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SYSTEMIC FLUORIDES PART -1 WATER FLUORIDATION
CONTENTS  Introduction  Tale of Fluoridated Water.  Pioneer studies  Modern studies  Water Fluoridation--  School Water Fluoridation  Myths and facts  Conclusion  References
INTRODUCTION • Fluorine—15th most common elements found on earth. • Researchers all over the world have used fluoride in several forms in the prevention of tooth decay. • water fluoridation and topical fluoride programs were important measures for the control of caries at the community level.
Fluorides Topical Professional APF gels Fluoride Varnish Stannous Flouride Self applied Dentifrices mouthwashes Systemic Water Milk Salt Tablets Lozenges drops
DEFINITION “Fluoridation is the deliberate upward adjustment of the natural trace element, fluoride, in accordance with scientific and dental guidelines, for the purpose of promoting the public's health through the prevention of tooth decay.” -US Dept. of Health & Human services, -Centers for Disease Control and Prevention 1986
UNIT OF MEASUREMENT FOR FLUORIDE? • Fluoride is measured in ppm (parts per million). • The maximum acceptable concentration (MAC) is 1.5mg/L (1ppm=1mg/L).
TALE OF FLUORIDATED WATER • Dr. Frederick Mckay, Colarado springs, colarado, USA --1901 • Colarado stain • 1909 Mckay ---define the exact geographical area of the stain Minute white flecks or yellow or brown spots scattered irregularly or streaked over tooth surfaces
• Dr. G.V.Black – 1909 to colarado springs-------------- • 1928 Mckay (US), 1930 Ainsworth (UK) -- Mottled Enamel -- caries • Dr. F.L. Robertson - Bauxite town, Ark -Aluminium company of America (ALCOA) 13.7ppm • In 1931 , Mr. H.V.Churchill – chief chemist of ALCOA , fluoride - 13.7ppm mottled enamel
SHOE LEATHER SURVEY - DR. H.TRENDLEY DEAN • A questionnaire study sent to local & state dental society - asking for any mottled enamel existed in their location • Out of 1197 questionnaire's 632 replies were received - reported that in 97 localities mottled enamel was reported. • Aim was also to find out minimum threshold of fluorine level at which F began to blemish teeth. Mottling  fluoride conc.
• Continuous use of water containing 1ppm - very mildest form of mottled enamel , 1.7ppm – mild types of mottling. • In 1938 Dean in conjunction with McKay - summarized mottled enamel in American Public Health Association. Successful conclusion to McKay's search for cause of mottled enamel, which lasted for almost 40 yrs.
• Dean 1938 – 12% US pop- 1mg/lt --- (mild- mod.)fluorosis • Milder fluorosis – decreased caries experience. • 12- 14 years children Galesburg & Monmouth -1.8 mg/lt , had half of the caries experience Quincy - 0.2mg/lt. • F in water 1- 1.2 mg/lt – change by temp. • Grand Rapids , Michigan --- January 1945
ACTION OF SYSTEMIC FLUORIDE • Burt et al in 1992 - F is more effective when low levels of F is maintained all the times. • F is also stored in plaque and inhibits glycolysis & prevents carbohydrate metabolism by cariogenic bacteria to produce acids • Action of F • 1. pre-eruptive • 2. post-eruptive Burt BA, Eklund SA. 2005. Dentistry, dental practice, and the community. 6th ed. St. Louis (MO): Elsevier Health Sciences
PRE ERUPTIVE -F GETS TO TEETH THROUGH BLOOD. • F contributes to anti caries activity by strengthening the enamel surface by formation of fluorapatite crystals • Fluorapatite - strengthens surface enamel to acid attack • F ions being more electronegative than OH ions • Total electron density around F is more than that of OH ions. • Shorter crystal axes of Fluorapatite compared to hydroxyapatite. Ca10 (po4)6 (OH)2 + 2 F - Ca10 (po4)6 F2 + 2 OH –
POST -ERUPTIVE - CONSUMED FLUIDS, TOPICAL THERAPY, SALIVA • F ions helps maintain surface enamel fluorapatite structure. • F conc. of enamel is further enhanced by continuous presence of F in plaque. so surface enamel is …. • F reduces wettability of enamel surfaces and reduces protein absorption on enamel surface. • F ion inhibits growth of s.mutans
• Singh & spencer 2004 • A study examining pre & post eruptive effects of F on permanent 1st molars in 6-15 yrs in Australian children • Suggested that pre-eruptive exposure was imp. for caries prevention. • It also demonstrated that high pre-eruptive exposure to F could decrease caries levels significantly in pit & fissure surfaces. Water fluoridation provides a mechanism for this continuous exposure as a benefit to all surfaces
WHAT HAPPENS IF MORE F IONS EXISTS THAN OPTIMAL CONC. ? • If large amounts of fluoride is present then the end product is calcium fluoride, a powdery substance turning enamel into chalky substance that wear off easily. Dental fluorosis Ca10 (po4)6 (OH)2 + 20 F - 10CaF2 + 4(po4)3 - +2 OH –
• Recommended concentration of fluorides is 1-1.2ppm. • US Dept. of Health & Human services(2015)--0.7-1.2ppm. Concentration of Fluoride in water Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep. 2015 Jul-Aug;130(4):318-31PMID: 26346489; PMCID: PMC4547570.
