Elsevier

Dental Abstracts

Volume 61, Issue 6, November–December 2016, Pages 284-285
Dental Abstracts

Commentary
Changing water fluoridation levels

https://doi.org/10.1016/j.denabs.2016.05.002Get rights and content

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Background

The United States Department of Health and Human Services (US HHS) has issued a recommendation for using an optimal concentration of 0.7 mg fluoride per liter (mg F/l) in water supplies, with the basis being a belief that this concentration permits the best balance of protection from dental caries and limitation of dental fluorosis risk. The recommendation changes the previous guideline that fluoride levels should be between 0.7 and 1.2 mg F/l based on the ambient air temperature of the

Risk/Protection Balance

Dental fluorosis is essentially a disorder affecting children age birth to 8 years, whereas dental caries is a disorder that occurs across the lifetime and in all dentitions. Therefore protection against fluorosis should be focused on young children, whereas caries protection requires an ongoing effort throughout the lifespan. These differences make the balance of risk/protection difficult to conceptualize.

Dental fluorosis and dental caries also differ in impact. Caries has well-established

Components Considered

The key research components evaluated in formulating the recommendation were water consumption and ambient air temperature, prevalence of dental fluorosis, and protection against dental caries. Several analyses have documented the relationship between water intake and temperature. Often research has indicated seasonal and regional differences in water intake, but some studies show no relationship. These differences may reflect the type of data collected and the analytic approach adopted. In

Other Factors

There is a curvilinear relationship between fluoride concentration and protection against caries in the United States and other countries. The dose-response relationship between fluoride concentration and caries experience measured as either decayed-missing-filled surfaces in permanent teeth (DFMS) or decayed-missing-filled teeth (DFMT) consists of a decrease in caries experience through fluoride levels of about 3 mg F/l, but a leveling off or increase subsequently. This finding did not appear

Monitoring

Along with the recommendations, the panel has called for enhanced surveillance of caries and fluorosis. Data collections will need to be carefully planned and analyzed to ensure changes are properly evaluated. In addition, there will need to be more data on both individual and population impacts related to caries and fluorosis, water intake patterns in various climate zones, and the curvilinear relationship of fluoride concentration in naturally fluoridated water supplies and the effect on

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Spencer AJ, Do LG: Caution needed in altering the ‘optimum’ fluoride concentration in drinking water. Community Dent Oral Epidemiol 44:101-108, 2016

Reprints available from AJ Spencer, Australian Research Ctr for Population Oral Health, The Univ of Adelaide, Adelaide, SA, Australia; fax: +61 8313 3070; e-mail: [email protected]

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