Seeking community water fluoridation information on state health department websites.

Community water fluoridation (CWF) is the most effective and equitable approach to preventing dental caries (tooth decay). Yet millions of Americans, especially those at highest risk of caries, do not know what CWF is or its preventive benefits. State health departments are responsible for educating their respective populations. Thus, this study assessed health department websites (N = 50) to determine if CWF content existed, the ease of finding it, and if it was written in plain language and for a consumer audience. We used the web component of the HLE2: The Health Literacy Environment of Hospitals and Health Centers (HLE2) to assess how easy or difficult it was to the navigate a website and find information. Forty-one websites had CWF information; 37 states had content written for a consumer audience. HLE2 scores ranged from 0 to 54 points (60 possible). Only five states had websites with a HLE2 score of 50 or higher. SHDs with higher HLE2 scores were easy to navigate and their content was written for a consumer audience. Study findings suggest most SHDs should improve their website's CWF content and its accessibility to better promote the role of fluoridated water in preventing dental caries.

Water fluoridation: current challenges.

Dental extraction for caries is the most common reason for children aged 6-10 years to be admitted to hospital. Community Water Fluoridation (CWF) is safe and effective at reducing dental caries. It is most effective where there is more deprivation. However, many deprived areas do not have CWF despite Public Health England recommending it. Those who lobby against fluoridation do so using emotionally charged language and misinformation. We discuss the benefits of fluoridation and the specious arguments used against this important public health measure. The National CWF Network is led by dentists and promotes CWF. COVID-19 has led to the suspension of routine dentistry, renewing the urgency of implementation of CWF. Professional bodies such as the Royal College of Paediatrics and Child Health are urged to give their support.

[Series: Caries prevention in historical perspective. Fluoride]. / Serie: Cariëspreventie in historisch perspectief. Fluoride.

Shortly after the Second World War it became known in the Netherlands that fluoride can contribute to the prevention of dental caries. As to how this effect was achieved, opinions differed. Initially, the dominant the view was that fluoride had to be absorbed into the enamel and dentine during tooth formation to make the teeth resistant to caries. Later it was discovered that decalcification of the enamel is inhibited if fluoride is present in the dental plaque. While in the beginning water fluoridation was considered to be the most effective measure to prevent caries, the current position is that tooth brushing with fluoride toothpaste plays the most important role in caries prevention.

Water fluoridation in Brazilian cities at the first decade of the 21st century.

OBJECTIVE: To assess the coverage of the fluoridation of the public water supply in Brazilian municipalities at the first decade of the 21st century, according to population size and municipal human development index (MHDI). METHODS: We have used data produced by national information agencies and the United Nations Development Programme. Population size was separated into < 10,000, 10,000-50,000, and > 50,000 inhabitants. The MHDI was classified into < 0.600, 0.600-0.699, 0.700-0.799, and > 0.799. Absolute and relative inequalities between categories were evaluated using indicators of effect and total impact. RESULTS: We have obtained information for 5,558 municipalities. The coverage rate of water fluoridation increased from 67.7% to 76.3%. Approximately 884 (15.9%) municipalities and 29,600,000 inhabitants started being benefited by the measure. We have observed a significant expansion in municipalities with < 10,000 inhabitants (increase of 21.0 percentage points) and low or very low MHDI (17.7 percentage points). CONCLUSIONS: Population coverage of the public policy has increased 8.6%, and we can also see significant reductions in absolute and relative inequality according to population size and MHDI. Regarding municipal coverage rate, there was also a reduction in inequality in all comparisons except for absolute inequality between the categories of MHDI. The public policy has operated as a factor of health protection in the context of the ongoing social protection policies in the country. OBJETIVO: Avaliar a cobertura da fluoretação da água de abastecimento público em municípios brasileiros na primeira década do século XXI, segundo porte demográfico e nível de desenvolvimento humano municipal (IDH-M). MÉTODOS: Foram utilizados dados produzidos por agências nacionais de informação e pelo Programa das Nações Unidas para o Desenvolvimento. O porte demográfico foi separado em < 10 mil; 10-50 mil; > 50 mil habitantes. O IDH-M foi classificado em < 0,600; 0,600-0,699; 0,700-0,799; > 0,799. As desigualdades absoluta e relativa entre as categorias foram avaliadas por meio de indicadores de efeito e de impacto total. RESULTADOS: Foram obtidas informações para 5.558 municípios. A taxa de cobertura da fluoretação da água aumentou de 67,7% para 76,3%. Passaram a ser beneficiados pela medida 884 (15,9%) municípios, e 29,6 milhões de habitantes. Observou-se ampliação expressiva em municípios com < 10 mil habitantes (aumento de 21,0 pontos percentuais) e com IDH-M baixo ou muito baixo (17,7 pontos percentuais). CONCLUSÕES: A cobertura populacional da política pública aumentou 8,6%, sendo expressivas as reduções das desigualdades absoluta e relativa segundo o porte demográfico e o IDH-M. Quanto à taxa de cobertura municipal, houve também redução da desigualdade em todas as comparações com exceção da desigualdade absoluta entre as categorias de IDH-M. A política pública operou como fator de proteção sanitária no contexto das políticas de proteção social em curso no país.