GALAGANS FORMULA Optimum Levels of Fluoride: • The optimum fluoride concentration for a particular community can be calculated by the following equation. • 🔹 Simplified: • F (ppm)=0.34/(T/1000F) • where T = mean maximum daily temperature (°F) 0.7 ppm 2 ppm
Annual maximum daily air temperature Recommended control limits fluoride mg/l Centigrade Fahrenheit Lower Optimum upper 10-12.1 50.0-53.7 0.9 1.2 1.7 12.2-14.6 53.8-58.3 0.8 1.1 1.5 14.7-17.7 58.4-63.8 0.8 1.0 1.3 17.8-21.4 63.9-70.6 0.7 0.9 1.2 21.5-26.2 70.7-79.2 0.7 0.8 1.0 26.3-32.5 79.3-90.5 0.6 0.7 0.8
PIONEER STUDIES ON WATER FLUORIDATION
1. Grand Rapids – Muskegon study • The first community water fluoridation scheme began in Grand Rapids, Michigan (U.S.A) on - 25th January, 1945. • In 1944, Dean ,Knutson & Francis Arnold – examined school children, aged 4-16 yrs • 19,680 grand rapids • 4291 Muskegon(control) • Arnold et al (1951) --- 6.5 yrs. reported 50% reduction in caries experience. • Baseline caries experience was similar in both the cities. • 15 years (1959) – 55.5% decrease in caries experience • 12% less caries experience compared to control
Caries experience in 15 yr. Grand Rapids study has fallen from 12.48 DMF teeth in 1944 to 6.22 DMF teeth per mouth in 1959 Grand Rapids, Michigan - site of the world’s first water fluoridation scheme in 1945
2. Newburgh - Kingston Study • On May 2nd 1945, sodium fluoride was added to the drinking water of Newburgh, New York. • After ten years of fluoridation, Ast et al (1955) reported that the DMFT rate had fallen from 23.5% to 13.9%. • 6- to 9-year-olds had 58% less dental decay than their counterparts • 1966-- 70%
3. Evanston- Oak Park Study • January 1946 • After 14years of fluoridation , there was a reduction of DMFT from 11.66-5.95 (48.4%) --12-14 yrs old school children • Presented the most detailed data of all the fluoridation studies. • These 3 American studies …….. reached similar conclusions Addition of 1ppm F in drinking water reduced caries experience by approx. 50%
4. Dutch Study (Tiel - Culemborg) • F drinking water -- anatomical siting of caries attack. • In March 1953, the drinking water in Tiel -- fluoridated to 1.1 ppm • Culemborg with fluoridation concentration of 0.1 ppm was the control. • Base line -- children aged 11-15 yrs. in 1952 were carried out. • After 16 years (1969) of fluoridation, caries experience was 56% lower in Tiel
This study was mainly designed to assess fluoride preventive effect on various surfaces of tooth • Maximum reduction was seen on free smooth surfaces- 86% • 75% in approximal surfaces • 31% in pit & fissure caries. • 1988---least DMFT
RECENT STUDIES ON WATER FLUORIDATION
• Dental findings of more than 286,000 subjects of either sex (6-15 years old) from the two industrial towns Chemnitz and Plauen • (1.0 +/- 0.1 ppm F) was implemented in Chemnitz 1959 -1990. • Plauen, 55% --- (0.9 ppm F) during the years 1972-1984. Another 20% -- (0.4-0.7 ppm F). Rise and fall of caries prevalence in German towns with different F concentrations in drinking water W kuzel et al Künzel, W., & Fischer, T. (1997). Rise and fall of caries prevalence in German towns with different F concentrations in drinking water. Caries research, 31(3), 166–173. https://doi.org/10.1159/000262393
• This cross-sectional study -- associations community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. • 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (dmfs) -- 7,000 children aged 2 to 8 y • permanent dentition (DMFS]) ---- 12,604 children and adolescents aged 6 to 17 y. Water Fluoridation and Dental Caries in U.S. Children and Adolescents G.D. Slade, , W.B. Grider Journal of Dental Research 2018, Vol. 97(10) 1122–1128© International & American Associations for Dental Research 2018
WATER FLUORIDATION
METHODOLOGY OF ESTIMATION OF FLUORIDE CONCENTRATION IN DRINKING WATER • Sample collection for fluoride estimation: 500ml - dry polythene container 2ml of 6N HCL is added to inhibit growth /enzymatic change Store at 4ºC for analysis. • Fluoride concentration in the water can be estimated by : 1. Fluoride electrode coupled with standard рН meter. 2. Scot – Sanchi’s method
ELECTRODE COUPLED WITH STANDARD METER РН • Most recent & universally accepted method. • quickly, simply, economically & accurately. • electrode potentials of the standard / sample solutions from which fluoride concentration • 0.1-10ppm. • 2 рН meters :Orion 901 microprocessor ion analyzer & Orion 407 are used - Direct ppm reading.
SCOT – SANCHIS METHOD: • Test is based on the reaction between fluoride & red Zirconium Alizarin lake. • Fluoride forms colorless complex ion & liberates free alzarin sulfuric acid, which is yellow in acid solution. • As the amount of fluoride increases color varies from yellow to red. • 1.5ppm standard sol. colour comparision– photometer
MONITORING OF FLUORIDE IN WATER SAMPLES USING A SMARTPHONE SAURABH LEVIN ET AL (2016) Levin S, Krishnan S, Rajkumar S, Halery N, Balkunde P. Monitoring of fluoride in water samples using a smartphone. Science of the Total Environment. 2016 May 1;551:101-7.
CHOICE OF EQUIPMENT FORWATER FLUORIDATION • It must be adapted to local conditions & needs of water network. • It should be of standard type , recognized as satisfactory • It should have well defined precision limits. --safe. • Adjustment of the distribution must be easy & rapid. • It should be operate between 20% & 80% of its total capacity. • In each system an anti-siphon mechanism should be installed to avoid a concentrated solution of fluoride entering the distribution system.
CHOICE OF CHEMICAL FOR WATER FLUORIDATION 1. Should be sufficiently soluble in water 2. No undue side effects 3. Readily available & inexpensive 4. Should not affect quality & taste of water
COMPOUNDS USED 1. Fluorspar: • Mineral containing varying amount of calcium fluoride 85-98%. • Raw mineral form • Easy / cheap • Fluorescence
2. Sodium fluoride: • White , odorless, free flowing material • Manufactured from hydrofluoric acid, a by-product of fluorspar • Most expensive source of fluorides. • Sodium fluoride is the easiest chemical to feed because of its uniform solubility in water. • (NaF) was the first compound -- reference standard • More expensive
3. Silicofluoride: • Is the sodium salt of fluorosilicic acid. • It is a powder or very fine crystal than fluorosilicic acid 4. Sodium silicofluorides: • Hydrofluosilicic acid is the basic raw material • Cheapest form of fluoride • Solutions of this compound are corrosive.
5. Hydrofluosilicic acid: • Slightly more expensive than silicofluoride • Most popular because --simple feed equipment • Handling is uncomplicated • Inexpensive liquid by product of phosphate fertilizer • manufacture.
6. Ammonium silicofluoride: • By neutralizing fluorosilicic acid • Use of ammonium silicofluoride provides part or all the ammonium required for producing chloramine. • Ammonium hexafluorosilicate, ammonium fluosilicate or ammonium silicofluoride. • (NH4)2SiF6 ---- 23–25%
TYPES OF EQUIPMENT FOR WATER FLUORDATION • The saturator system • The dry feeder • The solution feeder system
SATURATOR SYSTEM • Principle : • 4% saturated solution of sodium fluoride injected -- desired concentration --aid of pump. • Factors limiting utilization : • A high hard water level , the need to clean the gravel bed used for water filtration. • Recommendation : • Suitable for small towns with a total requirement of less than
DRY FEEDER • Principle : • Sodium fluoride or silicofluoride in the form of powder - dissolving basin with the aid of an automatic mechanism • Factors limiting utilization : • care in the handling of fluoride, obstruction of pipes, compacting of fluoride -- humid atmosphere. • Recommendation : • Suitable for medium-sized towns with a total requirement of 19 million liters
SOLUTION FEEDER • Principle : • Volumetric pump --hydrofluosilicic acid in proportion to the mount of water treated. • Factors limiting utilization : • All equipment must be resistant to attack by hydrofluosilicic acid, -- polyvinyl chloride or any other plastic. • Recommendation : • Suitable for medium- sized & large towns, with a total requirement of more than 7.6 million liters per day.
