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Home , Water fluoridation

SCIENTIFIC BACKGROUND

Fluoridated

A cost-effective way to prevent dental caries at community level

© 2015 Toothfriendly International Cover image: Dubravko Soric Dubravko image: Cover The smarter salt

Fluoridated salt is the single most inexpensive, effective and safe measure to prevent in entire populations.

Fluoride is a natural mineral found using , table salt or water fluoridation is either techni- throughout the earth‘s crust and food supplements. cally or politically impossible. widely distributed in nature. Some foods and water supplies contain Both water and salt fluoridation are What are the risks? . considered extremely cost-effective in preventing dental caries. The flu- Health risks associated with fluori- The use of fluoride strengthens oridation of water is considered by dation are mainly related to misuse and reduces the the U.S. Centers for Disease Control and overdoses. is harmful effects of plaque. Fluoride and Prevention as „one of 10 great a condition caused by an excessive also makes the entire tooth structure achievements of the intake of characterized by more resistant to decay and pro- 20th century”. yellow or brown stains on the teeth. motes remineralization, which aids in repairing early demineralisation In some countries where large, Some advocacy groups also publish before the damage is even visible. centralized water systems are reports on the hazards of fluorida- uncommon, fluoride is delivered to tion. The activists point to toxicity Most commonly, fluoride is applied the population by fluoridating table warnings on , concluding topically to the teeth using gels, salt. Salt fluoridation is recognized that any substance needing such ca- varnishes, toothpaste/dentifrices worldwide as a proven and viable reful dosage must be dangerous. The or mouth rinse. Systemic delivery means of consumer choice-related, World Health Organisation (WHO) involves fluoride supplementation community-based fluoridation where states that fluoride has both bene- Fluoridated salt

ficial and detrimental effects on hu- water. Typically, a salt fluoride man health. A high concentration of concentration of 250-310 mg/kg is fluoride in drinking water increases used and does not present a risk for the of dental fluoro- fluorosis. (Marthaler 2000) sis. In terms of general health, in communities where drinking water Why salt? and foodstuffs are naturally too high in fluoride, skeletal fluorosis and The advantages of fluoridated salt are the most relevant for developing countries can be adverse effects. considered under the following items (Gillespie 2005): However, the fact remains that in - the ability to reach all sectors of many countries the dramatic reduc- the population at minimum cost tions in tooth decay in the past 30 - low cost; it saves an average of years is due to fluoridation. When $250 per person per year in dental used appropriately, fluoridated salt treatment for every $1 spent is both safe and effective in preven- - little or no intentional action is ting caries (Menghini et al. 1995). needed of the public to benefit Figure 1. Average DMFT in children - safety (permanent residents) in 16 com- - can be implemented irrespective of Experiences with munities of the Canton of Zurich, changes in water quality fluoridated salt Switzerland, in which surveys were - developing countries tend to have conducted every 4 years since 1964. a reasonably stable diet, often Fluoridation of domestic salt (FS) for (Marthaler 2004) human consumption was first initia- based on rise, beans, pasta or ted in Switzerland in 1955. Following similar products which require the use of table salt in their preparation. the iodization of salt in Switzerland References since 1922, fluoridation of salt for Fluoridation of salt also profits from the prevention of dental disease was Estupinan-Day SR, Baez R, Horowitz H, Warpeha considered a valid approach based the experience gained in production, R, Sutherland B and Thamer M. Salt fluoridation quality control and monitoring in res- and dental caries in Jamaica, Community Dent on experiences of fluoride in the Oral Epidemiol 2001; 29: 247-252. prevention of dental caries (Wespi pect of the iodisation of edible salt. 1950). The results were excellent: Gillespie G. Salt fluoridation - a public health the average DMFT in 12-year olds Conclusion success story. Developing 2005; Vol. 6 (1), 1-6. decreased steadily from 8 in 1964 to one in 1992 (Marthaler et al. 1994) Untreated caries is a problem in many Irigoyen-Camacho (1997) Dental caries in developing country. Salt fluoridation school children in Mexico City. Salud Publica Mex In the period 1986–1992, Jamaica, is said to be the most efficient public 1997;39:133-136. Costa Rica, Mexico and Uruguay health preventive approach. Experi- Irigoyen-Camacho (1997) Dental caries in introduced nationwide salt fluo- ence in Latin America has shown that school children in Mexico City. Salud Publica Mex ridation. Results obtained from putting fluoride in salt can reduce 1997;39:133-136. these countries illustrate significant dental caries by as much as 84 per- Marthaler TM. Changes in the prevalence of den- reductions in caries prevalence in cent (Estupinan-Day et al. 2001). tal caries: How much can be attributed to dental caries. In Jamaica, caries- changes in diet? Caries Res (suppl. 1) free children increased from 2.8% Fluoride toothpaste, rinses, var- 1990;24:3-15. to 61.7%%, with 96% fluorosis free nish applications and supplements Marthaler TM, Steiner M, Menghini GD, Bandi A: (Estupinan-Day et al. 2001). Caries may have proven themselves in the Caries prevalence in Switzerland. Int Dent J prevalence decreased 73% in Costa West, but they are not universally 1994;44:393–401. Rica (Solorzano et al. 1999); 44% in affordable. Salt fluoridation is highly Marthaler TM. Salt Fluoridation in Europe, Com- Mexico and 40% in Uruguay (Irigo- equitable, benefiting equally rich and parisons with Latin America. In: Geertman yen & Camacho 1997). poor, young and old, urban and rural RM, editor. 8th World Salt Symposium. Amster- dwellers, those with access to pro- dam: Elsevier; 2000. p. 1021-1025. Today, fluoridated salt for household fessional dental services and those Marthaler TM. Changes in Dental Caries use is widely available in the fol- without. 1953–2003. Caries Res 2004;38:173–181 lowing European countries: Switzer- Menghini G, Steiner M, Marthaler TM, Bandi A. land, France, Germany, Spain, Aust- Kariesbefall bei Schülern des Kantons Glarus ria, Hungary and Czech Republic. in den Jahren 1974 bis 1992: Wirkung der Salz- fluoridierung. Schweiz Monatsschr Zahnmed 1995;105:467-473. Safety considerations Solorzano, Beltran, Salas, Chavarria, Estupinan: The combination of both salt and Prevalence and trends of dental caries in Costa Rican school children from 1984 to 1999. J of water fluoridation is not recommen- Dent Res 90 (Spec Issue): 36 (2001) ded. About 200-250 mg fluoride per kg of salt is reported to be equiva- Wespi H J: Fluoridiertes Kochsalz zur Caries- prophylaxe. Schweiz. Med Wschr 80: 561–564 lent to 0.5-1.2 ppm of fluoride in (1950)