RESUMEN

UNLABELLED: The aim of this paper is to make known the potential of fluoridated salt in community oral health programs, particularly in South Eastern Europe. Since 1922, the addition of iodine to salt has been successful in Switzerland. Goiter is virtually extinct. By 1945, the caries-protective effect of fluorides was well established. Based on the success of water fluoridation, a gynecologist started adding of fluoride to salt. The sale of fluoridated salt began in 1956 in the Swiss Canton of Zurich, and several other cantons followed suit. Studies initiated in the early seventies showed that fluoride, when added to salt, inhibits dental caries. The addition of fluoride to salt for human consumption was officially authorized in 1980-82. In Switzerland 85% of domestic salt consumed is fluoridated and 67% in Germany. Salt fluoridation schemes are reaching more than one hundred million in Mexico, Colombia, Peru and Cuba. The cost of salt fluoridation is very low, within 0.02 and 0.05 € per year and capita. Children and adults of the low socio-economic strata tend to have substantially more untreated caries than higher strata. Salt fluoridation is by far the cheapest method for improving oral health. CONCLUSION: Salt fluoridation has cariostatic potential like water fluoridation (caries reductions up to 50%). In Europe, meaningful percentages of users have been attained only in Germany (67%) and Switzerland (85%). In Latin America, there are more than 100 million users, and several countries have arrived at coverage of 90 to 99%. Salt fluoridation is by far the cheapest method of caries prevention, and billions of people throughout the world could benefit from this method.

Asunto(s)

Cariostáticos/uso terapéutico , Caries Dental/prevención & control , Fluoruración , Salud Bucal , Salud Pública , Cloruro de Sodio Dietético , Adolescente , Adulto , Niño , Preescolar , Análisis Costo-Beneficio , Índice CPO , Caries Dental/epidemiología , Países en Desarrollo/economía , Europa Oriental/epidemiología , Femenino , Fluoruración/economía , Educación en Salud , Educación en Salud Dental , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lactante , Masculino , Salud Bucal/economía , Salud Bucal/normas , Prevalencia , Salud Pública/economía

RESUMEN

RATIONALE: In 1984, the DMFT12 in Jamaican children was 6.7 (very severe). In 1987, national salt fluoridation was implemented (250 mg F-/kg salt). In 1995, a national survey showed a substantial decrease of caries severity (DMFT12 of 1.8). OBJECTIVES: To see whether the favorable exposure of fluoride was continued. METHODS: Assessment of urinary fluoride parameters based on WHO guidelines. Children were sampled in two urban and two rural sites. Valid nocturnal and daytime urinary collections were obtained from 128 children (mean age 4.7 y). A questionnaire administered to parents provided information on oral hygiene practice, and use of fluoride via salt, dentifrices or supplements. RESULTS: Excretion rate values extrapolated to 24 h were 271 in urban and 330 microgF/24 h in rural, F-concentrations were in the range of 1.13 and 1.30. Almost all children were reported to use toothpaste, most with 600 to 1000 ppm F; 65% of children use more than the recommended amount of toothpaste. Fluoridated salt was consumed by 98% of the children. There was no other apparent usage of fluorides. CONCLUSIONS: Urinary excretion results point to a suboptimal exposure of fluoride, whereas concentrations would suggest an optimal or slightly higher intake. Dentifrices with 500 ppm F should be made available in order to minimize the risk of enamel fluorosis.

Asunto(s)

Fluoruros/orina , Fluorosis Dental/prevención & control , Cariostáticos/administración & dosificación , Preescolar , Fluoruros/administración & dosificación , Humanos , Jamaica , Población Rural , Cloruro de Sodio Dietético , Pastas de Dientes/química , Población Urbana

RESUMEN

In 16 rural communities of the Canton of Zurich, school-children of all age groups participated in dental examinations conducted at intervals of 4 years since 1963/64. The same standardised method was used throughout the entire period. This study documents the caries experience over a period of 45 years. From 1964 to 2009, the DM*FT per 14-year-old child fell from 12.50 to 1.31, corresponding to a caries reduction of 90%. The caries experience in 8-, 10- and 12-year-olds decreased by 90% to 92%. From 1964 to 2009, the "Significant Caries Index" (the mean DM*FT in the third of 12-year-olds with the highest DM*FT values) fell from 13.09 to 2.20, corresponding to a caries reduction of 83%. The observed caries decline was unexpectedly high. The effect of fluorides may explain a caries reduction of roughly 50%. A large part of the decline, however, remains unexplained. Possible causes are discussed in this paper.

