The future of water fluoridation and other systemic fluorides

School and community water fluoridation, salt fluoridation, and use of dietary fluoride supplements have abundant scientific support as effective caries-preventive methods. Because caries has declined greatly in many developed countries from use of topical fluorides, the absolute caries reduction will be considerably smaller when systemic fluoride methods are implemented now than it was 20 to 40 years ago. For countries with most of the population living in cities with communal water supplies, community fluoridation is the most logical approach from the standpoints of cost-effectiveness and total caries-preventive impact. In countries with a mostly rural population without central water supplies, salt fluoridation is more practical. Dietary fluoride supplements can be recommended only for regions where neither water fluoridation nor salt fluoridation is possible, or as a temporary measure. Although divergent views exist concerning the relative caries-preventive effects of pre-eruptive and post-eruptive fluoride administration, the effectiveness of systemic fluoride methods for preventing dental caries remains unchallenged. Persuasive scientific and public health arguments exist to justify implementing and sustaining their use. The future of these methods will be influenced by the findings of new clinical and epidemiological research. Social, political, economic, and educational factors will be of equal, if not greater, importance. Perceptions of the current severity of dental caries as a health problem and of risks associated with preventing the problem may affect the future uses of systemic fluorides more than will recommendations of scientists.