VENTURI FLUORIDATOR SYSTEM - J.N.LEO • Non-electric system • Activated by the flow of water in the main waterline • Advantages: • Simple to install • Cost effective • No possibility of over dosing
SATURATION – SUSPENSION CONE: • Developed by state of Rio Grande , brazil • Consists of an upside down cone charged with a bag of sod silicofluoride through which a constatnt flow of water percolates. • The sol is collected at the top by a horizontal perforated plastic pipe, which forms the outlet • The cone is charged with a 45-kg bag of silicofluoride.
TECHNICAL CONSIDERATIONS FOR WATER FLUORIDATION • Maintenance and control • Control at the water treatment plants • Control of the quality of analysis • Control of the quality of water in the network • Control of the quality of fluorides used
SCHOOL WATER FLUORIDATION
SCHOOL WATER FLUORIDATION • Good alternative where community water fluoridation is not possible • Effective in the prevention of dental caries especially in the permanent dentition • Less benefit occur in the primary dentition since all these teeth would have developed and erupted.
• Virgin Islands (1954,USA) • 2.3 ppm of F added to water supply of 2 schools • After 8 years, 21.9% lower caries incidence in test schools • Pike county, Kentucky (1958) • 3 ppm of F added • After 8 years, 33% reduction in DMFT • Elk lake, Pennsylvania (1963) • 5 ppm of F added • After 8 years, 35% reduction in dental caries incidence (Horowitz et al, 1968)
Seagrove, North Carolina(1968) • 6.3 ppm F for 12 yrs – 4.5 x optimum • Largest school fluoridation programme are in North Carolina & Kentucky states grade 1- 12
DISADVANTAGES OF SCHOOL WATER FLUORIDATION • Children are usually five or six years old before they begin attending school and consuming the school's water, whereas maximum benefits accrue when fluoridated water is consumed from birth. • Children receive only intermittent exposure to fluorides because they attend school just five days a week for only part of the day.
FEASIBILITY OFWATER FLUORIDATION IN INDIA • Lack of preventive measures for dental caries prevention • High prevalence of dental caries. • The mean DMFT score is 2.4 in 15 year olds and as high as 5.4 among 35- 44 year olds (National Oral Health Survey) • Only 30% Population has centralized water supply • School water fluoridation can be utilized Ramachandra, S. S., Ramachandra, S. S., & Rao, M. (2010). Need for community water fluoridation in areas with suboptimal fluoride levels in India. Perspectives in public health, 130(5), 211–212. https://doi.org/10.1177/1757913910379188
• Antigo, Wisconsin began water fluoridation in June 1949, and ceased adding fluoride to its water in November 1960. • After 5.5 yrs. without optimal levels of fluoride, second grade children had over 200% more decay, fourth graders 70% more, and sixth graders 91% more than those of the same ages in 1960. Residents of Antigo re-instituted water fluoridation in October 1965 on the basis of the severe deterioration of their children’s oral health. WATER FLUORIDATION CESSATION STUDIES:
• 1979, fluoridation in the northern Scotland town of Wick was discontinued after eight years. • The water was returned to its sub-optimal naturally occurring fluoride level of 0.02 ppm. Data collected to monitor the oral health of Wick children clearly demonstrated a negative health effect from the discontinuation of water fluoridation. Five years after the cessation of water fluoridation, decay in permanent (adult) teeth had increased 27% and decay in primary teeth increased 40%. .
• Kalsbeek H et al - 15 year old children in 1987-1988 in Tiel had culemburg 18% higher caries experience than the same age group in 1968-1969 where the water fluoridation was stopped .
• compare prevalence and incidence of caries between fluoridation-ended and still-fluoridated communities in British Columbia, Canada, from a baseline survey and after three years. • At the baseline (1993/4 academic year) and follow-up (1996/7) surveys • The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9 • Regression models did not identify specific variables markedly affecting changes in the incidence of dental decay. • subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation- ended areas Patterns of dental caries following the cessation of water fluoridation G Maupome et al Maupomé, G., Clark, D. C., Levy, S. M., & Berkowitz, J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community dentistry and oral epidemiology, 29(1), 37–47
MYTHS AND FACTS OF WATER FLUORIDATION
MYTH: Adding fluoride to water is like forcing people to take medication. FACT: Fluoride is not a medication. • Fluoride in drinking water has two beneficial effects: preventing tooth decay and contributing to healthy bones. • The American Journal of Public Health summarized that “fluoride is not a medication, but rather a nutrient found naturally in some areas but deficient in others.” •Maintaining an optimal amount of fluoride in water is based on the principle that decisions about public health should be based on what is healthy for the entire community.
MYTH: Fluoridation causes cancer and other serious health problems. FACT : In 2006, a panel of the National Research Council- found no convincing evidence of a causal link between fluoridation and cancer. •Centers for Disease Control and Prevention notes that “60 years of research has shown that there’s no persuasive evidence that points to any harm from community water fluoridation.” •Fluoridation opponents cite an “exploratory” Harvard study in the , •The principal investigator of the study has stated that further analysis does not support this association. mid-1990s associating fluoride with osteosarcoma, a rare bone cancer.
MYTH: Fluoridated water isn’t safe for babies. FACT: •Water fluoridated at the optimal level is safe for babies and young children. The AAP & AMA support water fluoridation. Fluoridated water can be used to reconstitute infant formula. •The issue for parents of infants to consider is enamel fluorosis—a minor, cosmetic condition that produces faint white markings on permanent teeth as they are forming (from birth through age 8). •The risk of dental fluorosis is low. Even when it occurs, fluorosis is barely noticeable.
MYTH: There are better ways of delivering fluoride than adding it to water. FACT: • Water fluoridation provides dental benefits to people of all age and income groups without requiring them to spend extra money or change their daily routine. • The CDC notes that fluoride is most effective when provided in “the right amount in the right place at the right time,”. A 2003 study of fluoridation in Colorado concluded that “even in the current situation of widespread use of fluoride toothpaste,” water fluoridation “remains effective and cost saving” at preventing cavities. • For low-income individuals who are at higher risk of dental problems, fluoride rinses are a costly expense, Water fluoridation is the least expensive and most effective solution.
