Fluorosis prevalence has increased in North America since the 1930's-1940's. It may also have increased since 1970, though the evidence for that is less clear. Continued monitoring will help determine whether increased fluorosis prevalence in children in the United States is a cohort effect from the 1970's. This review considers the evidence for an increase in fluoride ingestion from all sources since the 1970's. If an increase has occurred, the most likely sources are fluoride dietary supplements, inadvertent swallowing of fluoride toothpastes, and increased fluoride in food and beverages. For adults, there is no evidence from dietary surveys to show that fluoride intake has increased over the last generation. Dietary surveys for children aged six months to two years are similarly inconclusive, though the great variation in fluoride content of various infant foods might be obscuring real effects. The data on fluoride intake by children from food and beverages, infant foods included, are not strong enough to conclude that an increase in fluoride ingestion has occurred since the 1970's. However, the suggested upper limit of fluoride intake is substantially being reached in many children by ingestion of fluoride from food and drink (0.2-0.3 mg per day) and from fluoride toothpaste (0.2-0.3 mg per day). Two public health issues that arise from this review are: (a) the need for a downward revision in the schedule for fluoride supplementation, and (b) education on the potential for high fluoride concentration of soft drinks and processed fruit juices.

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Existing data on the economics of sealant use are insufficient to permit firm conclusions; an additional handicap is that both data and attitudes are based principally on results with first‐generation sealants when it is clear that greatly improved materials are now available. The limited data plus the preceding discussion of issues, however, do allow the following statements by way of conclusions. In public programs, few would argue that the cost‐effectiveness of sealants would be enhanced by: (a) Using trained auxiliaries to apply sealant to the fullest extent allowed by law. (b) Applying the most recently developed sealants in which retention rates appear to be most favorable. (c) Their application in areas where proximal caries is low. This means many communities in the United States at present, especially fluoridated areas. Although marginal benefits have not been determined, sealants would appear to complement the use of fluoride. There is less clarity on other areas where some tradeoffs would be required, for the nature of the tradeoffs cannot be specified. These areas include: (d) Whether the program should be based on a single application or whether there should be annual checks and reapplications. Reapplications will push effectiveness closer to 100 percent, but will incur greater costs. The ideal situation would be virtual 100 percent retention of sealant over a long time following a single application, but that outcome is unlikely in a public program. (e) Whether all molars and premolars should be sealed. There is general agreement that first and second molars should be sealed as soon as possible after eruption because of their susceptibility to occlusal caries.(ABSTRACT TRUNCATED AT 250 WORDS)