Risks to oral health and intervention
Research has shown that fluoride is most effective in dental caries prevention when a low level of fluoride is constantly maintained in the oral cavity. The goal of community-based public health programmes, therefore, should be to implement the most appropriate means of maintaining a constant low level of fluoride in as many mouths as possible. Fluorides can be obtained from fluoridated drinking-water, salt, milk, mouthrinse or toothpaste as well as professionally applied fluorides, or from combinations of fluoridated toothpaste with either of the other two fluoride sources. There is clear evidence that long-term exposure to an optimal level of fluoride results in diminishing levels of caries in both child and adult populations.
However, there are some undesirable side-effects with excessive fluoride intake. Experience has shown that it may not be possible to achieve effective fluoride-based caries prevention without some degree of dental fluorosis, regardless of which methods are chosen to maintain a low level of fluoride in the mouth. The public health administrators must seek to maximize caries reduction while minimizing dental fluorosis.
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 (clinical topical fluorides, mouth-rinses, tablets/drops). Meanwhile, populations in many developing countries do not have access to fluorides for prevention of dental caries for practical or economic reasons.
In the WHO Technical Report Series No. 846 on "Fluorides and oral health" (1994) the recommendation on use of fluoridated toothpastes reads as follows:
One of WHO’s policies is to support the widespread use of affordable fluoridated toothpaste in developing countries. This is particularly important in light of the changing diet and nutrition status in these countries. Recent local studies have shown that affordable fluoridated toothpaste is effective in caries prevention and should be made available for use by health authorities in developing countries. The WHO Global Oral Health Programme is currently undertaking further demonstration projects in Africa, Asia and Europe in order to assess the relevance of affordable fluoridated toothpaste, milk fluoridation and salt fluoridation.