Asunto(s)

Caries Dental/epidemiología , Adolescente , Goma de Mascar , Niño , Preescolar , Índice CPO , Caries Dental/prevención & control , Placa Dental/microbiología , Dentición Permanente , Fluoruros/administración & dosificación , Humanos , Estudios Longitudinales , Selladores de Fosas y Fisuras , Reproducibilidad de los Resultados , Población Rural , Sodio en la Dieta , Suiza/epidemiología , Diente Primario , Pastas de Dientes/química , Pastas de Dientes/uso terapéutico

RESUMEN

The cost of salt fluoridation in a given country depends primarily on the number of salt factories and on the technical level available in the country. Equipment required may cost U.S. dollars 400,000 for large plants producing at least 20,000 tons/year providing salt for populations of several millions. Reliable batch mixers have been built locally for U.S. dollars 3000 to U.S. dollars 10,000, with one such mixer capable of producing 10 batches of one metric ton/day or 2000 to 3000 tons a year for a population of 350,000 to 500,000. Frequently 85-90% of the costs are devoted to infrastructure; in combination with salt iodization, the cost for fluoride equipment is 30-50% less. loIization is promoted by WHO, UNICEF, other international organizations and national aid agencies which can indirectly support salt fluoridation. With respect to running costs, the expense for the fluoride chemical is the major factor in small plants producing for example 6000 tons of salt, i. e U.S. dollars 0.015 to 0.03 per year and capita. The cost for personnel necessary for addition of fluoride and quality control is approximately U.S. dollars 0.008/capita/year in small plants and even less in large ones. With adequate implementation, salt fluoridation affords a cariostatic effectiveness equal to that of water fluoridation. When its cost is compared to that of water fluoridation, there may not be much difference regarding initial cost for equipment except in the case of small salt factories where local production of batch mixers may lower initial expenses substantially. Running costs for salt fluoridation are 10 to 100 times lower because the amount of fluoride chemical needed and its handling are up to 100 times less than with water fluoridation. In practice, the cost of salt fluoridation is often so low that many producers did not raise the price of fluoridated salt; this has been the case in Switzerland since 1955 and also in several countries in the Americas today.

Asunto(s)

Cariostáticos/economía , Fluoruros/economía , Costos de la Atención en Salud , Cloruro de Sodio Dietético/economía , Américas , Gastos de Capital , Cariostáticos/administración & dosificación , Costos y Análisis de Costo , República Checa , Organización de la Financiación , Fluoruración/economía , Fluoruros/administración & dosificación , Francia , Humanos , Suiza

RESUMEN

This paper aims at assessing the public health potential of salt fluoridation schemes. There is now solid evidence which shows that the cariostatic effectiveness of universal salt fluoridation is equivalent to that of water fluoridation in both the permanent and primary dentition. In countries of continental Europe, only domestic salt is fluoridated, and its consistent use may be expected to warrant a 30% reduction of caries prevalence. However, the effectiveness in the population at large is lower because only part of the population uses the fluoridated domestic salt. Under these conditions, it must be assumed that the effectiveness is further reduced because families in low S-E strata use fluoridated salt (FS) less frequently than those in the higher S-E strata who are known to use preventive methods like toothbrushing twice a day with a fluoride dentifrice more regularly. Model calculations tend to show that in Germany, where FS has reached a market share of 60%, the overall effectiveness is 14% instead of 30%. For France with a market share of 30% of the fluoridated domestic salt, model calculations lead to an overall effectiveness of 8%. In order to obtain a substantial decline of caries in the entire population, it is important to aim for a high market share of the FS of 80%, or preferably 90%. This goal can be reached with a relatively small budget. The task of health ministries would be to promote the switch from unfluoridated salt to FS; however, such promotion is often withheld by health ministries. It is possible, through modest price increases of salt, to finance effective campaigns inducing the majority of the population to use the fluoridated variety. On a world wide scale, fluoridation of salt has established itself as an efficient public health measure. It may be particularly beneficial for developing countries because it is by far the cheapest method and it is compatible with the use of fluoridated toothpastes.

