Efficiency of fluoride programs in the light of reduced caries levels in young populations

Since the late 1930s, when the efficacy of fluoride in caries prevention was first detected, various efficient methods for fluoride delivery have been developed. Nowadays, fluoride is used for caries prevention on a global scale, the most widely used methods being fluoridated toothpaste and water fluoridation. The latter is a typical community-based prevention method, whereas the former method relies on individual motivation. The goal of an efficient community-based fluoride program is to maintain a constant low level of fluoride in as many mouths as possible at as low a cost as possible. Initially, water fluoridation and other community-based programs were highly efficient, but nowadays in societies in which the major part of the population is using fluoride toothpaste and caries levels are low, population-based programs show a low efficiency. As an example, even though water fluoridation was withdrawn in Kuopio, there have been no dramatic effects on the dental health of children and youths. In societies with well-attended, community-based, free dental health care for children and youths, the dental motivation of individuals is, in general, very high and the use of fluoride for caries prevention may be taken care of at the individual level.