Acceptability of Salt Fluoridation in a Rural Latino Community in the United States: An Ethnographic Study

Abstract

Compared to other population groups in the United States, caries (tooth decay) is a disproportionately prevalent disease among Latino populations, especially among low-income and rural sub-groups and children under five years of age. Fluoride is a primary preventive for caries. While water fluoridation is a major and effective public health means for delivering fluoride on a mass scale, it does not reach many rural areas or population groups such as Latinos who eschew drinking water from municipal sources. This study examines the acceptability to such groups of salt fluoridation, an alternate means of delivering fluoride long used on a global scale. An ethnographic study in California’s rural Central Valley was performed. Thirty individual interviews and 5 focus groups (N = 61) were conducted in Spanish to investigate low-income Latino migrant caregivers’ experiences, views and understandings of domestic salt, oral health, caries prevention and fluoride. Audio data were transcribed, translated, coded and thematically analyzed. Table salt was readily available and frequently consumed. Both adult and child daily sodium consumption was high. Despite a general feeling that it was good, and present in dentifrices or dietary supplements, most participants had little knowledge about fluoride. Concerns were raised about cardio-vascular and other possibly deleterious effects if an increase in salt consumption occurred because fluoridated salt was viewed as having ‘extra’ benefits. Once informed about fluoride’s safety and role in caries prevention, most participants expressed willingness to use fluoridated salt, especially if it benefitted children. Reassurance about its safety and benefits, and demonstration of its taste, were important aspects of acceptance. Taste was paramount. Participants would not consume more fluoridated salt than their current salt as that would result in unpleasant changes in food flavor and taste. While salt fluoridation is acceptable, the feasibility of producing and distributing fluoridated salt in the United States is, however, complex and challenging.

The Fluoride Debate: The Pros and Cons of Fluoridation

“…Water fluoridation, in which controlled amount of fluoride is added to the public water supply, was considered one of the greatest successes in public health in the twentieth century ( 15 ), and one of the most popular methods of delivering fluoride systemically to a large population with no need for its active participation ( 13 ). It is actually practiced in many countries throughout the world.…”

“…Salt fluoridation comprises the addition of a mixture of potassium fluoride and sodium fluoride to domestic or table salt to reach a concentration of 250~300 mg of fluoride/kg salt ( 15 ). At this concentration, the level of fluoride in saliva is very similar to that found in the saliva of individuals exposed to water fluoridation at 1 mg/L.…”

“…Salt fluoridation has recently been adopted in some Asian countries including Cambodia and Laos, and also implemented in an African country, Madagascar ( 17 ). Presently, 300 million people worldwide are using fluoridated salt, including 200 million in Latin America (available in nearly all countries except Brazil, Chile, and Panama) and 70~80 million in Europe ( 15 ).…”

“…Moreover, a recent review shows that, in some circumstances, salt fluoridation is a more cost-effective caries preventive method for children than either water or milk fluoridation or fluoridated mouth rinses ( 15 ).…”

Water Quality Analysis for Fluoride Concentration in Fluoridated Drinking Water Distribution System via Hydraulic Simulation

“…Thus, water can be the major medium to improve the degree of public health. Controlled community water fluoridation bears a major responsibility in enhancing oral health and it has been marked as one of the greatest advances of public health interventions in the 20th century as it plays vital role in caries prevention [2][3][4]. Water fluoridation is the most economical and effective way of delivering fluoride to the community as it involves administration of fluoride into municipal water supply at recommended level to benefit the consumer through consumption.…”