Water fluoridation in Brazilian cities at the first decade of the 21st century / Fluoretação da água em cidades brasileiras na primeira década do século XXI

ABSTRACT OBJECTIVE To assess the coverage of the fluoridation of the public water supply in Brazilian municipalities at the first decade of the 21st century, according to population size and municipal human development index (MHDI). METHODS We have used data produced by national information agencies and the United Nations Development Programme. Population size was separated into < 10,000, 10,000–50,000, and > 50,000 inhabitants. The MHDI was classified into < 0.600, 0.600–0.699, 0.700–0.799, and > 0.799. Absolute and relative inequalities between categories were evaluated using indicators of effect and total impact. RESULTS We have obtained information for 5,558 municipalities. The coverage rate of water fluoridation increased from 67.7% to 76.3%. Approximately 884 (15.9%) municipalities and 29,600,000 inhabitants started being benefited by the measure. We have observed a significant expansion in municipalities with < 10,000 inhabitants (increase of 21.0 percentage points) and low or very low MHDI (17.7 percentage points). CONCLUSIONS Population coverage of the public policy has increased 8.6%, and we can also see significant reductions in absolute and relative inequality according to population size and MHDI. Regarding municipal coverage rate, there was also a reduction in inequality in all comparisons except for absolute inequality between the categories of MHDI. The public policy has operated as a factor of health protection in the context of the ongoing social protection policies in the country.

RESUMO OBJETIVO Avaliar a cobertura da fluoretação da água de abastecimento público em municípios brasileiros na primeira década do século XXI, segundo porte demográfico e nível de desenvolvimento humano municipal (IDH-M). MÉTODOS Foram utilizados dados produzidos por agências nacionais de informação e pelo Programa das Nações Unidas para o Desenvolvimento. O porte demográfico foi separado em < 10 mil; 10-50 mil; > 50 mil habitantes. O IDH-M foi classificado em < 0,600; 0,600-0,699; 0,700-0,799; > 0,799. As desigualdades absoluta e relativa entre as categorias foram avaliadas por meio de indicadores de efeito e de impacto total. RESULTADOS Foram obtidas informações para 5.558 municípios. A taxa de cobertura da fluoretação da água aumentou de 67,7% para 76,3%. Passaram a ser beneficiados pela medida 884 (15,9%) municípios, e 29,6 milhões de habitantes. Observou-se ampliação expressiva em municípios com < 10 mil habitantes (aumento de 21,0 pontos percentuais) e com IDH-M baixo ou muito baixo (17,7 pontos percentuais). CONCLUSÕES A cobertura populacional da política pública aumentou 8,6%, sendo expressivas as reduções das desigualdades absoluta e relativa segundo o porte demográfico e o IDH-M. Quanto à taxa de cobertura municipal, houve também redução da desigualdade em todas as comparações com exceção da desigualdade absoluta entre as categorias de IDH-M. A política pública operou como fator de proteção sanitária no contexto das políticas de proteção social em curso no país.

Oral health trends in Maryland.

