1Fluoride:A Public Health PerspectiveDavid O. Born, Ph.D.January, 2008Key Objectives Take away a sense of where MN stands with respect to the US in terms of water fluoridation and Healthy People 2010 goals Be able to list at least 3 ways of delivering fluoride other than water fluoridation Be aware of current recommendations regarding fluoride useFluoridation Questions How does it work? Drs. Rudney & Versluis –“Topics in Dental Biochemistry”Top Ten Public Health Achievements of the20thCenturyImmunizationsMotor-vehicle SafetyWorkplace SafetyControl of Infectious DiseasesDecline in Deaths from Heart Disease and StrokeSafer and Healthier FoodsHealthier Mothers and BabiesFamily PlanningFluoridation of Drinking WaterTobacco as a health HazardCommunity Water Fluoridation Benefits discovered in 1930s Both children and adults impacted Prevent & repair damage Efforts began in mid-1940s Minnesota law – 1967Percentage of State Population on Public Water Systems Receiving Fluoridated Water, 2002 (Data current as of 12-31-04)65.898.4020406080100120United States MinnesotaPercentUnited StatesMinnesota2Fluoridation Questions What are the benefits? Nearly all tooth decay can be prevented with fluoride (water, sealants & toothpaste) Stops or even reverses decay process Safe, effective, easily “delivered” Cost effective Minimal effort required from patient in most casesFluoridation Questions Is it safe? Naturally occurring element – found in all food and water sources Over 40 years of experience with community water fluoridation experience – no significant problems (Fluorosis) Normal consumption of fluoride varies widely around the worldFluoridation Questions How much does it cost? Annual cost of community water fluoridation is $.50 for towns >20,000 and $3.00 for towns < 5,000 (in 1995 dollars).Using “..the most current data available on the effectiveness and costs of water fluoridation, caries increment, and the costs and longevity of dental restorations, we found that the reduction in costs of restorative care due to averted disease exceeded the cost of water fluoridation in communities of any size.”Griffin,SO et al., JPHDent, 61(2), 2001, An economicevaluation of community water evaluation* Only 14 of 310 life-saving medical interventions were cost-saving.Fluoride Delivery Systems Public water systems, supplements Toothpaste Salt Tea Bread Sugar Rice Sealants, varnish, restorative materials, nail polish3Worldwide Use of Fluoride as a Preventive AgentWHO Technical Report Series 846, Geneva, 199414%86%World PopulationCurrent Recommendations Continue and expand fluoridation of community drinking water (.7-1.2 ppm) [WHO .5-1.0 ppm] Frequent use of small amounts of fluoride (drinking water and toothpaste) Use supplements and high concentration fluoridation products judiciously (gels, foams, varnishes) Parents should monitor intake in children under 6 years of age due to fluorosis risk/ECCCurrent Recommendations(continued) Label bottled water with fluoride concentration Educate health professionals and the public to encourage behavior change to facilitate improved, coordinated use of fluoride products and regimens currently available. Further research on use and cost-effectiveness of modalities (delivery systems/products)Resources www.cdc.gov/fluoridation www.nidcr.nih.gov www.ada.org/public/topics/fluoride/index.asp Oral Health in America: A Report of the Surgeon General www.Cochrane.org