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The Cochrane Database of Systematic... Jun 2015Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in the USA in 1945 and is currently practised in about 25 countries around the world; health authorities consider it to be a key strategy for preventing dental caries. Given the continued interest in this topic from health professionals, policy makers and the public, it is important to update and maintain a systematic review that reflects contemporary evidence.
OBJECTIVES
To evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries.To evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis.
SEARCH METHODS
We searched the following electronic databases: The Cochrane Oral Health Group's Trials Register (to 19 February 2015); The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2015); MEDLINE via OVID (1946 to 19 February 2015); EMBASE via OVID (1980 to 19 February 2015); Proquest (to 19 February 2015); Web of Science Conference Proceedings (1990 to 19 February 2015); ZETOC Conference Proceedings (1993 to 19 February 2015). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization's WHO International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language of publication or publication status in the searches of the electronic databases.
SELECTION CRITERIA
For caries data, we included only prospective studies with a concurrent control that compared at least two populations - one receiving fluoridated water and the other non-fluoridated water - with outcome(s) evaluated at at least two points in time. For the assessment of fluorosis, we included any type of study design, with concurrent control, that compared populations exposed to different water fluoride concentrations. We included populations of all ages that received fluoridated water (naturally or artificially fluoridated) or non-fluoridated water.
DATA COLLECTION AND ANALYSIS
We used an adaptation of the Cochrane 'Risk of bias' tool to assess risk of bias in the included studies.We included the following caries indices in the analyses: decayed, missing and filled teeth (dmft (deciduous dentition) and DMFT (permanent dentition)), and proportion caries free in both dentitions. For dmft and DMFT analyses we calculated the difference in mean change scores between the fluoridated and control groups. For the proportion caries free we calculated the difference in the proportion caries free between the fluoridated and control groups.For fluorosis data we calculated the log odds and presented them as probabilities for interpretation.
MAIN RESULTS
A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis.The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1.81 (95% CI 1.31 to 2.31; 9 studies at high risk of bias, 44,268 participants) and in DMFT of 1.16 (95% CI 0.72 to 1.61; 10 studies at high risk of bias, 78,764 participants). This translates to a 35% reduction in dmft and a 26% reduction in DMFT compared to the median control group mean values. There were also increases in the percentage of caries free children of 15% (95% CI 11% to 19%; 10 studies, 39,966 participants) in deciduous dentition and 14% (95% CI 5% to 23%; 8 studies, 53,538 participants) in permanent dentition. The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste.There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria.With regard to dental fluorosis, we estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12% (95% CI 8% to 17%; 40 studies, 59,630 participants). This increases to 40% (95% CI 35% to 44%) when considering fluorosis of any level (detected under highly controlled, clinical conditions; 90 studies, 180,530 participants). Over 97% of the studies were at high risk of bias and there was substantial between-study variation.
AUTHORS' CONCLUSIONS
There is very little contemporary evidence, meeting the review's inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.The available data come predominantly from studies conducted prior to 1975, and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. The decision to implement a water fluoridation programme relies upon an understanding of the population's oral health behaviour (e.g. use of fluoride toothpaste), the availability and uptake of other caries prevention strategies, their diet and consumption of tap water and the movement/migration of the population. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. We did not identify any evidence, meeting the review's inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults.There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes.There is a significant association between dental fluorosis (of aesthetic concern or all levels of dental fluorosis) and fluoride level. The evidence is limited due to high risk of bias within the studies and substantial between-study variation.
Topics: Adolescent; Child; Child, Preschool; DMF Index; Dental Caries; Fluoridation; Fluorosis, Dental; Humans; Observational Studies as Topic; Prospective Studies; Selection Bias
PubMed: 26092033
DOI: 10.1002/14651858.CD010856.pub2 -
Brazilian Dental Journal 2019Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride...
Since the 1950s, the benefits and risks of fluoridated water use have been debated worldwide. In the past, it was considered that the systemically ingested fluoride would exert its primary preventive effect after being incorporated into the enamel as fluorapatite, making the enamel more resistant to the caries process; however, it is now recognized that the main effect of water fluoridation is local and post eruptive. On the other hand, irrespective of the caries decline reported worldwide, the anticaries benefit of water fluoridation continues to be observed even in developed countries. Regarding the risks, water fluoridation is considered an acceptable community-based method for fluoride delivery, because the risk of developing dental fluorosis lesions due to the ingestion of fluoride during the enamel formation period has been deemed acceptable when contrasted to the anticaries benefits of fluoride. However, the use of fluoride in water to control caries has created a controversy due to data associating water fluoridation as the cause of some systemic diseases. Therefore, the aim of this descriptive review was to discuss the systemic effects (risks) of water fluoridation use.
