Oral Health in the United States: The Post-Fluoride Generation

Abstract

Tremendous strides have been made in reducing the incidence of tooth decay, periodontal diseases, and associated loss of teeth in adults and children since the inception of community water fluoridation programs. Yet the disadvantaged and poor have not fully shared in the benefits. Other challenges to oral health remain. Oral cancer and related smoking and smokeless tobacco use remain major public health problems. Access to preventive and therapeutic dental care is far from universal. Public health programs similar in commitment to the approach of community water fluoridation programs initiated in the 1950s and 1960s are needed to address neglected oral health needs of underserved and high-risk populations in the United States.

Refining definitions of periodontal disease and caries for prediction models of incident tooth loss

“…Caries is the prevailing cause for tooth loss over the whole life span (Milgrom & Reisine , Eklund & Burt ) in populations with limited access to prevention and treatment, but its contribution to tooth loss in other populations may be less marked, and unevenly distributed in age and gender strata (Chambrone et al. , Baelum et al.…”

Snacking Habits and Caries in Young Children

“…Energy-dense, low-nutrientdense foods are often characterized by a high content of added sugar, but several modern snack products such as chips (crisps), popcorn and shrimp crackers, while not sweet, are still potentially cariogenic due to their content of extensively hydrolysed starch [Lingström et al, 2000]. Snacking has gained an increasing role as a risk indicator for caries development in children [Milgrom and Reisine, 2000;Marshall, 2005], but so far the impact of products with extensively hydrolysed starch, such as potato chips, on caries risk has not been demonstrated in children or adults.…”

Hospitalizations for dental infections

“…Community water fluoridation has been recognized as a valuable public health measure that promotes dental health for both children and adults and is more cost effective than other forms of fluoride treatments or applications. 4 The decision to use fluoride supplements must balance the risk of caries against the risk of enamel fluorosis, which is the main adverse effect of systemic fluoride administration in recommended dosages and is basically only a cosmetic problem. 5 In Israel, the national water carrier fluoridates water centrally, but fluoride concentrations in drinking water in cities that use a local water supply vary according to the decision of the local municipality about whether to fluoridate its water supply.…”