Water fluoridation between public health and public law: an assessment of regulations across countries and their preventive medicine implications.

Background: Among health professionals and health policymakers concern is growing as to the difficulty of balancing the prevention of dental caries through cost-effective interventions and the need to limit unnecessary exposure of the population, and especially children, to environmental chemicals. In this respect, the use of water fluoridation to prevent tooth decay epitomizes the dilemma by raising questions relevant to both public health and public law, ranging from the balance of public health and medical self-determination, the division of powers between local or national authorities over water fluoridation, and the need to avoid the adverse effects of socioeconomic inequalities as well as both under- and over-exposure. Study design: We carried out a narrative review by searching the relevant literature about the laws and rules related to drinking water fluoridation at the community level in the US, UK, and Europe, in order to discuss how the issue is handled from both a public health and public law perspective. Methods: Sources of data for this review were the biomedical and legal literature retrieved by searching online databases, and websites of public health and legal institutions. Results and Conclusions: We found that water fluoridation is still largely adopted throughout the US, while in the UK and particularly in the European Union only a minor part of the population is subject to it. In addition, the recommended and maximum allowed amounts of fluoride in drinking water are being adapted to the public health recommendations and the new regulations, within an evolving evaluation of the epidemiologic evidence and the risk assessment currently in progress by two major regulatory agencies, the US National Toxicology Program - NTP and the European Food Safety Authority - EFSA. Under a comparative public law perspective, the three investigated legislations are facing a reassessment of their policies and regulations, to allow for effective and safe public health measures in the field of water fluoridation and more generally for a preferred use of topical fluoride for caries prevention. A consistent trend across these legislations is the choice to centralize at the national level regulatory and management issues related to water fluoridation, and to carefully balance benefits for dental caries prevention in children and the potential risks of systemic overexposure associated with excess fluoride intake, by promptly responding to the evolving indications by the scientific community and the public health professionals.

Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review.

OBJECTIVES: To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS: Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS: Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS: Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.

Probing the fluorination effect on the self-assembly characteristics, in vivo fate and antitumor efficacy of paclitaxel prodrug nanoassemblies.

Rationale: Small-molecule prodrug nanoassembly is emerging as an efficient platform for chemotherapy. The self-assembly stability plays a vital role on the drug delivery efficiency of prodrug nanoassembly. It is reported that fluoroalkylation could improve the self-assembly stability of amphiphilic polymers by utilizing the unique fluorination effect. But the application of fluoroalkylation on small-molecule prodrug nanoassembly has never been reported. Methods: Here, fluoro-modified prodrug was developed by conjugating paclitaxel with perfluorooctanol (F8-SS-PTX), and the paclitaxel-octanol prodrug (C8-SS-PTX) was used as control. The fluoro-mediated self-assembly mechanisms were illustrated using molecular dynamics simulation. In addition, the impacts of fluoroalkylation on the pharmacy characters, in vivo fate and antitumor effect of small-molecule prodrug nanoassembly were investigated in details. Results: Fluoroalkylation significantly improved the self-assembly stability of F8-SS-PTX NPs both in vitro and in vivo, which could be attributed to the fluoro-mediated hydrophobic force and halogen bonds. The AUC0-24h and tumor accumulation of F8-SS-PTX NPs was 6-fold and 2-fold higher than that of C8-SS-PTX NPs, respectively. As a result, F8-SS-PTX NPs exhibited much better antitumor effect than C8-SS-PTX NPs and Abraxane. Conclusion: Fluoroalkylation could improve the self-assembly stability, in vivo fate, and antitumor efficacy of small-molecule prodrug nanoassemblies, which could be an effective strategy for the rational design of advanced nanomedicines.

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.

Dental Cleaning, Community Water Fluoridation and Preterm Birth, Massachusetts: 2009-2016.

Objectives Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established. Methods This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n = 9234, weighted response rate = 64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC-CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth < 37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results During 2009-2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR = 0.74 [95% CI 0.55-0.98]), and DC-CWF and preterm birth (aRR = 0.74 [95% CI 0.57-0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR = 0.81 [95% CI 0.63-1.05]), compared to women without dental cleaning and CWF. Conclusions for Practice This study shows that the prevalence of preterm birth was lower among women with DC only and DC-CWF.

External control of fluoridation in public water supply systems in the state of Goiás, Brazil. / Heterocontrole da fluoretação da água de abastecimento público em cidades do estado de Goiás, Brasil.

