Dental caries in developing countries in relation to the appropriate use of fluoride

Although it is widely believed that caries prevalence in developing countries is increasing rapidly, a review of studies from Africa and China provides equivocal evidence. Data from child and adult populations indicate that the disease is almost ubiquitous but with a slow rate of progression. Theoretically, administration of fluoride in such populations should result in reducing caries progression rates, but too little is known about the magnitude of the effect, and therefore about the cost-effectiveness of different methods of fluoride administration. The lack of a developed infrastructure and of trained personnel in many developing countries limits the applicability of many strategies. Methods of fluoride administration that minimize systemic exposure are to be recommended where affordable or practical. In the light of economic constraints and slow caries lesion progression rates, however, improvements in oral hygiene practices may be the most important method of controlling the disease whether or not fluoride is available or accessible.