Water fluoridation: current effectiveness and dental fluorosis

This paper reviewed the literature on the evidence for water fluoridation's effectiveness under current conditions of multiple fluoride use at recommended and at reduced concentrations, the extent of dental fluorosis at different fluoride concentrations, and the "halo" effect of water fluoridation. Using the relative difference in dental caries between communities with low and optimal water fluoride as an indicator, the effectiveness of water fluoridation has decreased over time as the use of other fluorides has increased. Thus the effectiveness of water fluoridation alone cannot now be determined. Compared to the early fluoridation studies, the differences in dental caries and fluorosis prevalence between fluoridated and non-fluoridated areas have markedly narrowed. Both the prevalence and severity of dental fluorosis have increased since 1945; however, the portion of fluorosis due to water fluoridation is now less (40%) than that attributed to other fluoride sources (60%). Research also suggests that the "halo" effect of community water fluoridation may result in a significantly greater intake of fluoride for people in non-fluoridated communities. This review recognized that since water fluoridation has unique advantages from the perspectives of distribution, equity, compliance and cost-effectiveness over other fluoride technologies, it remains as the fundamental base for caries prevention. The increasingly greater contribution that other sources of fluoride make to dental fluorosis suggests that these sources of fluoride, many of which are used on an elective basis, should be more closely examined for needed changes.