Effectiveness of School Water Fluoridation and Dietary Fluoride Supplements in School‐aged Children

Abstract

School water fluoridation and school-based fluoride tablet programs both have been shown in many studies to be effective in preventing dental caries. These studies indicate that school water fluoridation reduces dental decay by approximately 40 percent and school-based fluoride tablet programs by about 30 percent. However, nearly all the studies were done when the prevalence of caries among US schoolchildren was greater than it is today, which makes it difficult to assess their current effectiveness. Data from dental surveys of school-aged children conducted during the past 30 years indicate that overall caries prevalence has declined by more than 75 percent and that of approximal tooth surfaces by more than 90 percent. Recent national data indicate the difference in caries prevalence between children with lifetime residence in either fluoridated or nonfluoridated areas has also diminished, which raises questions about the cost effectiveness of initiating school-based fluoride programs for all areas. There are still groups of children, however, seriously affected by dental caries. It is safe to assume that implementation of school water fluoridation or fluoride tablet programs will result in traditionally reported benefits among these children. Ongoing school-based fluoride programs should not be discontinued until it is known what impact their cessation will have on dental disease.

A Half‐century of Community Water Fluoridation in the United States: Review and Commentary

“…Of 134 examined children, 11 had "questionable" fluorosis and the rest were classified as normal. Because the caries inhibition from adjusting to seven times the optimal fluoride level was only slightly greater than the caries inhibition from adjusting to 4.5 times optimal (1371, the current recommendation is that the lower level, i.e., anadjustment to 4.5 times theoptimal fluoride concentration for the area, be used for school water fluoridation programs (140).…”

The Need for Toothpastes with Lower than Conventional Fluoride Concentrations for Preschool‐aged Children

“…The widespread availability of fluoride vehicles to the American public has served to diminish greatly the prevalence of dental caries among all US school-aged children. Data from local and national dental surveys of school-aged children conducted during the past 30 years indicate that DMF scores have declined by more than 75 percent and those of approximal tooth surfaces by more than90percent (7). Although fewerdata exist on the drop in dental caries prevalence in primary teeth, results from surveys of US schoolchildren conducted by the NIDR in 1979-80 and 1 9 8 H 7 show that the prevalence of caries in primary teeth of 5-9-year-olds declined by 26 percent during that interval (8).…”

The place of fluoride supplements in caries prevention today

“…This review included many of the early studies reviewed by BirchY2" but this time there was little criticism of the quality of the studies (and no reference to Birch's work). In fact, since Birch's 1969 review, a number of new studies had by 1978 appeared and several of these had demonstrable flaws, as has been pointed out s~b s e q u e n t l y ,~~~~~~~' but these flawed reports were included without adverse comment in the review of Binder et al*' Later, Driscoll (one of Binder's co-authors) arranged to have the eastern 336 European articles translated into English and he produced a new review in which he was very critical of many of the studies included in the 1978 review.24 However, the 1978 review of Binder et al had a large impact: it has served as the principal support for many later authors who have continued to endorse the use of fluoride supplements without having conducted adequate new research on the issue and even recent textbooks endorse supplements on the basis of the 1978 review of Binder et al [25][26][27][28][29] The current status of supplements: compliance…”