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.