OBJECTIVES: This paper describes the trends in oral health in Maryland over the past decade. METHODS: Data were compiled from several surveillance systems and then summarized to assess the trends in oral health in Maryland over the past ten years. RESULTS: The percentage of Maryland children with dental sealants increased from 33.8 to 42.8 percent; the percentage of children that have had a dental visit increased from 18.9 to 47.5 percent; and the percentage of children that received "dental treatment" increased from 8.4 to 22.4 percent. CONCLUSIONS: Maryland has made considerable progress in improving the oral health care for children covered by Medicaid. The availability of affordable oral health care for new mothers, adults, and elderly persons is a problem that goes beyond the Maryland boundaries. Following national trends, edentulism and deaths due to oral cancer have declined.

[Dental health in the United Kingdom and influencing variables]. / Zahngesundheit in Großbritannien - Einflussvariablen.

OBJECTIVE: To review four key topics pertaining to the oral health of the United Kingdom (UK): (1) provision of state-funded dentistry, (2) trends in oral health, (3) dental caries prevention, and (4) determinants of dental health. METHODS: Data were abstracted, mainly from peer-reviewed publications in the literature. Information was updated where appropriate. RESULTS: Since the 1948 inception of the National Health Service (NHS) and its General Dental Service (GDS), the system of providing dentistry has evolved in response to changing fiscal and health circumstances. Since the 1970s, the oral health of the population, both children's dental decay experience and the decline adult tooth loss, has improved steadily and substantially. Approaches towards prevention are discussed and the dominant position of water fluoridation highlighted. The determinants of dental health are analysed. CONCLUSION: Dental caries experience of children in the UK and the rest of Europe is highly correlated with national wealth as are two other significant determinants: fluoride toothpaste and sugar consumption. The activity of dental professionals appears to have only a limited influence on levels of oral health. There is reason to believe that UK water fluoridation coverage may broaden.

Estado del arte acerca del uso de fluoruros: documento de posición / State of the art on fluorides use: position paper

El objetivo de este documento es realizar una revisión basada en la evidencia del estado del arte referido a los fluoruros de aplicación masiva o individual con el propósito de favorecer la toma de decisiones político-sanitarias en los diferentes niveles y subsectores del sistema de salud. Se analizaron aspectos generales de los diferentes protocolos de investigación implementados para la vigilancia epidemiológica en los países, presentando los resultados de manera que permitan la utilización efectiva de la información para fines evaluativos y comparativos y la toma de decisiones. La evidencia científica soporta las recomendaciones de la fluoruración de aguas de consumo, sal o eventualmente leche, como las medidas preventivas más costo-efectivas. Otros recursos se han desarrollado para su empleo sobre grupos focalizados o para su uso a nivel individual. Es imposible asumir que los programas de fluoruración eliminarán la caries dental. Pero es imposible imaginar el cambio en la prevalencia y severidad de la caries dental en la ausencia de fluoruros. La fluoruración del agua ha sido considerada como uno de los diez logros más importantes en la salud pública del siglo XX.

Populations receiving optimally fluoridated public drinking water--United States, 1992-2006.

Water fluoridation has been identified by CDC as one of 10 great public health achievements of the 20th century. The decline in the prevalence and severity of dental caries (tooth decay) in the United States during the past 60 years has been attributed largely to the increased use of fluoride. Community water fluoridation is an equitable and cost-effective method for delivering fluoride to the community. A Healthy People 2010 objective is to increase to 75% the proportion of the U.S. population served by community water systems who receive optimally fluoridated water. To update and revise previous reports on fluoridation in the United States and describe progress toward the Healthy People 2010 objective, CDC analyzed fluoridation data for the period 1992-2006 from the 50 states and District of Columbia (DC). The results indicated that the percentage of the U.S. population served by community water systems who received optimally fluoridated water increased from 62.1% in 1992, to 65.0% in 2000, and 69.2% in 2006, and those percentages varied substantially by state. Public health officials and policymakers in states with lower percentages of residents receiving optimal water fluoridation should consider increasing their efforts to promote fluoridation of community water systems to prevent dental caries.

European citizens' opinions on water fluoridation.

