Preven Lec 5

Preventive Dentistry Assist Prof Alhan Ahmed
Community Water Fluoridation Lec 5
Introduction
Community water fluoridation, also referred to as fluoridation, is

defined as the upward adjustment of the natural fluoride level in a
community’s water supply to a level optimal for dental health. It is a
population‐based method of primary prevention that uses piped water
systems to deliver a low concentration of fluoride over frequent intervals
during the day. By consuming the water directly or indirectly through
incorporation in foods and beverages, consumers accrue preventive
benefits regardless of age or socioeconomic status. Fluoridation has been
cited by the Centers for Disease Control and Prevention (CDC) as one of
the 10 great public health achievements of the 20th century.
A. Communal water Artificial Fluoridation
Fluoridation is the controlled adjustment of a fluoride compound
to a public water supply in order to bring the fluoride concentration up to
a level which effectively prevents caries. The studies of Dean and others
up to 1943; shown that fluoride was associated with a lower prevalence of
caries, and that there was a sound basis for hypothesis that the
introduction of fluoride into a water supply would result in a lower
communal prevalence of caries. Water fluoridation requires a level of
dental caries in the community that is high or moderate, or a firm
indication that the caries level is increasing.
History of water Fluoridation
 Dean’s results showed that both a reduction of dental caries
and an acceptable level of enamel fluorosis could be attained
with water containing fluoride levels at approximately 1 ppm of
fluoride.
 In1945 Grand Rapids,Michigan city , became the first city in the
world to fluoridate its drinking water as a measure to promote
dental health and prevent disease. Grand Rapids was the test, or
intervention, city and Muskegon, Michigan, whose water was not
fluoridated, as control in USA. The previous year(1944) a baseline
study comparing Grand Rapids with the neighboring town of
Muskegon had found similar decay levels in deciduous and
permanent teeth in both areas. Six years later, surveys indicated
that decay levels in 6-year-old children (i.e. those born since
fluoridation commenced) in Grand Rapids was almost half of that
of Muskegon,in ‘non-fluoride’ Muskegon the average number of
teeth with decay experience was 5.7, compared with 3.0 in
‘fluoridated’ Grand Rapids .
1
Artificial water fluoridation level
World Health Organization ( 1984 )guidelines suggested that the
level of artificial water fluoride according to climate as:
1. In areas with a warm climate, the optimal fluoride concentration
in drinking water should remain below 1 mg/ liter (1 ppm or
part per million).
2. While in cooler climates it could go up to 1.2 mg/liter. (A range
of 0.7-1.2 ppm). The differentiation derives from the fact that
perspiration is more in hot weather and consequently intake is
more.
Then the National Advisory Committee on Oral Health
suggested a range 0.6-1.1 mg/L with variation within that range
according to the mean maximum daily temperature.
Advantages of water fluoridation:
1. Low cost.
2. No motivation or behavioral changes necessary.
3. Had pre and post eruptive benefit.
4. Caries reduction 50-60% in permanent teeth, and 40-50% in primary
teeth. And the disadvantage is the possibility of mild to moderate
fluorosis.
Disadvantages of water fluoridation
1. Political and/or emotional objections to water additives.
2. Possibility of mild to moderate fluorosis if other sources of fluoride are
ingested
3. Alleged toxicity.
Systemic effect of fluoride:
1. Pre-eruptive Systemic Effects: During tooth development, fluoride
is incorporated into the developing tooth’s mineralized structure.
Although this is no longer believed to be the most important reason
for the effect of fluoride in dental caries, the presence of fluoride in
the dental enamel probably increases resistance to demineralization
when the tooth surface is exposed to organic acids.
Systemic fluoride may enhance the resistance of the tooth by way of:
1. An alteration in tooth morphology, and
2. A conversion of the hydroxyapatite mineral to a fluoridated
state with an attendant reduction in solubility and an
enhancement of the remineralization phase of the caries process.
2. Post-eruptive Systemic Effects:
After tooth eruption, fluoride is no longer involved systemically in
tooth formation. However, consumed fluoride is excreted through the
saliva and can aid in tooth protection throughout the lifetime. At the time
of tooth eruption the enamel is not completely calcified and undergoes a
post-eruptive period of approximately 2 years during which enamel
2
calcification continues. Throughout this period-period of enamel
maturation’ there is continuous accumulation of fluoride as well as other
elements in the superficial part of enamel.
Fluoride compound used in water fluoridation
1. Fluorspar: It is a mineral containing calcium fluoride [CaF2].
2. Sodium fluoride.
3. Silicofluorides.
4. Sodium silicofluorides: Most commonly used due to its low
cost. Solutions of this compound are corrosive hence
materials for piping, etc. should be chosen accordingly.
5. Hydrofluosilicic acid.
6. Ammonium silicofluoride [(NH)2SiF6].
Medical aspect of Water Fluoridation
Medical aspect or Safety of water fluoridation was a research
concern from the time of fluoride’s identification in water in 1931.
According to World Health Organization’s monograph ‘fluoride and
human health’ there is evidence that ingestion of fluoride at
recommended levels presents no danger to humans.
Health benefits and risk of fluoridation has been the subject of
searching reviews by expert committees throughout the world
including the WHO. None has found evidence that drinking water with
a concentration of around 1 ppm is harmful to health. In fact other than
dental fluorosis only endemic skeletal fluorosis is known to result from
long-term ingestion of water containing high levels of fluoride. In
recent years opponents of fluoridation have attempted to link
fluoridation with a wide range of diseases, e.g. cancer, Alzheimer
diseases or that it interferes with the immune function. But there is
overwhelming agreement between the scientific, medical and dental
community worldwide that fluoridation of water is a safe and effective
public health measure.
B. School Water Fluoridation
An alternative to community water fluoridation is the fluoridation of
school drinking water. It’s most applicable in rural schools, where
fluoridation of community water is not feasible. Reduction in dental
caries was found to be about 40 percent.
Disadvantages
• The children do not receive the benefits until they begin school [belated
exposure]
• Children consume the fluoridated water only when the school is in
session [abbreviated exposure].
To compensate for this belated and abbreviated exposure,
the school water is usually fluoridated at 4.5 times the optimum
concentration recommended for that place.
3
There are two major concerns about school water fluoridation:
1. By age 6 all teeth expect 3rd molars are in an advanced stage of
mineralization, thus reducing the pre-eruptive benefits of fluoride.
2. There are no data to indicate expected caries incidence following
graduation.
Table (1): Effect of fluoride in water on human health when

consumed for longer durations
Fluoride concentration (mg/L) Effects
<1.0 Safe limit

1.0–3.0 Dental Fluorosis
3.0–4.0 Brittle and stiff bones and joints
4.0–10 Dental fluorosis, skeletal fluorosis
(pain in neck bones and back)

Preven Lec 5

Uploaded by

Copyright:

Available Formats

Preven Lec 5

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Preven Lec 5

Uploaded by

Copyright:

Available Formats

Preventive Dentistry Assist Prof Alhan Ahmed

Community Water Fluoridation Lec 5

Community water fluoridation, also referred to as fluoridation, is

Table (1): Effect of fluoride in water on human health when

<1.0 Safe limit

You might also like