promote water fluoridation more actively. Ongoing promotion of fluoridation by dentists is a key factor in ensuring sustained municipal water fluoridation. However, current undergraduate dental curricula do not adequately prepare dentists for this role, and continuing dental education may be insufficient to change clinical practice. Although smoking-cessation literature can shed some light on how to proceed, changing dentists' practice behavior remains a largely unstudied topic. Dental associations are a key resource for dentists, providing information that can assist them in becoming advocates for water fluoridation.

Cárie dentária, disponibilidade de açúcar e fatores associados nas capitais brasileiras em 2003: um estudo ecológico

INTRODUÇÃO: A associação entre a disponibilidade de açúcar e a cárie dentária, utilizando-se dados populacionais, ainda não foi testada na população brasileira. OBJETIVO: Investigar a associação entre a experiência de cárie em crianças e a disponibilidade domiciliar de açúcar no Brasil, em 2003. Buscou-se ainda testar a provável influência de indicadores socioeconômicos e do acesso à água fluoretada. MATERIAL E MÉTODO: Este estudo ecológico analisou dados das 27 capitais brasileiras sobre cárie em crianças de cinco e 12 anos, e abastecimento de água fluoretada, obtidos do levantamento nacional de saúde bucal de 2003. Os dados sobre disponibilidade domiciliar de açúcar foram obtidos da Pesquisa de Orçamento Familiar (POF) de 2003 e, sobre indicadores socioeconômicos, do Programa das Nações Unidas para o Desenvolvimento em 2000. Na análise estatística, foram utilizados testes de correlação e regressão linear simples e múltipla. RESULTADO: Não houve associação significativa entre a experiência de cárie em crianças de cinco anos e as variáveis independentes. Na idade de 12 anos, menor experiência de cárie foi correlacionada à maior aquisição de refrigerantes, ao maior tempo de fluoretação e ao IDH e à renda per capita mais elevados. O resultado da regressão linear múltipla, ajustado pelo tempo de fluoretação das águas, indicou que esta variável explica os níveis de cárie mais baixos. Após o ajuste pelos demais fatores, nenhuma variável foi associada à cárie. CONCLUSÃO: Não houve associação entre a experiência de cárie em crianças e a disponibilidade domiciliar de açúcar nas capitais brasileiras em 2003, quando indicadores socioeconômicos e presença de água fluoretada foram considerados na análise.

Effect of the widespread use of fluorides on the occurrence of hidden caries in children

It has been suggested that the widespread use of fluorides could interfere in the prevalence of clinically undetected occlusal dentine caries. The objective of this study was to determine the role of public water fluoridation and fluoride dentifrice on the prevalence of hidden caries in 8-10-year-old children. Clinical and radiographic data on schoolchildren collected in an epidemiologic study in Porto Alegre, Brazil, at two moments, 1975 (n = 228) and 1996 (n = 213), were analysed. Only the first permanent molars were studied. Only children of the 1996 examinations had benefited from fluoridated water soon after birth and had regular access to fluoride dentifrices. The criterion applied for hidden caries, when data from 1975 to 1996 were compared, was clinical sound surfaces that presented a radiolucent zone in the dentine. The prevalence of clinically sound surfaces and percentage of hidden caries was 0.51 and 26.4% in 1975 and 2.67 and 12.9% in 1996, respectively. The prevalence of hidden caries differed statistically between the two periods (P < 0.05). The results do indicate that the widespread use of fluoride via public water supply and dentifrices decreases the prevalence of hidden caries.

Drinking water fluoridation and osteosarcoma incidence on the island of Ireland

The incidence of osteosarcoma in Northern Ireland was compared with that in the Republic of Ireland to establish if differences in incidence between the two regions could be related to their different drinking water fluoridation policies. Data from the Northern Ireland Cancer Registry (NICR) and the National Cancer Registry of Ireland (NCRI) on osteosarcoma incidence in the respective populations were used to estimate the age-standardised and age-specific incidence rates in areas with and without drinking water fluoridation. One hundred and eighty-three osteosarcoma cases were recorded on the island of Ireland between 1994 and 2006. No significant differences were observed between fluoridated and non-fluoridated areas in either age-specific or age-standardised incidence rates of osteosarcoma. The results of this study do not support the hypothesis that osteosarcoma incidence in the island of Ireland is significantly related to public water fluoridation. However, this conclusion must be qualified, in view of the relative rarity of the cancer and the correspondingly wide confidence intervals of the relative risk estimates.