INTERNATIONAL ORGANIZATIONS –WATER FLUORIDATION American Academy of Pediatrics: •Important role in the prevention of dental caries. • Systemic mechanisms -preventing dental caries •“water fluoridation is a cost-effective means of preventing dental caries, with the lifetime cost per person equaling less than the cost of one dental restoration.
International Association of Dental Research: Considering that dental caries ranks among the most prevalent chronic diseases worldwide . . . and taking into account that over 50 years of research have clearly demonstrated its efficacy and safety; and noting that numerous national and international health-related organizations endorse fluoridation of water supplies; fully endorses and strongly recommends the practice of water fluoridation for improving the oral health of nations.”
World Health Organization: “Fluoride is being widely used on a global scale, with much benefit. Millions of people worldwide use fluoridated toothpaste. They benefit from fluoridated water, salt fluoridation or other forms of fluoride applications …”
International Agency for Research on Cancer: “Studies in the USA encompass periods of observation of 20 years or more. … The studies have shown no consistent tendency for people living in areas with high concentrations of fluoride in the water to have higher cancer rates than those living in areas with low concentrations or for cancer mortality rates to increase following fluoridation.
CONCLUSION • Fluoridation is safe, effective, efficient, socially equitable, and environmentally sound public health policy for the prevention of the most common disease afflicting children and adults. It is imperative that the optimal fluoridation of community water systems.
REFERENCES 1. Flourides in caries prevention – murray 3rd ed. 2. Flouride in dentistry – ole fejereskov 2nd ed. 3. Slade GD, Grider WB, Maas WR, Sanders AE. Water fluoridation and dental caries in US children and adolescents. Journal of Dental Research. 2018 Sep;97(10):1122-8. 4. Levin S, Krishnan S, Rajkumar S, Halery N, Balkunde P. Monitoring of fluoride in water samples using a smartphone. Science of the Total Environment. 2016 May 1;551:101-7. 5. Richard J. Hastreiter; Myron C. Falken; Gerald G. Smith; H. Curtis Wunderlich; Mildred H. Roesch (1991). The Venturi Fluoride Saturator Project. , 51(3), 170–177. doi:10.1111/j.1752- 7325.1991.tb02209.x 6. Rosário BS, Rosário HD, de Andrade Vieira W, Cericato GO, Nóbrega DF, Blumenberg C, Hugo FN, Costa MM, Paranhos LR. External control of fluoridation in the public water supplies of Brazilian cities as a strategy against caries: a systematic review and meta-analysis. BMC Oral Health. 2021 Dec;21:1-3.
REFERENCES • 8. Ramachandra, S. S., Ramachandra, S. S., & Rao, M. (2010). Need for community water fluoridation in areas with suboptimal fluoride levels in India. Perspectives in public health, 130(5), 211–212. https://doi.org/10.1177/1757913910379188 • 9. Community Water Fluoridation Exposure: A Review of Neurological and Cognitive Effects [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Oct 23. • 10. Kalsbeek, H., Kwant, G. W., Groeneveld, A., Backer Dirks, O., van Eck, A. A., & Theuns, H. M. (1992). Stopzetting van drinkwaterfluoridering. Resultaten van het cariësonderzoek in Tiel en Culemborg in de periode 1968-1988 [Cessation of fluoridation of drinking water; results of caries research in Tiel and Culemborg in the period of 1968-1988]. Nederlands tijdschrift voor tandheelkunde, 99(1), 24–28. • 11. Heifetz, S. B., Horowitz, H. S., & Driscoll, W. S. (1978). Effect of school water fluoridation on dental caries: results in Seagrove, NC, after eight years. Journal of the American Dental Association (1939), 97(2), 193–196. https://doi.org/10.14219/jada.archive.1978.0283 • 12. Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny AM. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010856. DOI: 10.1002/14651858.CD010856.pub2.
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9.Water fluoridation(symposium) .pptx

  • 1.
  • 2.
    CONTENTS  Introduction  Taleof Fluoridated Water.  Pioneer studies  Modern studies  Water Fluoridation--  School Water Fluoridation  Myths and facts  Conclusion  References
  • 3.
    INTRODUCTION • Fluorine—15th most commonelements found on earth. • Researchers all over the world have used fluoride in several forms in the prevention of tooth decay. • water fluoridation and topical fluoride programs were important measures for the control of caries at the community level.
  • 4.
    Fluorides Topical Professional APF gels Fluoride Varnish StannousFlouride Self applied Dentifrices mouthwashes Systemic Water Milk Salt Tablets Lozenges drops
  • 5.
    DEFINITION “Fluoridation is thedeliberate upward adjustment of the natural trace element, fluoride, in accordance with scientific and dental guidelines, for the purpose of promoting the public's health through the prevention of tooth decay.” -US Dept. of Health & Human services, -Centers for Disease Control and Prevention 1986
  • 6.
    UNIT OF MEASUREMENTFOR FLUORIDE? • Fluoride is measured in ppm (parts per million). • The maximum acceptable concentration (MAC) is 1.5mg/L (1ppm=1mg/L).
  • 7.
    TALE OF FLUORIDATEDWATER • Dr. Frederick Mckay, Colarado springs, colarado, USA --1901 • Colarado stain • 1909 Mckay ---define the exact geographical area of the stain Minute white flecks or yellow or brown spots scattered irregularly or streaked over tooth surfaces
  • 8.
    • Dr. G.V.Black– 1909 to colarado springs-------------- • 1928 Mckay (US), 1930 Ainsworth (UK) -- Mottled Enamel -- caries • Dr. F.L. Robertson - Bauxite town, Ark -Aluminium company of America (ALCOA) 13.7ppm • In 1931 , Mr. H.V.Churchill – chief chemist of ALCOA , fluoride - 13.7ppm mottled enamel
  • 9.
    SHOE LEATHER SURVEY- DR. H.TRENDLEY DEAN • A questionnaire study sent to local & state dental society - asking for any mottled enamel existed in their location • Out of 1197 questionnaire's 632 replies were received - reported that in 97 localities mottled enamel was reported. • Aim was also to find out minimum threshold of fluorine level at which F began to blemish teeth. Mottling  fluoride conc.
  • 10.
    • Continuous useof water containing 1ppm - very mildest form of mottled enamel , 1.7ppm – mild types of mottling. • In 1938 Dean in conjunction with McKay - summarized mottled enamel in American Public Health Association. Successful conclusion to McKay's search for cause of mottled enamel, which lasted for almost 40 yrs.