Asunto(s)

Cariostáticos/administración & dosificación , Caries Dental/prevención & control , Fluoruros/administración & dosificación , Mercadeo Social , Cloruro de Sodio Dietético , Niño , Índice CPO , Caries Dental/psicología , Fluoruración/psicología , Educación en Salud Dental , Humanos , Odontología en Salud Pública/métodos

RESUMEN

After an early start in 1955, the introduction and acceptance of fluoridated salt (FS) for domestic use was slow in Switzerland because up to around 1980 there was no consistent strategy for the support of the use of FS. Part of the dental community still supported water fluoridation, while others criticized the insufficient concentration of fluoride in the salt (90 ppm). All Swiss cantons have a historical monopoly on salt trade, and until 1983 most cantonal governments resolved to authorize the sale of fluoridated domestic salt. Some of the cantonal governments made fluoridated salt the only available type of "kitchen salt" in 1-kg packages. After the concentration had been increased to 250 ppm in 1983, the use of FS gained further acceptance. A temporary setback occurred in 1992-1994, but was successfully met with by making the FS available in several package sizes, while other types of salt (with or without iodine) were available in 500 g packages only. By 2004, the market share of fluoridated domestic salt reached 88%. Further endeavours aim at increasing the use of FS by large kitchens. FS is available in portions of 12.5 kg (since 2001) and 25 kg (since 1976).

Asunto(s)

Cariostáticos/administración & dosificación , Caries Dental/prevención & control , Fluoruros/administración & dosificación , Cloruro de Sodio Dietético/administración & dosificación , Cariostáticos/historia , Caries Dental/historia , Historia del Siglo XX , Humanos , Cloruro de Sodio Dietético/historia , Gobierno Estatal , Suiza

RESUMEN

For decades Central European countries have been interested in preventive dentistry. Water fluoridation played a major role in the former German Democratic and Czechoslovak Republics and a minor one in Poland. These schemes were abandoned after 1989. Extensive research on all aspects of salt fluoridation was conducted in Hungary from 1966 to 1984 but attempts to introduce it in the country have had little success. Salt fluoridation was implemented in the Czech and the Slovak Republics in the mid-nineties. The market share of the fluoridated domestic salt appears to have reached 35% in the Czech Republic; it became eventually part of a preventive strategy comprising school-based dental health education including topical fluoride. Another four countries have been considering salt fluoridation but schemes did not materialize. Antifluoridation activities occasionally impeded caries prevention, and for years some respected dentists declared their position against fluorides. Caries prevalence in 12-year-old children is by 1 to 3 DMFT higher than in Western Europe. For many years to come, modern fluoride-containing toothpastes and dentifrices may not be affordable for the lower socio-economic strata of the populations in Central and Eastern Europe. It is concluded that salt fluoridation, which is by far the cheapest means of lowering caries prevalence, could markedly improve the oral health situation even if the economical situation is slow to improve.