Dental caries and related factors in Brazilian children from fluoridated and non-fluoridated areas

Purpose: To compare the caries prevalence, saliva buffering capacity (SBC), oral hygiene (OH), dietary habits, family income (FI) and frequency of visits to a dental office (Do) between Brazilian children living in areas with and without fluoridated public water supply. Methods: Forty-six 5-7-year-old preschoolers were selected in Itatiba, SP, Brazil; 19 were from a fluoridated area, and 27 were from a non-fluoridated area. The caries index was determined according to the World Health Organization criteria, and the SBC was assessed by titration with hydrochloric acid. The FI, frequency of OH and visits to Do were estimated by questionnaire. The dietary habits were assessed with a diet chart. The differences between the groups were analyzed with Mann-Whitney-U tests (α=0.05). Results: Children from the non-fluoridated area showed significantly higher dmft/DMFT than those from the fluoridated area, but they showed significantly lower SBC, OH frequency and FI. No significant differences were observed between the areas for dietary habits and visits to Do. Conclusion: Children from fluoridated areas showed higher salivary buffering capacity, family income and oral hygiene frequency as well as lower caries prevalence, supporting the beneficial effect of fluoride in the tap water for caries prevention.

How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil

To evaluate the association between income inequality, a public policy scale and to oral health. Analysis, using the Brazilian oral health survey in 2002-2003, included 23,573 15-19-year-old subjects clustered in 330 municipalities. Missing and decayed teeth and malocclusion assessments were the outcomes. Gini coefficient and a novel Scale of Municipal Public Policies were the main exposure variables. Individual level covariates were used as controls in multilevel regressions. An increase from the lowest to the highest Gini value in Brazil was associated with an increase in the number of missing (rate ratio, RR=2.11 confidence interval 95% 1.18-3.77) and decayed teeth (RR=2.92 CI 95% 1.83-4.65). After adjustment for public policies and water fluoridation, the Gini effect was non-significant and public policies explained most of the variation in missing and decayed teeth. The public policy scale remained significant after adjustment with a rate ratio of 0.64 for missing and 0.72 for decayed teeth. Neither Gini nor public policies were significantly related to malocclusion. The public policy effect on missing and decayed teeth was stronger among those with higher education and income. Income inequality effect was explained mainly by public policies, which had an independent effect that was greater among the better-off.

The paradox of overlapping micronutrient risks and benefits obligates risk/benefit analysis

With risk analysis methods in the process of being deployed by European authorities for the purpose of limiting maximum dosages of vitamin and mineral supplements across the European Union (EU), scientific validation of recently emerging approaches using existing risk and benefit data is deemed essential. This review explores the function of existing European nutrient risk analysis methodologies applied to two vitamins, niacin and folate, and two minerals, selenium and fluoride. A major weakness of existing models is their exclusive focus on a single, most sensitive adverse effect on the most susceptible sub-population. Analysis of the four nutrients revealed, paradoxically, that dosages that induce risks in sensitive populations commonly overlap with those which induce benefits in the majority. This situation appears to be the norm, rather than the exception. Such overlaps are exacerbated when risk evaluations fail to consider differences between molecular forms of the same nutrient. A new conceptual risk/benefit model is proposed to replace the over-simplified two-tail risk model that has been widely accepted by regulatory authorities in Europe and the USA in recent years. This new model, which reveals pertinent zones of overlap between risks and benefits, demonstrates that statutory limitation of dosages at levels beneath existing tolerable upper levels would in many cases prevent the majority of the population from experiencing benefits from higher dosages. Accordingly, it is proposed that a critical zone of risk/benefit analysis is established for dosages in excess of the upper level to facilitate policy and risk management decision-making. Conventional risk assessment on fluoride as undertaken by European and US authorities is explored in detail, and it is shown that risk management, if applied by public authorities in a manner which is consistent with that used for other nutrients, would make public drinking water fluoridation programmes unfeasible in light of dental fluorosis risk to children. Possible explanations for the common overlap in dosages which induce both beneficial and adverse effects are given, both at a population and individual level. The review concludes by proposing that statutory restriction of vitamin and mineral food supplement dosages should be delayed in the EU until validated and more scientifically rational methodologies are developed. Where significant health benefits are known to result from habitual or short-term ingestion of dosages in excess of either upper levels or proposed statutory ‘maximum levels’, risk/benefit analysis should be undertaken to allow re-evaluation of risk management strategies.

