Water Fluoridation Water Fluoridation

November 21, 2007November 21, 2007

Abdullah S. Al-Swuailem BDS, MS, MPH, Dr PHAbdullah S. Al-Swuailem BDS, MS, MPH, Dr PH

Water FluoridationWater Fluoridation

Water Fluoridation:Water Fluoridation:- ““It is the adjustment of the natural flouride It is the adjustment of the natural flouride

concentration of fluoride-deficient water concentration of fluoride-deficient water supplies to the recommended level for optimal supplies to the recommended level for optimal dental health”dental health”

- Water fluoridation was first initiated on Water fluoridation was first initiated on January 25, 1945 in Grand Rapids, MichiganJanuary 25, 1945 in Grand Rapids, Michigan

Water FluoridationWater Fluoridation

Historical background:Historical background:- Clinical discovery phase: Dr. Fredrick Clinical discovery phase: Dr. Fredrick

McKay (Colorado Spring Dentist) noted in McKay (Colorado Spring Dentist) noted in 1920s that some of his patients exhibited a 1920s that some of his patients exhibited a varied degree of tooth hypo-mineralization varied degree of tooth hypo-mineralization and staining (mottled teeth). Dr. McKay and staining (mottled teeth). Dr. McKay attributed this to something in the drinking attributed this to something in the drinking water. water.

- by 1930, a chemist named Churchill by 1930, a chemist named Churchill identified fluoride in the drinking water (14 identified fluoride in the drinking water (14 ppm)ppm)

Water FluoridationWater Fluoridation

Historical background:Historical background:- Epidemiology phase (1933-1945): Epidemiology phase (1933-1945):

“Dean’s 21-City study” correlation of “Dean’s 21-City study” correlation of different levels of fluoride to dental different levels of fluoride to dental caries and dental fluorosis. Optimal caries and dental fluorosis. Optimal level of fluoride 0.7 – 1.2 ppm. Fig 8-1level of fluoride 0.7 – 1.2 ppm. Fig 8-1

Water FluoridationWater Fluoridation

Historical background:Historical background:- Demonstration phase (1945-1954): Series of Demonstration phase (1945-1954): Series of

clinical studies assessing the effect of adding clinical studies assessing the effect of adding fluoride to drinking water. e.g Dean’s study in fluoride to drinking water. e.g Dean’s study in Grand Rapids-Michigan with Muskegon-Grand Rapids-Michigan with Muskegon-Michigan as control. Approximately 60% Michigan as control. Approximately 60% reduction in caries incidence (DMFs)reduction in caries incidence (DMFs)

Water FluoridationWater Fluoridation

Historical background:Historical background:- Technology transfer phase (1950)Technology transfer phase (1950)- The Year 2010 Health Objectives for the Nation: 75% The Year 2010 Health Objectives for the Nation: 75%

of the population on community-water systems of the population on community-water systems should live in communities with fluoridated water by should live in communities with fluoridated water by the year 2010.the year 2010.

- In 1992, 62% of the population served by centralized In 1992, 62% of the population served by centralized pipe-water system have fluoridated water.pipe-water system have fluoridated water.

- World-wide implementation of water fluoridation World-wide implementation of water fluoridation

Water FluoridationWater Fluoridation

Mechanism of action:Mechanism of action:1.1. Systemic fluoride incorporated into tooth Systemic fluoride incorporated into tooth

structure by replacing hydroxyl group in structure by replacing hydroxyl group in hydroxyapatite to form a more resistant hydroxyapatite to form a more resistant fluoroapatitefluoroapatite

2.2. Fluoride present in saliva may inhibit the Fluoride present in saliva may inhibit the enzymatic activity of cariogenic bacteria and enzymatic activity of cariogenic bacteria and thereby inhibit acids productionthereby inhibit acids production

3.3. Remineralize tooth enamel that has been Remineralize tooth enamel that has been demineralized by bacterial acids demineralized by bacterial acids

Water FluoridationWater Fluoridation

Issues with water fluoridation:Issues with water fluoridation:- Dental fluorosisDental fluorosis- Cost of water fluoridation:Cost of water fluoridation: average cost of water fluoridation per average cost of water fluoridation per

person per year is $0.50 (average cost person per year is $0.50 (average cost for simple tooth filling = $62)for simple tooth filling = $62)For every $1 spent on fluoridation, $80 For every $1 spent on fluoridation, $80 is saved in treatment cost. is saved in treatment cost.

Water FluoridationWater Fluoridation

Issues with water fluoridation:Issues with water fluoridation:- Optimal fluoride levels: Table 8-5Optimal fluoride levels: Table 8-5

Water FluoridationWater Fluoridation

Issues with water fluoridation:Issues with water fluoridation:- Partial exposure to fluoride?Partial exposure to fluoride?- Effect on different tooth surfacesEffect on different tooth surfaces- Safety of water fluoridationSafety of water fluoridation

Water FluoridationWater Fluoridation

Issues with water fluoridation:Issues with water fluoridation:- Chemicals used: sodium fluoride, Chemicals used: sodium fluoride,

sodium silicofluoride, and sodium silicofluoride, and hydrofluosilcichydrofluosilcic

Water FluoridationWater Fluoridation

Other fluoride vehicles:Other fluoride vehicles:- Salt fluoridation: NaF or CaF2Salt fluoridation: NaF or CaF2- Milk fluoridation: 5 mg of F added to 1 Milk fluoridation: 5 mg of F added to 1

liter of milkliter of milk- Fluoride mouthrinsesFluoride mouthrinses- Supplemental fluoride tablets Supplemental fluoride tablets