Asunto(s)

Cariostáticos/administración & dosificación , Caries Dental/prevención & control , Fluoruros/administración & dosificación , Cloruro de Sodio Dietético/administración & dosificación , Niño , Índice CPO , Caries Dental/epidemiología , Europa Oriental/epidemiología , Fluoruración , Fluoruros/economía , Humanos , Pastas de Dientes/química

RESUMEN

This paper reviews problems associated with urinary collection for the estimation of fluoride exposure and recent findings in this context. After intake of a salted meal at noon, children aged 9 to 14 excreted on average 45 microgF/h. Morning and nocturnal excretions were only 16 microgF/h with the exception of those children who ate bread made with fluoridated salt (25 microF/h). Fluoride excretions in children consuming drinking water with 0.6 to 0.8 ppmF were similar, but the variations within the 24 h period were smaller. When it is not feasible to obtain reliable 24 h urinary collections, fairly precise extrapolations of 24 h excretions can be obtained from three separate collections lasting about 16 hours, which should cover morning, early afternoon and the whole night. Three- to six-year-old children benefitting from optimal fluoride supply through water or milk excreted approximately 0.35 to 0.40 mgF/24 h; this range seems to correspond to an optimal usage of fluorides. Studies on urinary fluoride excretion, like those on total fluoride intake, cannot be carried out on random samples. Due to the necessity of close cooperation of parents and children, such studies were done with "convenience" samples. In westernized countries with now low caries prevalence, intermittent high urinary excretions occur frequently. Possible sources are fluoride intake from concentrated oral care products (fluoride gels, fluoride chewing gums) or from dentifrices (containing 1000 to 1500 ppmF), mineral waters, industrial tea preparation or fluoride tablets (or other supplements). These problems do not affect the amount of fluoride in fingernail clippings which appear to be suitable for the routine monitoring of fluoride exposure.

Asunto(s)

Cariostáticos/farmacocinética , Fluoruros/orina , Adolescente , Cariostáticos/administración & dosificación , Niño , Preescolar , Ritmo Circadiano , Fluoruros/administración & dosificación , Humanos , Uñas/metabolismo , Proyectos de Investigación , Cloruro de Sodio Dietético/administración & dosificación , Manejo de Especímenes

RESUMEN

Fluoride prevention has a significant role in complex caries prevention, together with the appropriate diet and oral hygiene. The aim of the present review is--considering mainly the public health aspects--to give information on changes of the methods of fluoride prevention, and the changing views on pathomechanisms, as well as statements in the course of the last 50 years, based on present scientific evidence. The first great breakthrough in caries prevention was the introduction of water fluoridation between 1945-1950 in the USA and Canada. The measure was adopted in other countries and resulted in significant caries reduction. In the fifties and sixties fluoride tablets were widely used in many countries and brought good results, mainly in well-controlled smaller communities. Salt fluoridation has been initiated in Switzerland in 1955, and introduced in numerous countries in the eighties. The concept of a strong protective systemic effect of fluorides in the early eighties gave place to ideas on mainly topical effects, playing a decisive role in toothpastes, gels, acting topically on the enamel of the erupted teeth. Therefore many water fluoridation projects, mainly in Central- and Eastern Europe--where the prevalence of dental caries is still very high--were cancelled after 1990. Tablet fluoridation became questionable due to the fear of the possibility of dental fluorosis. Recent scientific views, however, confirmed a weak pre-, and peri-eruptive, as well as a strong posteruptive effect of systemically applied fluorides. In countries where caries prevalence is high, but the majority of the population cannot afford fluoridated toothpastes due to low socio-economic conditions, the introduction and extension of salt fluoridation to the whole population is well founded and recommended from a public health view.

Asunto(s)

Cariostáticos/historia , Caries Dental/historia , Fluoruros/historia , Política de Salud/historia , Canadá , Cariostáticos/administración & dosificación , Caries Dental/prevención & control , Europa (Continente) , Fluoruros/administración & dosificación , Historia del Siglo XX , Humanos , Hungría , Salud Pública/historia , Estados Unidos