The addition of fluoride to the public water supply is a method used for reducing tooth decay. In this sense, the control of fluoridation is important for maintaining its efficiency and, at the same time, for avoiding the risk of fluorosis as a result of the consumption of water with excess of fluoride. The objective of this study was to evaluate the adequacy of fluoride levels in the water distributed to populations of the state of Goiás, Brazil. Towards this aim, 5,039 water samples collected between 2011 and 2013 in 225 municipalities of the state of Goiás were analyzed for fluoride level. The results were assessed with regard to season, type of water source and geographic location. Fluoride levels were found to vary between complete absence and 2.5 mg F/L, with 28.2% of the samples being between 0.6 and 0.8 mg F/L, and 39.1% between 0.55 and 0.84 mg F/L. The rainy season produced a greater number of atypical results and higher values than the dry period. The systems supplied by groundwater sources were shown to have a limited control of fluoride concentration compared to systems supplied by surface water sources. Lower concentrations of fluoride were found in samples collected in the North and East Mesoregions of Goiás, with less than 7.5% being between 0.6 and 0.8 mg F/L, which systems are mainly supplied by groundwater sources with fluoride addition .

A adição do flúor na água é um método empregado na redução de cárie dentária. O controle da fluoretação é importante para manter a sua eficiência e, ao mesmo tempo, evitar o risco de ocorrência de fluorose, fruto do consumo de água com flúor em excesso. O objetivo deste trabalho foi avaliar a adequação dos níveis do fluoreto na água distribuída à população do estado de Goiás, Brasil. Foram analisadas 5.039 amostras de água coletadas em 225 municípios de Goiás, entre 2011 e 2013. Os resultados foram analisados por sazonalidade, tipo de manancial e localização geográfica. Ocorreu uma variação entre ausência e 2,5 mg F/L, com 28,2% das amostras entre 0,6 e 0,8 mg F/L e 39,1% entre 0,55 e 0,84 mg F/L. No período de chuva ocorreu um maior número de resultados atípicos e maiores valores quando comparados ao período da seca. Verificou-se que os sistemas abastecidos por água proveniente de mananciais subterrâneos possuem um menor controle de fluoreto quando comparados a sistemas provenientes de mananciais superficiais. Observou-se menores concentrações nas amostras coletadas no Norte e Leste goianos, com menos de 7,5% entre 0,6 e 0,8 mg F/L, para aquelas coletadas de sistemas de abastecimento que utilizam água de manancial subterrâneo com adição de fluoreto, existindo dificuldades na manutenção dos seus teores.

[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.

Fluoride concentrations in salt marketed in Managua, Nicaragua.

Nicaraguan legislation has established that fluoride concentrations in salt should be 200-225 mg/kg, but no report describes fluoride concentrations in salt marketed in this country. We evaluated the fluoride concentrations in 33 packages of salt of 11 brands (n = 3 each) purchased in Managua, Nicaragua. According to the package information, 9 of the 11 brands were fluoridated. Six aliquots of each package were weighed (mean 2.5 ± 0.3 g; n = 198) and dissolved in 0.025 g/ml water. Duplicates of 1.0 ml of solutions prepared were buffered (1:1; v/v) with TISAB II. Fluoride concentrations were determined with ion-specific electrode, calibrated with standard solutions (0.25-16.0 µg F/ml) mixed (1:1; v/v) with TISAB II added to 0.025 g (p.a.) NaCl/ml. The mean (± standard deviation, n = 3) fluoride concentrations of two fluoridated brands were in accord with Nicaraguan law (209.8 ± 48.0 and 211.4 ± 26.0 mg F/kg), and those of five brands were below the mandated range (131.0 ± 34.3, 180.6 ± 12.3, 184.6 ± 34.8, 190 ± 47.2, and 199.0 ± 18.9 mg F/kg); two brands contained only traces of fluoride. The two non-fluoridated brands had traces of fluoride. The findings show that the surveillance system for the salt fluoridation program in Nicaragua should be improved, as most salt analyzed violated the requirements of the national legislation.

Caries and fluoridated water in two Brazilian municipalities with low prevalence of the disease.

