Development of salt fluoridation in the Americas

Fluoridation of water supplies has proven to be an effective preventive measure for dental caries. Many developing countries in the Americas have multiple water systems and economies that do not permit the viable application of this approach. Some of the highest dental caries prevalence in the world was evident in the Americas. Fluoridated salt was considered as a potential solution on account of the urgent need for dental caries prevention to millions of people with limited access to routine dental services. A fluoridated salt trial was initiated in Colombia (1963) and upon successful completion with preventive results comparable to water fluoridation, the approach was introduced to other countries and was supported by resolutions of WHO, PAHO, regional health groups and the FDI. The procedures for addition of fluoride were comparable to those for iodization and the two elements were compatible. In the period 1972-2004, ten countries introduced national or localized programmes and five more initiated programmes. Results, based on addition of F ion at 200-250 mg/kg salt, indicated caries prevalence reductions in 12 year olds ranging from 84% in Jamaica, 73% in Costa Rica to 40% in Uruguay at an average cost of 0.06 U.S. dollars /capita/year. This paper provides a background to the situation in the Americas, illustrates the approaches and feasibility of implementing viable fluoridated salt programmes in countries, and demonstrates the results obtainable at minimum cost.