  • 11.
    • Dean 1938– 12% US pop- 1mg/lt --- (mild- mod.)fluorosis • Milder fluorosis – decreased caries experience. • 12- 14 years children Galesburg & Monmouth -1.8 mg/lt , had half of the caries experience Quincy - 0.2mg/lt. • F in water 1- 1.2 mg/lt – change by temp. • Grand Rapids , Michigan --- January 1945
  • 12.
    ACTION OF SYSTEMICFLUORIDE • Burt et al in 1992 - F is more effective when low levels of F is maintained all the times. • F is also stored in plaque and inhibits glycolysis & prevents carbohydrate metabolism by cariogenic bacteria to produce acids • Action of F • 1. pre-eruptive • 2. post-eruptive Burt BA, Eklund SA. 2005. Dentistry, dental practice, and the community. 6th ed. St. Louis (MO): Elsevier Health Sciences
  • 13.
    PRE ERUPTIVE -FGETS TO TEETH THROUGH BLOOD. • F contributes to anti caries activity by strengthening the enamel surface by formation of fluorapatite crystals • Fluorapatite - strengthens surface enamel to acid attack • F ions being more electronegative than OH ions • Total electron density around F is more than that of OH ions. • Shorter crystal axes of Fluorapatite compared to hydroxyapatite. Ca10 (po4)6 (OH)2 + 2 F - Ca10 (po4)6 F2 + 2 OH –
  • 14.
    POST -ERUPTIVE - CONSUMEDFLUIDS, TOPICAL THERAPY, SALIVA • F ions helps maintain surface enamel fluorapatite structure. • F conc. of enamel is further enhanced by continuous presence of F in plaque. so surface enamel is …. • F reduces wettability of enamel surfaces and reduces protein absorption on enamel surface. • F ion inhibits growth of s.mutans
  • 15.
    • Singh &spencer 2004 • A study examining pre & post eruptive effects of F on permanent 1st molars in 6-15 yrs in Australian children • Suggested that pre-eruptive exposure was imp. for caries prevention. • It also demonstrated that high pre-eruptive exposure to F could decrease caries levels significantly in pit & fissure surfaces. Water fluoridation provides a mechanism for this continuous exposure as a benefit to all surfaces
  • 16.
    WHAT HAPPENS IFMORE F IONS EXISTS THAN OPTIMAL CONC. ? • If large amounts of fluoride is present then the end product is calcium fluoride, a powdery substance turning enamel into chalky substance that wear off easily. Dental fluorosis Ca10 (po4)6 (OH)2 + 20 F - 10CaF2 + 4(po4)3 - +2 OH –
  • 17.
    • Recommended concentrationof fluorides is 1-1.2ppm. • US Dept. of Health & Human services(2015)--0.7-1.2ppm. Concentration of Fluoride in water Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries. Public Health Rep. 2015 Jul-Aug;130(4):318-31PMID: 26346489; PMCID: PMC4547570.
  • 18.
    GALAGANS FORMULA Optimum Levelsof Fluoride: • The optimum fluoride concentration for a particular community can be calculated by the following equation. • 🔹 Simplified: • F (ppm)=0.34/(T/1000F) • where T = mean maximum daily temperature (°F) 0.7 ppm 2 ppm
  • 19.
    Annual maximum dailyair temperature Recommended control limits fluoride mg/l Centigrade Fahrenheit Lower Optimum upper 10-12.1 50.0-53.7 0.9 1.2 1.7 12.2-14.6 53.8-58.3 0.8 1.1 1.5 14.7-17.7 58.4-63.8 0.8 1.0 1.3 17.8-21.4 63.9-70.6 0.7 0.9 1.2 21.5-26.2 70.7-79.2 0.7 0.8 1.0 26.3-32.5 79.3-90.5 0.6 0.7 0.8
  • 20.
    PIONEER STUDIES ONWATER FLUORIDATION
  • 21.
    1. Grand Rapids– Muskegon study • The first community water fluoridation scheme began in Grand Rapids, Michigan (U.S.A) on - 25th January, 1945. • In 1944, Dean ,Knutson & Francis Arnold – examined school children, aged 4-16 yrs • 19,680 grand rapids • 4291 Muskegon(control) • Arnold et al (1951) --- 6.5 yrs. reported 50% reduction in caries experience. • Baseline caries experience was similar in both the cities. • 15 years (1959) – 55.5% decrease in caries experience • 12% less caries experience compared to control
  • 22.
    Caries experience in15 yr. Grand Rapids study has fallen from 12.48 DMF teeth in 1944 to 6.22 DMF teeth per mouth in 1959 Grand Rapids, Michigan - site of the world’s first water fluoridation scheme in 1945
  • 23.
    2. Newburgh -Kingston Study • On May 2nd 1945, sodium fluoride was added to the drinking water of Newburgh, New York. • After ten years of fluoridation, Ast et al (1955) reported that the DMFT rate had fallen from 23.5% to 13.9%. • 6- to 9-year-olds had 58% less dental decay than their counterparts • 1966-- 70%
  • 24.
    3. Evanston- OakPark Study • January 1946 • After 14years of fluoridation , there was a reduction of DMFT from 11.66-5.95 (48.4%) --12-14 yrs old school children • Presented the most detailed data of all the fluoridation studies. • These 3 American studies …….. reached similar conclusions Addition of 1ppm F in drinking water reduced caries experience by approx. 50%
  • 25.
    4. Dutch Study(Tiel - Culemborg) • F drinking water -- anatomical siting of caries attack. • In March 1953, the drinking water in Tiel -- fluoridated to 1.1 ppm • Culemborg with fluoridation concentration of 0.1 ppm was the control. • Base line -- children aged 11-15 yrs. in 1952 were carried out. • After 16 years (1969) of fluoridation, caries experience was 56% lower in Tiel
  • 26.
    This study wasmainly designed to assess fluoride preventive effect on various surfaces of tooth • Maximum reduction was seen on free smooth surfaces- 86% • 75% in approximal surfaces • 31% in pit & fissure caries. • 1988---least DMFT
  • 27.
    RECENT STUDIES ONWATER FLUORIDATION
  • 28.
    • Dental findingsof more than 286,000 subjects of either sex (6-15 years old) from the two industrial towns Chemnitz and Plauen • (1.0 +/- 0.1 ppm F) was implemented in Chemnitz 1959 -1990. • Plauen, 55% --- (0.9 ppm F) during the years 1972-1984. Another 20% -- (0.4-0.7 ppm F). Rise and fall of caries prevalence in German towns with different F concentrations in drinking water W kuzel et al Künzel, W., & Fischer, T. (1997). Rise and fall of caries prevalence in German towns with different F concentrations in drinking water. Caries research, 31(3), 166–173. https://doi.org/10.1159/000262393
  • 30.
