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"Fluoridation"
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U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries
US Public Health Service (PHS) recommendation for fluoride concentration in drinking water for the prevention of dental caries is presented. For these community water systems that add fluoride, PHS now recommends an optimal fluoride concentration of 0.7 milligrams/liter (mg/L). In this guidance, the optimal concentration of fluoride in drinking water is the concentration that provides the best balance of protection from dental caries while limiting the risk of dental fluorosis. This updated guidance is intended to apply to community water systems that currently fluoridate, or that will initiate fluoridation.
Journal Article
Water fluoridation for the prevention of dental caries
Key pointsEarly studies of community water fluoridation showed an important effect on prevention of tooth decay in children. Recent studies show smaller effects.Any potential oral health benefits should be comprehensively considered alongside potential harms and costs (taking contemporary effect estimates into account).There is inconsistent evidence with regards to the impact of water fluoridation on oral health inequalities.Where community water fluoridation is implemented, monitoring of water fluoride concentrations is critical to ensure schemes consistently provide optimal potential benefits in terms of caries prevention.
Journal Article
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.
Journal Article
Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water
BackgroundWhile previous research has suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism, few population level studies have been undertaken. In England, approximately 10% of the population live in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. This observational study examines the association between levels of fluoride in water supplies with practice level hypothyroidism prevalence.MethodsWe used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/2013 Quality and Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner registered patient numbers and 2012 practice level Index of Multiple Deprivation scores.FindingsWe found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).InterpretationIn many areas of the world, hypothyroidism is a major health concern and in addition to other factors—such as iodine deficiency—fluoride exposure should be considered as a contributing factor. The findings of the study raise particular concerns about the validity of community fluoridation as a safe public health measure.
Journal Article
Potential fluoride toxicity from oral medicaments: A review
The beneficial effects of fluoride on human oral health are well studied. There are numerous studies demonstrating that a small amount of fluoride delivered to the oral cavity decreases the prevalence of dental decay and results in stronger teeth and bones. However, ingestion of fluoride more than the recommended limit leads to toxicity and adverse effects. In order to update our understanding of fluoride and its potential toxicity, we have described the mechanisms of fluoride metabolism, toxic effects, and management of fluoride toxicity. The main aim of this review is to highlight the potential adverse effects of fluoride overdose and poorly understood toxicity. In addition, the related clinical significance of fluoride overdose and toxicity has been discussed.
Journal Article
The ethics of community water fluoridation: Part 2 - how has the ethics of community water fluoridation been appraised in the literature? A scoping review
Aim
To examine how the ethics of community water fluoridation has been appraised in the literature.
Method
A scoping review using an updated Arksey and O'Malley framework. Six electronic databases were searched: Medline via OVID; Scopus; Web of Science; Cochrane Library; StarPlus and Google Scholar. Grey literature and reference lists of included studies were also searched.
Results
In total, 51 studies from 15 countries were included. Many referred to biomedical ethical principles intended for clinical rather than public health interventions. Some primarily aimed to appraise its ethics whereas others considered it as part of more general discussions on fluoridation. While most acknowledged its complexity, those more supportive of fluoridation often emphasised collective benefit and those less supportive emphasised infringement of autonomy or personal liberty and concerns about harm. Few referred to public health ethics principles and frameworks available in the literature.
Conclusion
Different approaches have been taken to appraise the ethics of fluoridation. Frequently, these were conceived for individual medical rather than public health interventions and are inadequate to resolve tension between inevitable infringement of individual consent and collective benefit in public health. Other approaches conceived specifically for public health exist that have more utility in debates and ethical decision-making.
Key points
Justifying the introduction, maintenance and cessation of community water fluoridation requires the consideration of its ethics. This paper summarises the different approaches used to appraise its ethics in the literature.
The paper reports that most studies used approaches conceived for medical rather than public health interventions. These were unable to adequately resolve the tension between the infringement of individual consent and collective benefit associated with community water fluoridation.
The paper also identifies other multidimensional approaches conceived for public health interventions with more utility for appraising the ethics of water fluoridation.
Journal Article
Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review
Objectives
To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis.
Methods
Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal.
Results
Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis.
Conclusions
Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
Journal Article
Correction: Genetic variants in pachyonychia congenita-associated keratins increase susceptibility to tooth decay
[This corrects the article DOI: 10.1371/journal.pgen.1007168.].
Journal Article
P04 Milk Fluoridation as a caries intervention: Assessing the knowledge and attitudes of parents with young children in Gateshead
BackgroundOver 80% of school-aged children in some developed nations, including the United Kingdom, suffer from dental caries (DC), which causes discomfort, pain, and reduced school attendance for children.The aim of this study was to evaluate the knowledge and attitude of parents with children aged 4–11 in a ward of the Gateshead Borough regarding milk fluoridation as a caries preventive measure.MethodsA quantitative cross-sectional research method was adopted for this study, study participants (parents having children aged 4–11 years that reside in Gateshead) were conveniently recruited using an online validated questionnaire prepared and pooled using Qualtrics. The questionnaire examined the general knowledge and attitude the respondents had in addition to the oral habits of the wards using 27 closed-ended questions which were analyzed using descriptive, univariate, and multivariate regression.ResultsData analysed (20.9% response rate) revealed poor knowledge and general negativity towards milk fluoridation in Gateshead. A significant relationship was observed between the level of education and monthly income; secondary level education increased the likelihood (p= 0.048) seven times (B= 7.000) of the respondents having adequate knowledge of fluoridation with reference to the post-tertiary educational level, nonetheless, having none, primary, and tertiary education had no prediction relationship.ConclusionUndoubtedly, there remains limited information on general knowledge about milk fluoridation in Gateshead. It is therefore recommended that educational interventions and socioeconomic development be implemented before any community-level milk fluoridation program in Gateshead.
Journal Article