RESUMEN

In ancient and medieval times, the prevalence of caries and periodontal disease varied. There were no treatments for dental hard tissue, but dental cosmetics played an important role. In the late 19th century, caries levels reached a maximum in Europe and North America after refined sugar became a cheap staple food. Toothlessness became frequent even in young adults. Caries prevention, effective on a public health scale, began with the introduction of water fluoridation in the 1940s. By 1985, dental academia had acknowledged that substantial declines could also be obtained in entire populations through topical fluorides, mainly in toothpastes. While decreasing caries prevalence is irrefutable in affluent countries, the specific reasons of the decline are still a matter of debate. In countries where caries has declined substantially, activities of dentists are shifting towards cosmetic dentistry. However, caries continues to be a problem for the lower socioeconomic strata, even in affluent countries, and is a serious problem in developing countries. Thus, water fluoridation is still important, and salt fluoridation should be considered where water fluoridation is not feasible. Both measures are extremely cheap to implement. Controlled fluoridation has a great potential for developing countries and low social strata of affluent countries. Its reduced effectiveness in high socioeconomic strata of affluent countries, due to the widespread usage of fluoride in toothpastes and other oral care products, should not detract from the public health value of fluoridation.

Asunto(s)

Caries Dental/historia , Estética Dental/historia , Europa (Continente) , Femenino , Fluoruración/historia , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Historia Medieval , Humanos , Masculino , Boca Edéntula/historia , América del Norte

RESUMEN

This study evaluated urinary fluoride excretion by school children 4-6 years old who were living in a south Texas rural community that had concentrations of fluoride in drinking water supplies generally around the optimal level. We took supervised collections of urine samples in the morning and afternoon at school, and parents of the participating students collected nocturnal samples. We recorded the beginning and end times of the three collection periods and then determined the urinary volume and urinary flow for each of the periods. We measured urinary fluoride concentrations and calculated the urinary excretion rate per hour. The children had breakfast and lunch provided at the school, where the drinking water contained 1.0-1.3 milligrams/liter (mg/L) fluoride. Fluoride concentrations in the tested household water supplies, from wells, ranged from 0.1 to 3.2 mg/L fluoride. The children's average urinary fluoride concentrations found for the day were similar to those for the night, with means ranging from 1.26 mg/L to 1.42 mg/L. Average excretion was 36.4 mg/h in the morning, 45.6 mg/h in the afternoon, and 17.5 mg/h at night. The lower nocturnal excretion rates are easily explained by low urinary flow at night. Based on the 15 hours of urine collected, the extrapolated 24-hour fluoride excretion was 749 µg. In conjunction with similar studies, the data from this study will help in developing upper limits for urinary fluoride excretion that are appropriate for avoiding unsightly fluorosis while providing optimal protection against dental decay

Asunto(s)

Humanos , Masculino , Femenino , Preescolar , Orina , Agua Potable , Fluoruros , Estados Unidos

RESUMEN

This study evaluated urinary fluoride excretion by school children 4-6 years old who were living in a south Texas rural community that had concentrations of fluoride in drinking water supplies generally around the optimal level. We took supervised collections of urine samples in the morning and afternoon at school, and parents of the participating students collected nocturnal samples. We recorded the beginning and end times of the three collection periods and then determined the urinary volume and urinary flow for each of the periods. We measured urinary fluoride concentrations and calculated the urinary excretion rate per hour. The children had breakfast and lunch provided at the school, where the drinking water contained 1.0-1.3 milligrams/liter (mg/L) fluoride. Fluoride concentrations in the tested household water supplies, from wells, ranged from 0.1 to 3.2 mg/L fluoride. The children's average urinary fluoride concentrations found for the day were similar to those for the night, with means ranging from 1.26 mg/L to 1.42 mg/L. Average excretion was 36.4 mg/h in the morning, 45.6 mg/h in the afternoon, and 17.5 mg/h at night. The lower nocturnal excretion rates are easily explained by low urinary flow at night. Based on the 15 hours of urine collected, the extrapolated 24-hour fluoride excretion was 749 µg. In conjunction with similar studies, the data from this study will help in developing upper limits for urinary fluoride excretion that are appropriate for avoiding unsightly fluorosis while providing optimal protection against dental decay

Asunto(s)

Orina , Fluoruros , Agua Potable , Estados Unidos

Asunto(s)

Orina , Fluoruros , Estados Unidos , Agua Potable