    • This cross-sectionalstudy -- associations community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. • 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (dmfs) -- 7,000 children aged 2 to 8 y • permanent dentition (DMFS]) ---- 12,604 children and adolescents aged 6 to 17 y. Water Fluoridation and Dental Caries in U.S. Children and Adolescents G.D. Slade, , W.B. Grider Journal of Dental Research 2018, Vol. 97(10) 1122–1128© International & American Associations for Dental Research 2018
  • 32.
  • 33.
    METHODOLOGY OF ESTIMATIONOF FLUORIDE CONCENTRATION IN DRINKING WATER • Sample collection for fluoride estimation: 500ml - dry polythene container 2ml of 6N HCL is added to inhibit growth /enzymatic change Store at 4ºC for analysis. • Fluoride concentration in the water can be estimated by : 1. Fluoride electrode coupled with standard рН meter. 2. Scot – Sanchi’s method
  • 34.
    ELECTRODE COUPLED WITHSTANDARD METER РН • Most recent & universally accepted method. • quickly, simply, economically & accurately. • electrode potentials of the standard / sample solutions from which fluoride concentration • 0.1-10ppm. • 2 рН meters :Orion 901 microprocessor ion analyzer & Orion 407 are used - Direct ppm reading.
  • 35.
    SCOT – SANCHISMETHOD: • Test is based on the reaction between fluoride & red Zirconium Alizarin lake. • Fluoride forms colorless complex ion & liberates free alzarin sulfuric acid, which is yellow in acid solution. • As the amount of fluoride increases color varies from yellow to red. • 1.5ppm standard sol. colour comparision– photometer
  • 36.
    MONITORING OF FLUORIDEIN WATER SAMPLES USING A SMARTPHONE SAURABH LEVIN ET AL (2016) Levin S, Krishnan S, Rajkumar S, Halery N, Balkunde P. Monitoring of fluoride in water samples using a smartphone. Science of the Total Environment. 2016 May 1;551:101-7.
  • 37.
    CHOICE OF EQUIPMENTFORWATER FLUORIDATION • It must be adapted to local conditions & needs of water network. • It should be of standard type , recognized as satisfactory • It should have well defined precision limits. --safe. • Adjustment of the distribution must be easy & rapid. • It should be operate between 20% & 80% of its total capacity. • In each system an anti-siphon mechanism should be installed to avoid a concentrated solution of fluoride entering the distribution system.
  • 38.
    CHOICE OF CHEMICALFOR WATER FLUORIDATION 1. Should be sufficiently soluble in water 2. No undue side effects 3. Readily available & inexpensive 4. Should not affect quality & taste of water
  • 39.
    COMPOUNDS USED 1. Fluorspar: •Mineral containing varying amount of calcium fluoride 85-98%. • Raw mineral form • Easy / cheap • Fluorescence
  • 40.
    2. Sodium fluoride: •White , odorless, free flowing material • Manufactured from hydrofluoric acid, a by-product of fluorspar • Most expensive source of fluorides. • Sodium fluoride is the easiest chemical to feed because of its uniform solubility in water. • (NaF) was the first compound -- reference standard • More expensive
  • 41.
    3. Silicofluoride: • Isthe sodium salt of fluorosilicic acid. • It is a powder or very fine crystal than fluorosilicic acid 4. Sodium silicofluorides: • Hydrofluosilicic acid is the basic raw material • Cheapest form of fluoride • Solutions of this compound are corrosive.
  • 42.
    5. Hydrofluosilicic acid: •Slightly more expensive than silicofluoride • Most popular because --simple feed equipment • Handling is uncomplicated • Inexpensive liquid by product of phosphate fertilizer • manufacture.
  • 43.
    6. Ammonium silicofluoride: •By neutralizing fluorosilicic acid • Use of ammonium silicofluoride provides part or all the ammonium required for producing chloramine. • Ammonium hexafluorosilicate, ammonium fluosilicate or ammonium silicofluoride. • (NH4)2SiF6 ---- 23–25%
  • 44.
    TYPES OF EQUIPMENTFOR WATER FLUORDATION • The saturator system • The dry feeder • The solution feeder system
  • 45.
    SATURATOR SYSTEM • Principle: • 4% saturated solution of sodium fluoride injected -- desired concentration --aid of pump. • Factors limiting utilization : • A high hard water level , the need to clean the gravel bed used for water filtration. • Recommendation : • Suitable for small towns with a total requirement of less than
  • 46.
    DRY FEEDER • Principle: • Sodium fluoride or silicofluoride in the form of powder - dissolving basin with the aid of an automatic mechanism • Factors limiting utilization : • care in the handling of fluoride, obstruction of pipes, compacting of fluoride -- humid atmosphere. • Recommendation : • Suitable for medium-sized towns with a total requirement of 19 million liters
  • 47.
    SOLUTION FEEDER • Principle: • Volumetric pump --hydrofluosilicic acid in proportion to the mount of water treated. • Factors limiting utilization : • All equipment must be resistant to attack by hydrofluosilicic acid, -- polyvinyl chloride or any other plastic. • Recommendation : • Suitable for medium- sized & large towns, with a total requirement of more than 7.6 million liters per day.
  • 48.
    VENTURI FLUORIDATOR SYSTEM- J.N.LEO • Non-electric system • Activated by the flow of water in the main waterline • Advantages: • Simple to install • Cost effective • No possibility of over dosing
  • 49.
    SATURATION – SUSPENSIONCONE: • Developed by state of Rio Grande , brazil • Consists of an upside down cone charged with a bag of sod silicofluoride through which a constatnt flow of water percolates. • The sol is collected at the top by a horizontal perforated plastic pipe, which forms the outlet • The cone is charged with a 45-kg bag of silicofluoride.
  • 50.
    TECHNICAL CONSIDERATIONS FORWATER FLUORIDATION • Maintenance and control • Control at the water treatment plants • Control of the quality of analysis • Control of the quality of water in the network • Control of the quality of fluorides used
  • 51.
  • 52.
    SCHOOL WATER FLUORIDATION •Good alternative where community water fluoridation is not possible • Effective in the prevention of dental caries especially in the permanent dentition • Less benefit occur in the primary dentition since all these teeth would have developed and erupted.
  • 54.