OBJECTIVE: To analyze the association between exposure to fluoridated water and dental caries in a context of widespread use of fluoride toothpaste in Brazil, in a scenario of low prevalence of the disease. METHODS: This is a cross-sectional observational study, of the census type, in the form of a double population-based epidemiological survey carried out in two municipalities of the state of São Paulo in 2014. The sample consisted of adolescents aged 11 and 12 years, exposed (n = 184) or not exposed (n = 128) to fluoridated water for at least five years. The populations studied lived in communities of the same geographic region and had small demographic size and similar socioeconomic classification, differing only in the exposure (Silveiras) or not exposure (São José do Barreiro) to fluoridated water. The experience, magnitude, and degree of polarization of dental caries in these populations were analyzed using the DMFT and SiC indexes, and the association was tested using Pearson's chi-square statistics and prevalence ratio between those not exposed and those exposed to fluoridated water. RESULTS: Although caries experience (DMFT ≥ 1) was not associated with exposure to fluoridated water (chi-square = 1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in those not exposed and the means of SiC were 4.04 and 6.16, respectively. The degree of polarization, indicated by the percentage of subjects with DMFT = 0, was different, being it higher (41.8%) in subjects exposed and lower (34.3%) in subjects not exposed. The prevalence ratio between those not exposed and those exposed was 1.13, indicating little expressiveness in prevalence difference. CONCLUSIONS: Exposure to fluoridated water implied lower mean values for the DMFT and SiC indexes, even in the presence of the concomitant exposure to fluoridated toothpaste, in a scenario of low prevalence of the disease, and with a similar pattern of caries distribution in the populations analyzed.

Cost-effectiveness analysis of a school-based dental caries prevention program using fluoridated milk in Bangkok, Thailand.

BACKGROUND: This study modelled the cost-effectiveness, from a societal perspective, of a program that used fluoridated milk to prevent dental caries in children who were 6 years old at the beginning of the program, versus non-intervention, after 6 years. METHODS: After 6 years, children in the milk-fluoridation program had a significant (34%) reduction in dental caries experience compared to those in the comparison community (i.e., received school milk without added fluoride) (DMFS: 1.06 vs. 1.60). RESULTS: This improvement was achieved with an investment of Thailand Baht (THB) 5,345,048 over 6 years (or THB 11.88 per child, per year) (1 US$ = THB(2011) 30.0). When comparing the costs of the operation of the program and dental treatment in the test community with those of the comparison community, the program resulted in a net societal savings of THB 8,177,179 (range 18,597,122 to THB 7,920,711) after 6 years. This investment would result in 40,500 DMFS avoided in a community with a childhood population of 75,000 [DMFS avoided: 75,000 x (- 0.54)]. CONCLUSIONS: While the analysis has inherent limitations due to its dependence on a range of assumptions, the results suggest that, from a societal perspective, when compared with the non-intervention group, the Bangkok Metropolitan Administration intervention appeared to be a more cost-efficient option than current standard oral health care.

Management of dental caries among children: a look at the cost-effectiveness.

INTRODUCTION: Dental caries is the most prevalent non-communicative disease worldwide. Although the etiological factors are well known for years, reducing the number of decayed and missing teeth in children still remains as a barrier. Preventive and curative options are numerous but little is known about their economical advantages. Selecting the intervention that offers the best balance of effectiveness and financial resources becomes crucial in the current situation of budget restrictions worldwide. AREAS COVERED: This expert review summarizes available evidence on cost-effectiveness analyses of preventive and curative measures to manage dental caries in children. EXPERT COMMENTARY: Preventive measures have been more extensively studied than dental caries treatment. Only water fluoridation and tooth brushing are well-established as cost-effective preventive approaches. Despite the increasing number of cost analysis treatment studies in the literature, most of them focus on the cost description, with no correlation to the intervention effectiveness. There is a current need of well-designed and well-reported cost-effectiveness regarding dental caries management.

Fluoride concentrations in salt marketed in Managua, Nicaragua

Abstract Nicaraguan legislation has established that fluoride concentrations in salt should be 200-225 mg/kg, but no report describes fluoride concentrations in salt marketed in this country. We evaluated the fluoride concentrations in 33 packages of salt of 11 brands (n = 3 each) purchased in Managua, Nicaragua. According to the package information, 9 of the 11 brands were fluoridated. Six aliquots of each package were weighed (mean 2.5 ± 0.3 g; n = 198) and dissolved in 0.025 g/ml water. Duplicates of 1.0 ml of solutions prepared were buffered (1:1; v/v) with TISAB II. Fluoride concentrations were determined with ion-specific electrode, calibrated with standard solutions (0.25-16.0 μg F/ml) mixed (1:1; v/v) with TISAB II added to 0.025 g (p.a.) NaCl/ml. The mean (± standard deviation, n = 3) fluoride concentrations of two fluoridated brands were in accord with Nicaraguan law (209.8 ± 48.0 and 211.4 ± 26.0 mg F/kg), and those of five brands were below the mandated range (131.0 ± 34.3, 180.6 ± 12.3, 184.6 ± 34.8, 190 ± 47.2, and 199.0 ± 18.9 mg F/kg); two brands contained only traces of fluoride. The two non-fluoridated brands had traces of fluoride. The findings show that the surveillance system for the salt fluoridation program in Nicaragua should be improved, as most salt analyzed violated the requirements of the national legislation.