Topics: Dental Caries; Dental Enamel; Fluoridation; Fluorides; Fluorosis, Dental; Humans
PubMed: 31596325
DOI: 10.1590/0103-6440201903124 -
TheScientificWorldJournal 2014Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust. It has the highest electronegativity of all elements. Fluoride is widely... (Review)
Review
Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust. It has the highest electronegativity of all elements. Fluoride is widely distributed in the environment, occurring in the air, soils, rocks, and water. Although fluoride is used industrially in a fluorine compound, the manufacture of ceramics, pesticides, aerosol propellants, refrigerants, glassware, and Teflon cookware, it is a generally unwanted byproduct of aluminium, fertilizer, and iron ore manufacture. The medicinal use of fluorides for the prevention of dental caries began in January 1945 when community water supplies in Grand Rapids, United States, were fluoridated to a level of 1 ppm as a dental caries prevention measure. However, water fluoridation remains a controversial public health measure. This paper reviews the human health effects of fluoride. The authors conclude that available evidence suggests that fluoride has a potential to cause major adverse human health problems, while having only a modest dental caries prevention effect. As part of efforts to reduce hazardous fluoride ingestion, the practice of artificial water fluoridation should be reconsidered globally, while industrial safety measures need to be tightened in order to reduce unethical discharge of fluoride compounds into the environment. Public health approaches for global dental caries reduction that do not involve systemic ingestion of fluoride are urgently needed.
Topics: Drinking Water; Fluoridation; Fluorides; Humans; Public Health
PubMed: 24719570
DOI: 10.1155/2014/293019 -
Journal of Dental Research May 2011Fluorides are present in the environment. Excessive systemic exposure to fluorides can lead to disturbances of bone homeostasis (skeletal fluorosis) and enamel... (Review)
Review
Fluorides are present in the environment. Excessive systemic exposure to fluorides can lead to disturbances of bone homeostasis (skeletal fluorosis) and enamel development (dental/enamel fluorosis). The severity of dental fluorosis is also dependent upon fluoride dose and the timing and duration of fluoride exposure. Fluoride's actions on bone cells predominate as anabolic effects both in vitro and in vivo. More recently, fluoride has been shown to induce osteoclastogenesis in mice. Fluorides appear to mediate their actions through the MAPK signaling pathway and can lead to changes in gene expression, cell stress, and cell death. Different strains of inbred mice demonstrate differential physiological responses to ingested fluoride. Genetic studies in mice are capable of identifying and characterizing fluoride-responsive genetic variations. Ultimately, this can lead to the identification of at-risk human populations who are susceptible to the unwanted or potentially adverse effects of fluoride action and to the elucidation of fundamental mechanisms by which fluoride affects biomineralization.
Topics: Ameloblasts; Amelogenesis; Animals; Bone Development; Bone Marrow Cells; Endoplasmic Reticulum; Fluorides; Fluorosis, Dental; Gene Expression; Humans; MAP Kinase Signaling System; Mice; Osteoblasts; Osteoclasts; Osteosclerosis; Tooth Calcification
PubMed: 20929720
DOI: 10.1177/0022034510384626 -
Acta Medica Academica Nov 2013To provide a brief commentary review of fluoride-containing toothpastes and mouthrinses with emphasis on their use at home. Toothpastes and mouthrinses are just two of... (Review)
Review
OBJECTIVE
To provide a brief commentary review of fluoride-containing toothpastes and mouthrinses with emphasis on their use at home. Toothpastes and mouthrinses are just two of many ways of providing fluoride for the prevention of dental caries. The first investigations into incorporating fluoride into toothpastes and mouthrinses were reported in the middle 1940s. Unlike water fluoridation (which is 'automatic fluoridation'), fluoride-containing toothpastes and fluoridecontaining mouthrinses are, primarily, for home use and need to be purchased by the individual. By the 1960s, research indicated that fluoride could be successfully incorporated into toothpastes and clinical trials demonstrated their effectiveness. By the end of the 1970s, almost all toothpastes contained fluoride. The widespread use of fluoride- containing toothpastes is thought to be the main reason for much improved oral health in many countries. Of the many fluoride compounds investigated, sodium fluoride, with a compatible abrasive, is the most popular, although amine fluorides are used widely in Europe. The situation is similar for mouthrinses. Concentrations of fluoride (F), commonly found, are 1500 ppm (1500 μg F/g) for toothpastes and 225 ppm (225 μg F/ml) for mouthrinse. Several systematic reviews have concluded that fluoride-containing toothpastes and mouthrinses are effective, and that there is added benefit from their use with other fluoride delivery methods such as water fluoridation. Guidelines for the appropriate use of fluoride toothpastes and mouthrinses are available in many countries.