    • Virgin Islands(1954,USA) • 2.3 ppm of F added to water supply of 2 schools • After 8 years, 21.9% lower caries incidence in test schools • Pike county, Kentucky (1958) • 3 ppm of F added • After 8 years, 33% reduction in DMFT • Elk lake, Pennsylvania (1963) • 5 ppm of F added • After 8 years, 35% reduction in dental caries incidence (Horowitz et al, 1968)
  • 55.
    Seagrove, North Carolina(1968) •6.3 ppm F for 12 yrs – 4.5 x optimum • Largest school fluoridation programme are in North Carolina & Kentucky states grade 1- 12
  • 57.
    DISADVANTAGES OF SCHOOLWATER FLUORIDATION • Children are usually five or six years old before they begin attending school and consuming the school's water, whereas maximum benefits accrue when fluoridated water is consumed from birth. • Children receive only intermittent exposure to fluorides because they attend school just five days a week for only part of the day.
  • 58.
    FEASIBILITY OFWATER FLUORIDATIONIN INDIA • Lack of preventive measures for dental caries prevention • High prevalence of dental caries. • The mean DMFT score is 2.4 in 15 year olds and as high as 5.4 among 35- 44 year olds (National Oral Health Survey) • Only 30% Population has centralized water supply • School water fluoridation can be utilized Ramachandra, S. S., Ramachandra, S. S., & Rao, M. (2010). Need for community water fluoridation in areas with suboptimal fluoride levels in India. Perspectives in public health, 130(5), 211–212. https://doi.org/10.1177/1757913910379188
  • 59.
    • Antigo, Wisconsinbegan water fluoridation in June 1949, and ceased adding fluoride to its water in November 1960. • After 5.5 yrs. without optimal levels of fluoride, second grade children had over 200% more decay, fourth graders 70% more, and sixth graders 91% more than those of the same ages in 1960. Residents of Antigo re-instituted water fluoridation in October 1965 on the basis of the severe deterioration of their children’s oral health. WATER FLUORIDATION CESSATION STUDIES:
  • 60.
    • 1979, fluoridationin the northern Scotland town of Wick was discontinued after eight years. • The water was returned to its sub-optimal naturally occurring fluoride level of 0.02 ppm. Data collected to monitor the oral health of Wick children clearly demonstrated a negative health effect from the discontinuation of water fluoridation. Five years after the cessation of water fluoridation, decay in permanent (adult) teeth had increased 27% and decay in primary teeth increased 40%. .
  • 61.
    • Kalsbeek Het al - 15 year old children in 1987-1988 in Tiel had culemburg 18% higher caries experience than the same age group in 1968-1969 where the water fluoridation was stopped .
  • 62.
    • compare prevalenceand incidence of caries between fluoridation-ended and still-fluoridated communities in British Columbia, Canada, from a baseline survey and after three years. • At the baseline (1993/4 academic year) and follow-up (1996/7) surveys • The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9 • Regression models did not identify specific variables markedly affecting changes in the incidence of dental decay. • subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation- ended areas Patterns of dental caries following the cessation of water fluoridation G Maupome et al Maupomé, G., Clark, D. C., Levy, S. M., & Berkowitz, J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community dentistry and oral epidemiology, 29(1), 37–47
  • 63.
    MYTHS AND FACTSOF WATER FLUORIDATION
  • 64.
    MYTH: Adding fluorideto water is like forcing people to take medication. FACT: Fluoride is not a medication. • Fluoride in drinking water has two beneficial effects: preventing tooth decay and contributing to healthy bones. • The American Journal of Public Health summarized that “fluoride is not a medication, but rather a nutrient found naturally in some areas but deficient in others.” •Maintaining an optimal amount of fluoride in water is based on the principle that decisions about public health should be based on what is healthy for the entire community.
  • 65.
    MYTH: Fluoridation causescancer and other serious health problems. FACT : In 2006, a panel of the National Research Council- found no convincing evidence of a causal link between fluoridation and cancer. •Centers for Disease Control and Prevention notes that “60 years of research has shown that there’s no persuasive evidence that points to any harm from community water fluoridation.” •Fluoridation opponents cite an “exploratory” Harvard study in the , •The principal investigator of the study has stated that further analysis does not support this association. mid-1990s associating fluoride with osteosarcoma, a rare bone cancer.
  • 66.
    MYTH: Fluoridated waterisn’t safe for babies. FACT: •Water fluoridated at the optimal level is safe for babies and young children. The AAP & AMA support water fluoridation. Fluoridated water can be used to reconstitute infant formula. •The issue for parents of infants to consider is enamel fluorosis—a minor, cosmetic condition that produces faint white markings on permanent teeth as they are forming (from birth through age 8). •The risk of dental fluorosis is low. Even when it occurs, fluorosis is barely noticeable.
  • 67.
    MYTH: There arebetter ways of delivering fluoride than adding it to water. FACT: • Water fluoridation provides dental benefits to people of all age and income groups without requiring them to spend extra money or change their daily routine. • The CDC notes that fluoride is most effective when provided in “the right amount in the right place at the right time,”. A 2003 study of fluoridation in Colorado concluded that “even in the current situation of widespread use of fluoride toothpaste,” water fluoridation “remains effective and cost saving” at preventing cavities. • For low-income individuals who are at higher risk of dental problems, fluoride rinses are a costly expense, Water fluoridation is the least expensive and most effective solution.
  • 68.
    INTERNATIONAL ORGANIZATIONS –WATERFLUORIDATION American Academy of Pediatrics: •Important role in the prevention of dental caries. • Systemic mechanisms -preventing dental caries •“water fluoridation is a cost-effective means of preventing dental caries, with the lifetime cost per person equaling less than the cost of one dental restoration.
  • 69.
    International Association ofDental Research: Considering that dental caries ranks among the most prevalent chronic diseases worldwide . . . and taking into account that over 50 years of research have clearly demonstrated its efficacy and safety; and noting that numerous national and international health-related organizations endorse fluoridation of water supplies; fully endorses and strongly recommends the practice of water fluoridation for improving the oral health of nations.”
  • 70.
    World Health Organization: “Fluorideis being widely used on a global scale, with much benefit. Millions of people worldwide use fluoridated toothpaste. They benefit from fluoridated water, salt fluoridation or other forms of fluoride applications …”
  • 71.
    International Agency forResearch on Cancer: “Studies in the USA encompass periods of observation of 20 years or more. … The studies have shown no consistent tendency for people living in areas with high concentrations of fluoride in the water to have higher cancer rates than those living in areas with low concentrations or for cancer mortality rates to increase following fluoridation.
  • 72.
    CONCLUSION • Fluoridation issafe, effective, efficient, socially equitable, and environmentally sound public health policy for the prevention of the most common disease afflicting children and adults. It is imperative that the optimal fluoridation of community water systems.