Caries and fluoridated water in two Brazilian municipalities with low prevalence of the disease / Cárie e água fluoretada em dois municípios brasileiros com baixa prevalência da doença

ABSTRACT OBJECTIVE To analyze the association between exposure to fluoridated water and dental caries in a context of widespread use of fluoride toothpaste in Brazil, in a scenario of low prevalence of the disease. METHODS This is a cross-sectional observational study, of the census type, in the form of a double population-based epidemiological survey carried out in two municipalities of the state of São Paulo in 2014. The sample consisted of adolescents aged 11 and 12 years, exposed (n = 184) or not exposed (n = 128) to fluoridated water for at least five years. The populations studied lived in communities of the same geographic region and had small demographic size and similar socioeconomic classification, differing only in the exposure (Silveiras) or not exposure (São José do Barreiro) to fluoridated water. The experience, magnitude, and degree of polarization of dental caries in these populations were analyzed using the DMFT and SiC indexes, and the association was tested using Pearson's chi-square statistics and prevalence ratio between those not exposed and those exposed to fluoridated water. RESULTS Although caries experience (DMFT ≥ 1) was not associated with exposure to fluoridated water (chi-square = 1.78; p = 0.18; α = 5%), a significant difference was observed in the magnitude with which the disease reached the population: the means of DMFT were 1.76 in those exposed and 2.60 in those not exposed and the means of SiC were 4.04 and 6.16, respectively. The degree of polarization, indicated by the percentage of subjects with DMFT = 0, was different, being it higher (41.8%) in subjects exposed and lower (34.3%) in subjects not exposed. The prevalence ratio between those not exposed and those exposed was 1.13, indicating little expressiveness in prevalence difference. CONCLUSIONS Exposure to fluoridated water implied lower mean values for the DMFT and SiC indexes, even in the presence of the concomitant exposure to fluoridated toothpaste, in a scenario of low prevalence of the disease, and with a similar pattern of caries distribution in the populations analyzed.

RESUMO OBJETIVO Analisar a associação entre a exposição à água fluoretada e cárie dentária, em contexto de uso generalizado de creme dental fluoretado no Brasil, em cenário de baixa prevalência da doença. MÉTODOS Realizado estudo observacional transversal, de tipo censitário, na modalidade de duplo inquérito epidemiológico populacional, em dois municípios paulistas em 2014. Participaram adolescentes de 11 e 12 anos, imersos na sua condição de exposição (n = 184) ou não exposição (n = 128) à água fluoretada, há pelo menos cinco anos. As populações avaliadas residiam em comunidades da mesma região geográfica, de pequeno porte demográfico e com classificação socioeconômica similar, diferenciando-se apenas pela condição de exposição à água fluoretada (Silveiras) e de não exposição (São José do Barreiro). A experiência, a magnitude e o grau de polarização da cárie dentária nessas populações foram analisadas por meio dos índices CPOD e SiC e a associação foi testada empregando-se as estatísticas qui-quadrado de Pearson e razão de prevalência entre não expostos e expostos à água fluoretada. RESULTADOS Embora a experiência de cárie (CPOD ≥ 1) não tenha se associado com a exposição à água fluoretada (qui-quadrado = 1,78; p = 0,18; α = 5%), observou-se expressiva diferença na magnitude com que a doença atingiu a população: as médias CPOD foram de 1,76 em expostos e 2,60 em não expostos e as médias SiC foram de 4,04 e 6,16, respectivamente. O grau da polarização, indicado pela porcentagem de indivíduos com CPOD = 0, foi diferente, maior (41,8%) em expostos e menor (34,3%) em não expostos. A razão de prevalência entre não expostos e expostos foi de 1,13, indicando pouca expressividade na diferença das prevalências. CONCLUSÕES A exposição à água fluoretada implicou menores valores médios dos índices CPOD e SiC, ainda que em presença de exposição concomitante a dentifrício fluoretado, em cenário de baixa prevalência da doença e padrão similar de distribuição de cárie nas populações analisadas.

