Finn Brudevold's laboratory: the Forsyth Institute, 1958-1986.

The years 1930-1931 ushered in the initial group of Rockefeller Fellows at the University of Rochester School of Medicine and Dentistry the first time in this country that an organized attempt was made in a university framework to formally train dental researchers. A 2001 article published in the JOURNAL OF THE MASSACHUSETTS DENTAL SOCIETY--"A Research Model for Dental Science" (Vol. 49, No. 4, pages 30-31)--examined the preliminary phase of this innovative project. One of the early members, Norwegian émigré Dr. Finn Brudevold, arrived at the Forsyth Dental Infirmary for Children in 1958. His mission was to start a small laboratory in inorganic chemistry and continue his research on the causation and prevention of dental decay. For almost 30 years, Brudevold's ever-expanding laboratory acted as a template for the far-reaching discipline now known as sialogy, the biological laws of saliva.

Overview of salt fluoridation in Switzerland since 1955, a short history.

After an early start in 1955, the introduction and acceptance of fluoridated salt (FS) for domestic use was slow in Switzerland because up to around 1980 there was no consistent strategy for the support of the use of FS. Part of the dental community still supported water fluoridation, while others criticized the insufficient concentration of fluoride in the salt (90 ppm). All Swiss cantons have a historical monopoly on salt trade, and until 1983 most cantonal governments resolved to authorize the sale of fluoridated domestic salt. Some of the cantonal governments made fluoridated salt the only available type of "kitchen salt" in 1-kg packages. After the concentration had been increased to 250 ppm in 1983, the use of FS gained further acceptance. A temporary setback occurred in 1992-1994, but was successfully met with by making the FS available in several package sizes, while other types of salt (with or without iodine) were available in 500 g packages only. By 2004, the market share of fluoridated domestic salt reached 88%. Further endeavours aim at increasing the use of FS by large kitchens. FS is available in portions of 12.5 kg (since 2001) and 25 kg (since 1976).

[History of fluoride prevention: successes and problems (literature review)]. / A fluoridprevenció története: sikerek és problémák (irodalmi áttekintés).

Fluoride prevention has a significant role in complex caries prevention, together with the appropriate diet and oral hygiene. The aim of the present review is--considering mainly the public health aspects--to give information on changes of the methods of fluoride prevention, and the changing views on pathomechanisms, as well as statements in the course of the last 50 years, based on present scientific evidence. The first great breakthrough in caries prevention was the introduction of water fluoridation between 1945-1950 in the USA and Canada. The measure was adopted in other countries and resulted in significant caries reduction. In the fifties and sixties fluoride tablets were widely used in many countries and brought good results, mainly in well-controlled smaller communities. Salt fluoridation has been initiated in Switzerland in 1955, and introduced in numerous countries in the eighties. The concept of a strong protective systemic effect of fluorides in the early eighties gave place to ideas on mainly topical effects, playing a decisive role in toothpastes, gels, acting topically on the enamel of the erupted teeth. Therefore many water fluoridation projects, mainly in Central- and Eastern Europe--where the prevalence of dental caries is still very high--were cancelled after 1990. Tablet fluoridation became questionable due to the fear of the possibility of dental fluorosis. Recent scientific views, however, confirmed a weak pre-, and peri-eruptive, as well as a strong posteruptive effect of systemically applied fluorides. In countries where caries prevalence is high, but the majority of the population cannot afford fluoridated toothpastes due to low socio-economic conditions, the introduction and extension of salt fluoridation to the whole population is well founded and recommended from a public health view.

Successes and drawbacks in the caries-preventive use of fluorides--lessons to be learnt from history.

Water fluoridation was the first breakthrough in the practice of preventive cariology on a community level and has remained one of the cornerstones of prevention in dentistry. The concepts regarding the mechanisms of the caries-inhibitory effect, however, have changed in several respects. Today there is general agreement that topical effects on the erupted enamel are most important. The contention that there is no pre-eruptive effect whatsoever has created confusion; there is in fact evidence for a minor pre-eruptive protective effect. Around 1980 many experts believed that fluorides should not be used in high concentrations, for instance above those in dentifrices, because this could block remineralisation in the body of pre-cavity lesions. However, it is now known that such undesirable effects are negligible or non-existent. In the fifties and sixties, fluoride tablets were widely used in Europe and helped to make the concept of caries prevention popular. From 1980 onwards, fluoride dentifrices were found to have a much greater impact and were recognized as being able to lead to a decline of caries prevalence in entire countries, and fluoride tablets gradually lost their importance. Antifluoridationists were unable to delay or hinder the widespread use of fluoride toothpastes but in many cases have successfully opposed public health measures such as fluoridation of water or of salt. The spread of these methods, beneficial for all social strata, might have been more rapid if some of the experts had not propounded the erroneous supposition that fluoride dentifrice will be sufficient for caries prevention. Sale of fluoridated salt has been authorized in several countries on a nationwide scale. However, only Latin American countries have introduced salt fluoridation for entire populations. In Central and Eastern Europe where caries prevalence continues to be high and where the level of usage of topical fluorides including dentifrices will presumably remain at a low level for many years, salt fluoridation would be beneficial.

A Victorian physician ahead of his time. The story of fluorine advocate Sir James Crichton-Browne.

Sir James Crichton-Browne, one of England's most renowned psychiatrists, whose career spanned two centuries, had very strong feelings about the need to secure proper dental care for all the children of his country. He translated these feelings into action when he advocated that fluorine be added to the diets of pregnant women and children. And this was almost a half-century before definitive research showed the value of fluorine as a preventive of caries.

Overview of the history and current status of fluoride supplementation schedules.

Clinical trials of dietary fluoride supplements began in the 1940s in an effort to bring the benefits of fluoride to those who did not receive it through their drinking water. Following the early success of these trials, the Council on Dental Therapeutics of the American Dental Association (ADA) published its first recommendations for fluoride supplementation in 1958. The American Academy of Pediatrics (AAP) followed with its own recommendations in 1972. During the 1970s a variety of alternative schedules appeared in the literature, most in reaction to the findings of unexpectedly high levels of enamel fluorosis in children being supplemented with the AAP schedule. In 1979 the ADA and AAP agreed on essentially identical schedules. During the 1980s, however, the prevalence of enamel fluorosis continued to increase, and fluoride supplements were found in some studies to be a risk factor for fluorosis. This finding prompted another round of dosage schedule recommendations in the early 1990s. This paper presents a history of fluoride dosage recommendations and reviews the recent proposals for reducing supplement dosage.

Dr. Basil Bibby: early fluoride investigator and intellectual provocateur.

Dr. Basil Bibby assumed many roles during his productive career as a researcher, teacher, and administrator. Although best known for his research on oral microbiology and on foodstuff as it relates to dental caries, and for fostering the careers of many distinguished researchers, he played an important generative role in determining the local cariostatic effects of fluoride. His seminal work in this area has not received its due because of the mixed success of his initial clinical studies. We hope that a review of his contributions in this area will bring those contributions into focus and illustrate his open personality and multi-dimensional approach to research.