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Fluorides and oral health
Fluoride has been remarkably successful in reducing the burden of dental caries. While the rise in dental caries, which has occurred in many countries, has been due to an increase in sugar consumption, the fall in caries has been due to the increased use of fluorides. Over 50 years ago, fluoride in drinking water was shown to protect against caries development. Since then, much research has shown that fluoride delivered in ways other than in water also protects against dental caries. These methods include: solutions, gels, toothpastes, mouthrinses, tablets, salt, milk, varnishes, mousses, and slow-release devices. It is common to class these as those providing a systemic effect (where fluoride is swallowed intentionally) and those providing a topical effect (formulated not to be swallowed). However, there is much overlap since these 'systemic' methods provide an important topical effect, and some of these 'topical' agents are swallowed, providing some systemic effect. Another way of classifying these methods is automatic, home-care and professional care. All are effective: they can be used in combination, with increased effectiveness, and the task is to choose appropriately to maximise benefit, especially for those with the greatest need, and at least cost. The World Health Organization has repeatedly promoted the appropriate use of fluorides, as illustrated in the statement adopted in May 2007 in Geneva by the Sixtieth World Health Assembly. Fluoride controls caries effectively because it acts in several different ways. When present in dental plaque and saliva, it hastens the remineralisation of early enamel lesions, a healing process before cavities become established. Fluoride also interferes with the process by which cariogenic bacteria metabolise sugars to produce acid. In higher concentrations, it has a bactericidal action on cariogenic and other bacteria. This versatility of action adds to fluoride's value in caries prevention. The goals of community-based public health programmes, therefore, should be to implement the most appropriate means of maintaining a constant low level of fluoride in as many mouths as possible. There is clear evidence that when this goal is achieved through long-term exposure of a population to fluoride, whether it be from drinking-water, salt, milk, or toothpaste, or from combinations of fluoridated toothpaste with any of the other fluoride sources, it results in ever-diminishing numbers of caries in that population. Fluoride is being used widely on a global scale, for the most part with great benefits, though few developing countries have large-scale fluoridation programmes in operation. The use of fluoride toothpaste is almost universal in developed countries, and has been responsible for the massive reduction in dental caries seen in the 1970s and 1980s. However, again in developing countries, even where the use of fluoride toothpaste is becoming more common its use is not the norm. Extensive water fluoridation programmes have been introduced in Australia, Brazil, Chile, Columbia, Canada, Hong Kong, Israel, Malaysia, New Zealand, the Republic of Ireland, Singapore, Spain, the UK, the USA and elsewhere. Fluoridated salt is widely used in parts of Europe, for example Switzerland, France, Germany, and the Czech Republic, and used very extensively throughout Latin America, in, for example Belize, Bolivia, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Jamaica, Mexico, Peru, and Uruguay among many others. Milk fluoridation programmes targeted at children are currently in operation in Bulgaria, Chile, Macedonia, Russian Federation,...