Fluoridation

Overview

Water Fluoridation as a Public Health Measure

Throughout decades of research and more than fifty years of practical experience, fluoridation of public water supplies has been responsible for dramatically improving the public’s oral health status. In 1998, recognizing the ongoing need to improve health and well being, the U.S. Public Health Service revised national health objectives to be achieved by the year 2010. Included under oral health was an objective to significantly expand the fluoridation of public water supplies.8 In 1994, the U.S. Department of Health and Human Services issued a report which reviewed public health achievements. Along with other successful public health measures such as the virtual eradication of polio and reductions in childhood blood lead levels, fluoridation was lauded as one of the most economical preventive values in the nation.9 Finally, a policy statement on water fluoridation reaffirmed in 1995 by the USPHS stated that water fluoridation is the most cost-effective, practical and safe means for reducing the occurrence of tooth decay in a community.10

Simply by drinking optimally fluoridated water, the entire community benefits regardless of age, socioeconomic status, educational attainment or other social variables. Community water fluoridation does not discriminate against anyone based on income, education or ethnicity. Fluoridation’s benefits are realized without behavior change on the part of an individual. The benefits of water fluoridation are not limited to those with access to dental care.

Water Fluoridation’s Role in Reducing Dental Decay

Water fluoridation and the use of topical fluoride have played a significant role in improving oral health. Studies show that water fluoridation can reduce the amount of cavities children get in their baby teeth by as much as 60%; and can reduce tooth decay in permanent adult teeth by nearly 35%. Increasing numbers of adults are retaining their teeth throughout their lifetimes due in part to the benefits they receive from water fluoridation. Dental expenditures for these individuals are likely to have been reduced and innumerable hours of needless pain and suffering due to untreated dental decay have been avoided.

It is important to note that dental decay is caused by dental plaque, a thin, sticky, colorless deposit of bacteria that constantly forms on teeth. When sugar and carbohydrates are eaten, the bacteria in plaque produce acids that attack the tooth enamel. After repeated attacks, the enamel breaks down, and a cavity (hole) is formed. There are several factors that increase an individual’s risk for decay:12

• Recent history of dental decay
• Elevated oral bacteria count
• Inadequate exposure to fluorides
• Exposed roots
• Frequent sugar and carbohydrate intake
• Fair to poor oral hygiene
• Inadequate saliva flow
• Deep pits and fissures in the chewing surfaces of teeth

Exposure to fluoride is not the only measure available to decrease the risk of decay. In formulating a decay prevention program, a number of intervention strategies may be recommended.