OBJECTIVES: To understand European citizens' opinions on water fluoridation, as part of research on their attitudes to the tensions between private and public interest. METHODS: Sixty-eight focus groups held (with an average of eight people per group) in September and October 2003 in 16 countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Poland, Portugal, Spain, Sweden and the UK). RESULTS: Most participants were against water fluoridation, although groups in Greece, Ireland, Poland and Sweden were more in favour. Many felt dental health was an issue to be dealt with at the level of the individual, rather than a solution to be imposed en masse. While people accepted that some children were not encouraged to brush their teeth, they proposed other solutions to addressing these needs rather than having a solution of unproved safety imposed on them by public health authorities whom they did not fully trust. They did not see why they should accept potential side effects in order that a minority may benefit. In particular, water was something that should be kept as pure as possible, even though it was recognized that it already contains many additives. CONCLUSIONS: While the vast majority of people opposed water fluoridation, this may be indicative of shifts away from public support of population interventions towards private interventions, as well as reduced trust in public agencies. Thus if research were to demonstrate more clear benefits of water fluoridation over and above that which can be achieved by use of fluoride toothpaste, then the public may become more supportive. However, lobby groups are likely to remain influential.

Oral health in the United States: the post-fluoride generation.

Tremendous strides have been made in reducing the incidence of tooth decay, periodontal diseases, and associated loss of teeth in adults and children since the inception of community water fluoridation programs. Yet the disadvantaged and poor have not fully shared in the benefits. Other challenges to oral health remain. Oral cancer and related smoking and smokeless tobacco use remain major public health problems. Access to preventive and therapeutic dental care is far from universal. Public health programs similar in commitment to the approach of community water fluoridation programs initiated in the 1950s and 1960s are needed to address neglected oral health needs of underserved and high-risk populations in the United States.

Educación para la salud: reflexiones / Health education: relections

El concepto de Educación para la salud planteado en este estudio fue el de Educación para la vida. Este concepto se basa en tres principios fundamentales: Educación para la salud, como construcción colectiva del conocimiento. Educación para la salud, volcada hacia la construcción de proyectos de vida y Educación para la Salud, no separada del acto médico

Fluoride prospects for the new millennium--community and individual patient aspects.

Over the past 2 decades, it has been suggested that with the generalized availability of fluoridated dentifrices, and coupled with a possible increased likelihood of fluorosis, the benefits of community-based fluoridation have receded. However, while this may be so for dentally motivated populations, there are convincing data to suggest that the least fortunate amongst us could still benefit from communally delivered fluoride. Furthermore, the deleterious effects of such program withdrawals have been demonstrated and, with respect to fluorosis fears, client assessment of their own fluorosis status has indicated few concerns. Alternative, centrally delivered means of fluoride dispensing, e.g. via schools, etc., although effective in the short-term, are impractical over longer time-spans. Nonetheless, at the individual level, fluoride supplements and dentifrices, in particular, are successful caries inhibitors. This is especially so if these vehicles are employed in their most effective, proven manners. Finally, fears relating to disfiguring fluorosis should be allayed, but where fluoride abuses result in mild mottling, a simple remineralizing technique obviates the need for traumatic restorative procedures.

New, or biased, evidence on water fluoridation?

The recent review, 'New evidence on fluoridation', by Diesendorf, Colquhoun, Spittle, Everingham and Clutterbuck (Aust N Z J Public Health 1997; 21: 187-90) claims a consistent pattern of evidence pointing to fluoride damaging bone, a negligible benefit in dental caries reduction from ingested fluoride, and any small benefit from fluoride coming from the action of fluoride at the tooth surface. Public health authorities are allegedly reluctant to pursue such evidence. In the interest of scholarly debate, invited by Diesendorf et al., this reaction paper examines six separate areas raised in the original paper: fluoridation and hip fracture; fluoridation and osteosarcomas; pre-eruptive and posteruptive benefits in dental caries reduction; fluoride ingestion; benefit in dental caries reduction for contemporary Australian children; and bias of health authorities and responsible science. Numerous examples of bias in the identification, selection and appraisal of the evidence on water fluoridation presented by Diesendorf et al. are developed. Further, this reaction paper puts forward both studies and appraisal indicating that water fluoridation should continue to be regarded as a safe and effective public health measure.