Heterocontrole da fluoretação da água de abastecimento público em cidades do estado de Goiás, Brasil / External control of fluoridation in public water supply systems in the state of Goiás, Brazil

Resumo A adição do flúor na água é um método empregado na redução de cárie dentária. O controle da fluoretação é importante para manter a sua eficiência e, ao mesmo tempo, evitar o risco de ocorrência de fluorose, fruto do consumo de água com flúor em excesso. O objetivo deste trabalho foi avaliar a adequação dos níveis do fluoreto na água distribuída à população do estado de Goiás, Brasil. Foram analisadas 5.039 amostras de água coletadas em 225 municípios de Goiás, entre 2011 e 2013. Os resultados foram analisados por sazonalidade, tipo de manancial e localização geográfica. Ocorreu uma variação entre ausência e 2,5 mg F/L, com 28,2% das amostras entre 0,6 e 0,8 mg F/L e 39,1% entre 0,55 e 0,84 mg F/L. No período de chuva ocorreu um maior número de resultados atípicos e maiores valores quando comparados ao período da seca. Verificou-se que os sistemas abastecidos por água proveniente de mananciais subterrâneos possuem um menor controle de fluoreto quando comparados a sistemas provenientes de mananciais superficiais. Observou-se menores concentrações nas amostras coletadas no Norte e Leste goianos, com menos de 7,5% entre 0,6 e 0,8 mg F/L, para aquelas coletadas de sistemas de abastecimento que utilizam água de manancial subterrâneo com adição de fluoreto, existindo dificuldades na manutenção dos seus teores.

Abstract The addition of fluoride to the public water supply is a method used for reducing tooth decay. In this sense, the control of fluoridation is important for maintaining its efficiency and, at the same time, for avoiding the risk of fluorosis as a result of the consumption of water with excess of fluoride. The objective of this study was to evaluate the adequacy of fluoride levels in the water distributed to populations of the state of Goiás, Brazil. Towards this aim, 5,039 water samples collected between 2011 and 2013 in 225 municipalities of the state of Goiás were analyzed for fluoride level. The results were assessed with regard to season, type of water source and geographic location. Fluoride levels were found to vary between complete absence and 2.5 mg F/L, with 28.2% of the samples being between 0.6 and 0.8 mg F/L, and 39.1% between 0.55 and 0.84 mg F/L. The rainy season produced a greater number of atypical results and higher values than the dry period. The systems supplied by groundwater sources were shown to have a limited control of fluoride concentration compared to systems supplied by surface water sources. Lower concentrations of fluoride were found in samples collected in the North and East Mesoregions of Goiás, with less than 7.5% being between 0.6 and 0.8 mg F/L, which systems are mainly supplied by groundwater sources with fluoride addition .

[Caries prevention with fluoridated and iodinated salt in school-aged children living in areas with fluoride and iodine deficiency]. / Rezul'taty profilaktiki kariesa zubov u detei shkol'nogo vozrasta ftorirovanno-iodirovannoi sol'iu pri biogeokhimicheskom defitsite ftorida i iodida.

The aim of the study was to evaluate the efficacy of dental caries prevention program with 3 years follow-up in children living in areas with fluoride and iodine deficiency. The study involved 625 school-aged children aged 6, 12 and 15 years receiving endogenous prevention with fluoridated and iodinated salt (300±50 mgF/kg and 40±10 mgI/kg). Enamel and dentine concentrations of CA, P, F and I were measured in 98 intact deciduous teeth by X-ray microanalysis before and after prevention program. Enamel and dentin microhardness was assessed in the same 98 teeth by Vickers Hardness Test. Obtained reduction of DMFT growth, positive changes of mineral composition and dental hard tissues microhardness prove high clinical efficacy of applied prevention program.

Milestones and controversies in maternal and child health: examining a brief history of micronutrient fortification in the US.

Fortification of our food and drinking supply has decreased morbidity rates related to micronutrient deficiencies among mothers and their children, particularly during the perinatal and neonatal periods of development. The purpose of this historical review is to examine the impact of public policy changes related to micronutrient fortification. We provide a historical investigation of achievements and controversies related to iodine, vitamin D, fluoride and folic acid fortifications in our food and drinking supply. We also discuss the current status of fortification recommendations and their significance to maternal and child health.

La caries dental en los niños: una deuda pendiente / Dental caries in children: an outstanding debt

La caries dental influye considerablemente en la salud general de la población infantil y en la evolución de su salud bucal. Si bien obedece a múltiples causas, más que un problema individual, es el resultado de factores estructurales y contextuales. Por ende, su atención requiere un abordaje integral y coordinado de profesionales de la salud, autoridades nacionales, instituciones académicas, asociaciones odontológicas y agentes multiplicadores, por medio de programas de educación, promoción y atención de la salud bucal desde temprana edad