Community water fluoridation and the integrity of equitable public health infrastructure.

Community water fluoridation is a population health program that is in a unique position to equitably prevent dental caries across all socioeconomic groups. A review of the 76-year long history of community water fluoridation shows that the challenges to expanding this program persist despite continued evidence of its efficacy. We offer dental health practitioners an opportunity to share the evidence of this oral disease prevention program with the communities they serve. While dental caries is still the most prevalent chronic disease that disproportionately effects lower socioeconomic status communities, community water fluoridation continues to decrease cavities by 25% at the population level. COVID-19 has reaffirmed the importance of disease prevention and valuing public health infrastructure. There is a continued need for community water fluoridation to offer equitable access to oral disease prevention interventions.

Community Water Fluoridation Benefits US Children From Poor Families More Than Those From More Affluent Families.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Association Between Water Fluoridation and Income-Related Dental Caries of US Children and Adolescents. Sanders AE, Grider WB, Maas WR, Curiel JA, Slade GD. JAMA Pediatr 2019;173(3):288-90. SOURCE OF FUNDING: National Institute of Dental and Craniofacial Research of the National Institutes of Health under award number UH2DE025494. TYPE OF STUDY/DESIGN: Cross-sectional study.

Children Who Live in Mainly Fluoridated us Counties Have Less Tooth Decay.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Water Fluoridation and Dental Caries in U.S. Children and Adolescents. Slade GD, Grider WB, Maas WR, Sanders AE. J Dent Res 2018;97(10):1122-8. SOURCE OF FUNDING: National Institute of Dental and Craniofacial Research of the National Institutes of Health under award number UH2DE025494. TYPE OF STUDY/DESIGN: Cross-sectional study.

The Role of Fluoride in the Prevention of Tooth Decay.

Although there are recommendations to prevent tooth decay by other means, this nonsystematic review finds that fluoride is the key to prevention and control of tooth decay. There are multiple fluoride modalities with effectiveness and safety of fluoride depending on dose and concentration. Prevention of tooth decay occurs at the individual level by fluoride use at home and with professional application and at the community level through fluoridation of water or salt.

Science, Politics, and Communication: The Case of Community Water Fluoridation in the US.

Community water fluoridation (CWF) and its effect in reducing the burden of dental caries (tooth decay) is considered one of the 10 public health achievements in the 20th century. In the U.S., three-quarters (74.4%) of people on community water supplies have optimally fluoridated water, and each year approximately 90 communities actively consider starting or discontinuing CWF. CWF exists within the policy environment and includes actions taken by local community councils, health and water boards, and groups; state legislatures and health departments; national regulatory and science agencies; independent science entities; and professional and nonprofit organizations. Epidemiologists have been in the forefront of CWF. Experience with the past 70 years reveals that the coming decades will bring additional questions, recommendations, and challenges for CWF. The continued involvement of epidemiologists as part of multidisciplinary teams is needed in research, surveillance, peer review of studies, assessment of systematic review findings, and in the translation and communication of science findings to audiences with limited science/health literacy. This chapter's purpose is to 1) examine how epidemiologic evidence regarding CWF has been translated into practice and policy, 2) examine how recommendations for and challenges to CWF have affected epidemiologic research and community decision-making, and 3) identify lessons learned for epidemiologists.

Salt fluoridation: a review.

Salt fluoridation is sometimes suggested as a prospect for communities that have a low water fluoride concentration and have no possibility of implementing community water fluoridation. School-based milk fluoridation programs also are practiced in some countries as an alternative. This paper reviews the evidence of effectiveness in dental caries prevention and risks of dental fluorosis in countries where salt or milk fluoridation is practiced.

The CDA Foundation model to fluoridate communities.

California's population receiving the benefits of fluoridated public water supplies has increased from 15.7 percent to 62.1 percent in the past 20 years. This growth has been achieved through a broad-based coalition of organizations and individuals, starting with the creation of the California Fluoridation Task Force in 1994 and supported by the California Fluoridation Act of 1995. This paper describes the process whereby the most recent gains have been made in San Diego and are ongoing in San Jose.

Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations regarding the intake of fluoride from reconstituted infant formula and its potential association with enamel fluorosis. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following question: Is consumption of infant formula reconstituted with water that contains various concentrations of fluoride by infants from birth to age 12 months associated with an increased risk of developing enamel fluorosis in the permanent dentition? TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry (CEBD), conducted a MEDLINE search to identify systematic reviews and clinical studies published since the systematic reviews were conducted that addressed the review question. RESULTS: CEBD staff identified one systematic review and two clinical studies. The panel reviewed this evidence to develop recommendations. CLINICAL IMPLICATIONS: The panel suggested that when dentists advise parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition, they can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being cognizant of the potential risks of enamel fluorosis development. These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations for the prescription of dietary fluoride supplements. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following questions: when and for whom should fluoride supplements be prescribed, and what should be the recommended dosage schedule for dietary fluoride supplements? TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry, conducted a MEDLINE search to identify publications that addressed the research questions: systematic reviews as well as clinical studies published since the systematic reviews were conducted (June 1, 2006). RESULTS: The panel concluded that dietary fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is deficient in fluoride. CLINICAL IMPLICATIONS: These recommendations are a resource for practitioners to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. Providers should carefully monitor the patient's adherence to the fluoride dosing schedule to maximize the potential therapeutic benefit.

Water consumption beliefs and practices in a rural Latino community: implications for fluoridation.

OBJECTIVE: Adequate fluoride exposure is especially important for those experiencing disproportionately high prevalence of dental caries, such as rural Latino farm-workers and their children. Water is an important source of fluoride. This qualitative study examined water consumption beliefs and practices among Latino parents of young children in a rural community. METHODS: Focus groups and open-ended in-depth interviews explored parents beliefs about tap water, beverage preferences, and knowledge of fluoride. A questionnaire documented socio-demographic characteristics and water consumption practices. Qualitative analysis revealed how water-related beliefs, social and cultural context, and local environment shaped participants' water consumption. RESULTS: The vast majority of participants (n = 46) avoided drinking unfiltered tap water based on perceptions that it had poor taste, smell, and color, bolstered by a historically justified and collectively transmitted belief that the public water supply is unsafe. Water quality reports are not accessible to many community residents, all of whom use commercially bottled or filtered water for domestic consumption. Most participants had little knowledge of fluoride beyond a general sense it was beneficial. While most participants expressed willingness to drink fluoridated water, many emphatically stated that they would do so only if it tasted, looked, and smelled better and was demonstrated to be safe. CONCLUSIONS: Perceptions about water quality and safety have important implications for adequate fluoride exposure. For vulnerable populations, technical reports of water safety have not only to be believed and trusted but matched or superseded by experience before meaningful change will occur in people's water consumption habits.

Water fluoridation and the environment: current perspective in the United States.

Evidence of water fluoridation's effects on plants, animals, and humans is considered based on reviews by scientific groups and individual communities, including Fort Collins, CO, Port Angeles, WA, and Tacoma-Pierce County, WA. The potential for corrosion of pipes and the use of fluoridation chemicals, particularly fluorosilicic acid, are considered, as is the debate about whether fluoridation increases lead in water, with the conclusion that there is no such increase. The arguments of anti-fluoridationists and fluoridation proponents are examined with respect to the politics of the issue.

The association of early childhood caries and race/ethnicity among California preschool children.

OBJECTIVES: This paper explores the role of race/ethnicity in the occurrence of early childhood caries (ECC) among California Head Start (HS) and non-HS preschool children. METHODS: Using oral examination and questionnaire data from the 1993-94 California Oral Health Needs Assessment of Children, we computed the prevalence of ECC using various definitions and fitted logistic regression models to explore the effect of race/ethnicity on ECC, separately for HS and non-HS children, adjusting for bedtime feeding habits and other covariates. RESULTS: Among 2,520 children, the largest proportion with a history of falling asleep sipping milk/sweet substance was among Latinos/Hispanics (72% among HS and 65% among non-HS) and HS Asians (56%). HS Asians and Latinos/Hispanics had the largest prevalence of ECC (30%-33%) and untreated caries (49%-54%). The estimated risk for ECC was more than three times higher in HS Asians compared to HS whites and among non-HS African Americans and Asians compared to non-HS whites controlling for socioeconomic status variables. The risk of ECC was also significantly higher among children who fell asleep while sipping milk or any sweet substance compared to those who did not. CONCLUSION: Studies of the cultural/behavioral patterns that may be specific to ethnic subgroups with the highest risk for ECC seem essential to the development of effective prevention strategies.