CONCLUSION
Fluoride toothpastes and mouthrinses have been developed and extensive testing has demonstrated that they are effective and their use should be encouraged.
Topics: Adolescent; Adult; Cariostatic Agents; Child; Child, Preschool; Dental Caries; Female; Fluoridation; Fluorides; Health Knowledge, Attitudes, Practice; History, 20th Century; History, 21st Century; Humans; Infant; Male; Mouthwashes; Oral Health; Toothpastes
PubMed: 24308396
DOI: 10.5644/ama2006-124.84 -
Environmental Health : a Global Access... Feb 2021Fluoride from dietary and environmental sources may concentrate in calcium-containing regions of the body such as the pineal gland. The pineal gland synthesizes...
BACKGROUND
Fluoride from dietary and environmental sources may concentrate in calcium-containing regions of the body such as the pineal gland. The pineal gland synthesizes melatonin, a hormone that regulates the sleep-wake cycle. We examined associations between fluoride exposure and sleep outcomes among older adolescents and adults in Canada.
METHODS
We used population-based data from Cycle 3 (2012-2013) of the Canadian Health Measures Survey. Participants were aged 16 to 79 years and 32% lived in communities supplied with fluoridated municipal water. Urinary fluoride concentrations were measured in spot samples and adjusted for specific gravity (UF; n = 1303) and water fluoride concentrations were measured in tap water samples among those who reported drinking tap water (n = 1016). We used multinomial and ordered logistic regression analyses (using both unweighted and survey-weighted data) to examine associations of fluoride exposure with self-reported sleep outcomes, including sleep duration, frequency of sleep problems, and daytime sleepiness. Covariates included age, sex, ethnicity, body mass index, chronic health conditions, and household income.
RESULTS
Median (IQR) UF concentration was 0.67 (0.63) mg/L. Median (IQR) water fluoride concentration was 0.58 (0.27) mg/L among participants living in communities supplied with fluoridated municipal water and 0.01 (0.06) mg/L among those living in non-fluoridated communities. A 0.5 mg/L higher water fluoride level was associated with 34% higher relative risk of reporting sleeping less than the recommended duration for age [unweighted: RRR = 1.34, 95% CI: 1.03, 1.73; p = .026]; the relative risk was higher, though less precise, using survey-weighted data [RRR = 1.96, 95% CI: 0.99, 3.87; p = .05]. UF was not significantly associated with sleep duration. Water fluoride and UF concentration were not significantly associated with frequency of sleep problems or daytime sleepiness.
CONCLUSIONS
Fluoride exposure may contribute to sleeping less than the recommended duration among older adolescents and adults in Canada.
Topics: Adolescent; Adult; Aged; Canada; Drinking Water; Environmental Exposure; Female; Fluorides; Humans; Male; Middle Aged; Sleep; Young Adult
PubMed: 33602214
DOI: 10.1186/s12940-021-00700-7 -
Community Dental Health May 2022Contemporary research, surveillance and monitoring of water fluoridation requires an understanding of the population coverage of this intervention. The aims of this...
OBJECTIVES
Contemporary research, surveillance and monitoring of water fluoridation requires an understanding of the population coverage of this intervention. The aims of this research are to create the first publicly available record of water fluoride concentrations in England and to describe and visualise the observed variation in water fluoride concentrations and optimal fluoridation (⟩/= 0.7 mg F/L) between 2009-2020.
BASIC RESEARCH DESIGN
Routine water quality sampling data were requested from water companies in England from 2009-2020 under the provisions of the Environmental Information Regulations 2004. Fluoride concentrations of Water Supply Zones (WSZs) were assigned to Lower Super Output Areas (LSOAs) using population-weighted centroids.
RESULTS
Between 2009-2020 4247 LSOAs (12.9%) had an annual mean water fluoride concentration of ⟩/= 0.7 mg F/L in at least one year, and 3019 LSOAs (9.1%) had a grand mean fluoride concentration of ⟩/= 0.7 mg F/L. Coverage of optimal fluoridation varied over time; from 10.9% of LSOAs in 2014 to 6.3% in 2016.
DISCUSSION
This study confirms previous work identifying variability in the coverage and achieved concentrations of water fluoridation programmes. The current provision for accessing, collating and utilising these data are a barrier to essential monitoring, surveillance and research. An annually maintained and publicly accessible database of water fluoride concentrations is urgently required.