Dental caries in preschoolers from communes with fluoridated and non-fluoridated public water supplies in Chile

PURPOSE: To determine the prevalence and severity of dental caries in three- to five-year-old preschool children from two communes in Chile: one with a fluoridated public water supply and the other with a non-fluoridated public water supply. METHODS: Study design: Cross-sectional observational study. The sample was composed of 200 children from three to five years old, with good general health, of low socioeconomic status, attending four kindergarten schools of the Metropolitan Region of Santiago, Chile. Two schools were located in the commune of Maipú, which does not have fluoridated public water, and two schools were located in the commune of Peñalolen, which has had fluoridated public water since 1996, at a fluoride concentration of 0.6 mg/L. The WHO (World Health Organization) methodology was used to measure the percentage of caries-free children, and the dmft index was used to measure the severity of the disease. RESULTS: The results showed that 24% of the children in Maipú were caries free, compared to 55% in Peñalolen. The dmft index was 3.38 and 1.84 in Maipú and Peñalolen, respectively. These indices increased with age. CONCLUSION: The prevalence and severity of dental caries in three- to five-year-old preschoolers were higher in Maipú, the commune with non-fluoridated water, than in Peñalolen, the commune with fluoridated water.

Fluoride intake in preschoolers from two different communes in Santiago, Chile

PURPOSE: To determine the fluoride intake in three- to five-year-old preschool children from two communes in Chile, one with a non-fluoridated public water supply (Maipú) and the other with fluoridated public water supply since 1996, at a fluoride concentration of 0.6 mg/L (Peñalolen). METHODS: Cross-sectional, observational design. The sample population was composed of 200 three-to-five-year-old children attending four kindergartens in the Santiago Metropolitan Region, Chile, in the communes of Maipú and Peñalolen. Intake of fluoride was measured in a morning urine sample by using an ion-specific electrode and creatinine concentration. The fluoride intake from other sources was estimated from the parents' and educators' survey answers. RESULTS: The daily dose of fluoride intake (DDI) for all Maipú preschoolers was 0.021 mg F/kg body weight (bw)/day, a value less than the optimal dose, which is 0.05 to 0.07 mg F/kg bw/day. The DDI for the Peñalolen sample reached 0.066 mg F/kg bw/day. There is a contribution from fluoride toothpaste ingestion of 0.019 mg F/kg bw/day in Maipú and 0.017 mg F/kg bw/day in Peñalolen. The overall frequency of daily brushing was 3.15 times, during which 31% of Maipú children and 33% of Peñalolen children ingested toothpaste. The estimated amount of fluoride intake from toothpaste and tea consumption explained the contribution of fluoride not coming from fluoridated water. CONCLUSION: The fluoride ingestion from water and other sources in the preschool commune of Peñalolen is much higher than the fluoride intake in preschoolers of the Maipú district.

Promoting Social Welfare Through Oral Health: New Jersey's Fluoridation Experience

This study examines the contentious public health policy of treating community water with fluoride in the United States. The question for scholarly investigation is why water fluoridation has been unsuccessful in several parts of the United States relative to the rest. It addresses this question by looking into the processes of scientific discovery and information dissemination, benefits and risks of science-based health policy, related issues of provision and production, and spatial dimensions of policy development. The case method based on New Jersey's experience in public water fluoridation, was opted for this study. We find that policy debates, which are confined to single key issues, tend to breed binary choices and bipolar debates and result in policy stalemates. Consumer accessibility and desirability of merit goods thus become sharply conflicting social welfare values. They undermine the intent of science-based policies and often make alternative and second-best policies more practical to adopt.