Does fluoridation of drinking water prevent dental caries?

Summary

These studies suggest that fluoridation of drinking water significantly prevents dental caries, especially in children, by reducing the prevalence and severity of decayed, missing, and filled teeth.

Introduction

Fluoridation of drinking water has been a public health strategy for preventing dental caries since its inception in the mid-20th century. Dental caries, or tooth decay, is a prevalent global issue affecting children and adults. This synthesis aims to evaluate the effectiveness of water fluoridation in preventing dental caries based on contemporary research findings.

Key Insights

• Effectiveness in Reducing Dental Caries in Children:

  • Water fluoridation significantly reduces the prevalence of dental caries in children, with reductions in decayed, missing, and filled teeth (DMFT) by 35% and in permanent dentition (DMFT) by 26%.

  • Studies show a 15% increase in the percentage of caries-free children in deciduous dentition and a 14% increase in permanent dentition due to water fluoridation.

• Effectiveness in Reducing Dental Caries in Adults:

  • Lifetime access to fluoridated water is associated with lower adult dental caries rates. Adults with less than 50% lifetime access to fluoridated water have higher rates of decayed, missing, and filled teeth (DMFT) than those with more than 75%.

  • There is limited contemporary evidence specifically evaluating the effectiveness of water fluoridation in preventing caries in adults, but available data suggest a beneficial effect.

• Comparative Effectiveness of Fluoride Delivery Methods:

  • Fluoride toothpaste and mouth rinses also effectively reduce dental caries, with higher fluoride concentrations providing greater caries control.

  • Where feasible, water fluoridation is recommended for its substantial public health benefits, especially in areas with limited fluoride sources.

• Dental Fluorosis Concerns:

  • There is a significant association between water fluoridation and dental fluorosis, with approximately 12% of participants experiencing fluorosis of aesthetic concern at a fluoride level of 0.7 ppm.

  • Policies have been adjusted to balance the benefits of caries prevention with the risk of fluorosis, recommending an optimal fluoride concentration of 0.7 mg/L in drinking water.

Conclusion

The fluoridation of drinking water is an effective public health measure for reducing dental caries in children and adults. While there are concerns about dental fluorosis, the benefits of caries prevention outweigh the risks when fluoride levels are appropriately managed. Fluoride toothpaste and other fluoride delivery methods complement water fluoridation, preventing additional caries. Water fluoridation remains a key strategy in improving dental health and reducing health inequalities.

Sources:

1. Zipporah Iheozor-Ejiofor et al. "Water fluoridation for the prevention of dental caries.." The Cochrane database of systematic reviews, 6 (2015): CD010856 .

2. T. Walsh et al. "Fluoride toothpastes of different concentrations for preventing dental caries.." The Cochrane database of systematic reviews, 3 (2019): CD007868 .

3. P. Petersen et al. "Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach.." Community dentistry and oral epidemiology, 32 5 (2004): 319-21 .

4. M. A. Peres et al. "Access to Fluoridated Water and Adult Dental Caries." Journal of Dental Research, 95 (2016): 868 - 874.

5. B. Gooch et al. "U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries." Public Health Reports, 130 (2015): 318 - 331.

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