Topics: England; Fluoridation; Fluorides; Humans; Water Supply
PubMed: 34982862
DOI: 10.1922/CDH_00267Nyakutsikwa07 -
Nutrients Mar 2022There is preliminary evidence to suggest a positive association between fluoride exposure and higher blood pressure among children, but population-based biomarker...
There is preliminary evidence to suggest a positive association between fluoride exposure and higher blood pressure among children, but population-based biomarker studies are lacking. Thus, data from the 2013/2014 and 2015/2016 cycles of the US-based National Health and Nutrition Examination Survey (NHANES) were analysed to evaluate the association between plasma fluoride concentrations and blood pressure among children and adolescents aged 8 to 19 years. Secondary analyses were carried out on fluoride status in relation to further markers of cardio-metabolic health, i.e., anthropometric indices, biomarkers of lipid and sugar metabolism, and C-reactive protein levels. There was a positive correlation between water fluoride content and plasma fluoride concentrations (Spearman’s r = 0.41, p < 0.01). However, multivariable linear regression models did not show significant differences in adjusted mean values of systolic and diastolic blood pressure across increasing quartiles of fluoride concentrations. Further markers of cardio-metabolic health were not associated with fluoride status, with the exception of a weak inverse association between plasma fluoride and HbA1c levels. Higher plasma fluoride may not be a risk factor for increased blood pressure or impaired cardio-metabolic health among children in the USA, a non-fluoride endemic country, with wide-spread water fluoridation.
Topics: Adolescent; Anthropometry; Cardiovascular Diseases; Child; Fluorides; Humans; Nutrition Surveys; Risk Factors
PubMed: 35406071
DOI: 10.3390/nu14071459 -
Toxicology Letters Apr 2023Fluoride is added to drinking water in some countries to prevent tooth decay (caries). There is no conclusive evidence that community water fluoridation (CWF) at WHO... (Review)
Review
Fluoride is added to drinking water in some countries to prevent tooth decay (caries). There is no conclusive evidence that community water fluoridation (CWF) at WHO recommended concentrations for caries prevention has any harmful effects. However, research is ongoing regarding potential effects of ingested fluoride on human neurodevelopment and endocrine dysfunction. Simultaneously, research has emerged highlighting the significance of the human microbiome in gastrointestinal and immune health. In this review we evaluate the literature examining the effect of fluoride exposure on the human microbiome. Unfortunately, none of the studies retrieved examined the effects of ingested fluoridated water on the human microbiome. Animal studies generally examined acute fluoride toxicity following ingestion of fluoridated food and water and conclude that fluoride exposure can detrimentally perturb the normal microbiome. These data are difficult to extrapolate to physiologically relevant human exposure dose ranges and the significance to humans living in areas with CWF requires further investigation. Conversely, evidence suggests that the use of fluoride containing oral hygiene products may have beneficial effects on the oral microbiome regarding caries prevention. Overall, while fluoride exposure does appear to impact the human and animal microbiome, the long-term consequences of this requires further study.
Topics: Animals; Humans; Fluorides; Fluoridation; Food; Microbiota; Fluorosis, Dental
PubMed: 36871794
DOI: 10.1016/j.toxlet.2023.03.001 -
Journal of Oral Science Oct 2022A water fluoridation program launched in the United States in 1945 has become a worldwide application for caries prevention. Although such a program is important in...
PURPOSE
A water fluoridation program launched in the United States in 1945 has become a worldwide application for caries prevention. Although such a program is important in Japan, water fluoridation in large communities has not been established. This study aimed to develop safe small-scale water fluoride equipment that can be easily used to carry out water fluoridation programs in areas with children in long-term care facilities, and in developing countries without water supply facilities.
METHODS
Batch-type NaF addition adjustment equipment was manufactured as small-scale water fluoride equipment. The fluoride concentration of the adjusted water with this equipment was measured using an ion meter and a fluoride composite electrode. All 51 water quality standards set by the Ministry of Health, Labour, and Welfare of Japan were tested.
RESULTS
The fluoride ion concentration of the adjusted water was 0.7 mg/L and it was constant and stable. The adjusted water conformed to the water quality standard values of the Japanese Water Supply Law.
CONCLUSION
Water produced with small-scale water fluoridation equipment had a fluoride concentration of 0.7 mg/L, which is the recommended concentration for caries prevention. The fluoride concentration was stable.
Topics: Child; Dental Caries; Fluoridation; Fluorides; Humans; Japan; Water Supply
PubMed: 36089373
DOI: 10.2334/josnusd.21-0541