The status of community water fluoridation in the United States.

Community water fluoridation has served the American public extremely well as the cornerstone of dental caries prevention activities for 45 years. The dental and general health benefits associated with the ingestion of water-borne fluorides have been well known by researchers for an even longer period. Continued research has repeatedly confirmed the safety, effectiveness, and efficiency of community water fluoridation in preventing dental caries for Americans regardless of age, race, ethnicity, religion, educational status, or socioeconomic level. Despite the obvious benefits associated with this proven public health measure, slow progress has been made toward achieving the 1990 national fluoridation objectives as listed in "Promoting Health/Preventing Disease: Objectives for the Nation." This paper documents the lagging pace of community fluoridation by reviewing and analyzing data reported in "Fluoridation Census, 1985," a document published in late 1988 by the Public Health Service's Centers for Disease Control. Failure to attain the 1990 objectives is attributable to a combination of circumstances, including their low priority within many local, State, and Federal health agencies, inadequate funding at all levels of government, lack of a coordinated and focused national fluoridation effort, failure of most States to require fluoridation, lack of Federal legislation mandating fluoridation, general apathy of most health professional organizations toward fluoridation, misconceptions by the public about effectiveness and safety and, finally, unrelenting opposition by a highly vocal minority of the lay public. In addition, fluoridation successes have not been consistent among States, with wide variation in accomplishments documented in the reported data.While fluoridation still is one of the most cost effective public health measures available to local,State, and Federal public health agencies, it remains significantly underused nearly a half century after its discovery. Without a major increase in emphasis at the highest policy levels within local, State, and Federal health agencies, fluoridation objectives currently proposed for inclusion in the year 2000 national health objectives are not likely to be achieved. More private sector involvement and better coordination of efforts among all levels of government will be necessary to make significant improvements in progress toward universal fluoridation of all public water supplies in the United States.

Caries levels and patterns in head start children in fluoridated and non-fluoridated, urban and non-urban sites in Ohio, USA.

The purpose of the study was to determine caries levels and prevalences of previously identified caries patterns in low income children in the primary dentition in Ohio, USA. Children were examined from urban fluoridated (n = 505), urban non-fluoridated (n = 395), non-urban optimal fluoride (n = 183), and non-urban suboptimal fluoride (n = 227) sites. Caries scores were similar for the two sites having optimal fluoride; scores from fluoridated sites were lower than scores from the two suboptimal fluoride sites. Children from all four sites were caries-free ranging from 36% in the urban non-fluoridated site to 50% in the non-urban optimally fluoride site. More children in the suboptimal fluoridated sites had smooth surface lesions than in the optimally fluoridated sites. More children with defect associated lesions had fewer than six (chi 2 = 222; P less than 0.01) carious surfaces than did children with smooth surface lesions.

The new antifluoridationists: who are they and how do they operate?

Since Grand Rapids became the first community to adjust the fluoride content of its water supply, individuals and groups have objected to water fluoridation. Early opponents of fluoridation were often members of fringe groups or were associated with the health food movement, were chiropractors, or were Christian Scientists. Once these individuals and groups began exchanging ideas and experiences, national groups were formed for the sole purpose of fighting fluoridation. While most of these organizations lacked sufficient funding or expertise to have much impact outside of the communities where they were based, some national multi-issue organizations appeared that were well funded and that focused on antifluoridation as one of their goals. Through exploitation of society's current phobias about health and disease, these national groups have become increasingly successful in negatively influencing the public about the effectiveness, safety, and economy of community water fluoridation. Their tactics range from community actions aimed at local governmental bodies, to well-organized local referenda, to litigation in state and federal courts, to lobbying state legislatures and the US Congress. Specific legal, community organizational, and political tactics employed by the antifluoride groups are reviewed and classified.

Caries patterns in Head Start children in a fluoridated community.

Assessment of caries experience based on the person rather than on the tooth opens the possibility for qualitative descriptions of caries in a population, as well as for the study of specific factors associated with different caries experiences. The study of a Head Start population in adjacent fluoridated communities was divided into two parts. It was the purpose of part one of the study to determine the prevalence of specific caries patterns (presumably associated with different etiologies). Of the children, 39 percent were caries-free; 32 percent had carious lesions only in pit-and-fissure defects of molars; 6.5 percent had carious lesions in hypoplastic defects; 11 percent had facial-lingual lesions, compatible with "nursing caries"; and 11.5 percent had approximal lesions of molars; no child in the study had rampant caries. The second part compared specific lifestyle variables with specific caries patterns. Statistically significant differences or trends were found between caries-free children and those with smooth-surface lesions for mother's educational level, time spent with grandparents, mother's perceived primary reason for cavities, and mother's tendency to permit the child to eat sweets without restriction. No significant differences or trends were found for lifestyle variables between caries-free children and those having lesions associated only with tooth defects.

Celebrating 50 years of fluoridation: a public health success story.

Community water fluoridation has served Americans extremely well as the cornerstone of dental caries prevention activities for over 49 years. While January 25, 1995, marks the fiftieth anniversary of fluoridation's inauguration at Grand Rapids, Michigan, the dental and general health benefits associated with the ingestion of water-borne fluorides have been well known by researchers for an even longer period. Continued research has repeatedly confirmed the safety, effectiveness and efficiency of community water fluoridation in preventing dental caries for the world's population.

Dietary fluoride supplements: the Maryland physician's role.

Appropriate use of fluoride, either systemically or topically, remains the best defense against dental caries.