  • 73.
    REFERENCES 1. Flourides incaries prevention – murray 3rd ed. 2. Flouride in dentistry – ole fejereskov 2nd ed. 3. Slade GD, Grider WB, Maas WR, Sanders AE. Water fluoridation and dental caries in US children and adolescents. Journal of Dental Research. 2018 Sep;97(10):1122-8. 4. Levin S, Krishnan S, Rajkumar S, Halery N, Balkunde P. Monitoring of fluoride in water samples using a smartphone. Science of the Total Environment. 2016 May 1;551:101-7. 5. Richard J. Hastreiter; Myron C. Falken; Gerald G. Smith; H. Curtis Wunderlich; Mildred H. Roesch (1991). The Venturi Fluoride Saturator Project. , 51(3), 170–177. doi:10.1111/j.1752- 7325.1991.tb02209.x 6. Rosário BS, Rosário HD, de Andrade Vieira W, Cericato GO, Nóbrega DF, Blumenberg C, Hugo FN, Costa MM, Paranhos LR. External control of fluoridation in the public water supplies of Brazilian cities as a strategy against caries: a systematic review and meta-analysis. BMC Oral Health. 2021 Dec;21:1-3.
  • 74.
    REFERENCES • 8. Ramachandra,S. S., Ramachandra, S. S., & Rao, M. (2010). Need for community water fluoridation in areas with suboptimal fluoride levels in India. Perspectives in public health, 130(5), 211–212. https://doi.org/10.1177/1757913910379188 • 9. Community Water Fluoridation Exposure: A Review of Neurological and Cognitive Effects [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Oct 23. • 10. Kalsbeek, H., Kwant, G. W., Groeneveld, A., Backer Dirks, O., van Eck, A. A., & Theuns, H. M. (1992). Stopzetting van drinkwaterfluoridering. Resultaten van het cariësonderzoek in Tiel en Culemborg in de periode 1968-1988 [Cessation of fluoridation of drinking water; results of caries research in Tiel and Culemborg in the period of 1968-1988]. Nederlands tijdschrift voor tandheelkunde, 99(1), 24–28. • 11. Heifetz, S. B., Horowitz, H. S., & Driscoll, W. S. (1978). Effect of school water fluoridation on dental caries: results in Seagrove, NC, after eight years. Journal of the American Dental Association (1939), 97(2), 193–196. https://doi.org/10.14219/jada.archive.1978.0283 • 12. Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny AM. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010856. DOI: 10.1002/14651858.CD010856.pub2.
  • 75.

Editor's Notes

  • #7 Year following his graduation from university of pennyslyvania dental school. In 1909 mckay decided that he need help from dental research worker and define the exact geographical area of the stain.
  • #8  In 1909 mckay decided that he need help from dental research worker and define the exact geographical area of the stain.
  • #9 1st task was to identify extent and geographical distribution of mottled enamel in U.SA Study of relation ship b/w F conc. In drinking water & mottled enamel and dental caries – Clinton t Messner (U.S. public health service) in 1931 ---- Dr. H. Trendley Dean for full time research on mottled enamel
  • #12 Anticaries effect is both pre and post eruptive
  • #13 Hydoxy apatite crystals with fluorine reacts to form fluoro apatite crystals ..Oh – hydroxy groups
  • #14 … in continuous state of flux pushing the reaction towards remineralisation ….thereby decreasing plaque formation and acid retention
  • #16 Opt conc – 1-1.5 parts per million (ppm)
  • #18 The optimum recommended fluoride levels vary with climate because the average consumption of water increases in warmer climates.
  • #19 Based on this formula newbrun has given optimal amount of fluoride that should be adjusted for different climatic areas
  • #21  Muskegon was the control town In Grand Rapids, Michigan, the first city in the world to fluoridate its water supply, a 15-year landmark study showed that children who consumed fluoridated waterfrom birth had 50-63% less dental decay than children who had been examined during the original baseline survey completed in Non-fluoridated Muskegon, Michigan 5116 children of naturally fluoridated area of aurora, Illinois (F=1.4ppm) were also examined . NaF was the source of fluoride. Arnold et al (1951) --- 6.5 yrs. reported 50% reduction in caries experience.
  • #24 …….. carried out by different investigators in different parts of the country reached similar conclusions
  • #25 Caries inhibitory action of F was not uniform . F inhibits smooth surface caries much more than pit & fissure caries.this was an imp. Component of dutch study This study indicates that adequate ingestion of f at early stage of enamel formation is important in preventing pit & fissure caries.
  • #31 primary dentition >7 5% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23)
  • #37 When planning a fluoridation system,
  • #39 (NaF) was the first compound used and is the reference standard It is more expensive than the other compounds, but is easily handled and is usually used by smaller utility companies.[33]
  • #41 . It is also known as sodium silicofluoride.[
  • #42  It comes in varying strengths, typically 23–25%;  It is also known as hexafluorosilicic,, hydrofluosilicic, and silicofluoric acid.[31] The saturator system The dry-feeder system The solution-feeder system
  • #43  It comes in varying strengths, typically 23–25%;  It is also known as hexafluorosilicic,, hydrofluosilicic, and silicofluoric acid.[31] The saturator system The dry-feeder system The solution-feeder system
  • #54 3 studies have been planned to last for 12 yrs in mainland USA. first 2 were in pike and Kentucky, other in elk lake These levels of F were chosen bcse children consume part of their daily water from schools and they attend school for a max. of 200 days a year. Noquessionable mottling was seen in these children so a higher F level – 6.3ppm was tested in seagrove children
  • #60 These data suggest that decay levels in children can be expected to rise where water fluoridation is interrupted or terminated, even when topical fluoride products are widely used
  • #64 Fluoride occurs naturally in water. The term “fluoridated water” simply means that the fluoride level in a water system has been adjusted to a certain level—or optimal level—to prevent tooth decay It is a mineral essential for human life based on its role in metabolism and other cell functions.
  • #65 Fluoridated water is safe. Claims that it causes cancer or other life-threatening illnesses are unproven. The National Cancer Institute has stated, “Many studies, in both humans and animals, have shown no association between fluoridated water and risk for cancer
  • #66 American Medical Association The CDC concludes the vast majority of fluorosis cases are mild, and fluorosis can also occur in communities without fluoridated water.
  • #67 Cdc – centre of disease control
  • #68 In short, fluoridated water is the cheapest and most effective way to deliver anticaries benefits to communities.”
  • #71 ……Fluoridation of drinking-water was introduced in the USA in 1950
  • #72 continue throughout the United States and, indeed, the world