Global consultation on oral health through fluoride
WHO in collaboration with the World Dental Federation and the International Association for Dental Research
17 November 2006
The World Health Organization (WHO) recently published an overview of the global oral disease burden (1) and a statement which describes the WHO approach to promoting further improvement in oral health during the 21st century (2). The reports emphasized that despite great improvements in the oral health of populations in some countries, problems still persist. This is particularly so among underprivileged groups in both high income and low- and middle-income societies. Dental caries remains a major public health problem in most high income countries, affecting 60-90% of schoolchildren and the vast majority of adults. It is also the most prevalent oral disease in several Asian and Latin American countries. Although for the moment it appears to be less common and less severe in the greater part of Africa, the World Oral Health Report 2003 (2) anticipates that in light of changing living conditions and dietary habits, the incidence of dental caries will increase in many of that continent's low income countries. The principal reasons for this increase are growing consumption of sugars and inadequate exposure to fluoride.
The importance of effective use of fluoride for the prevention of dental caries has been emphasized in World Health Assembly Resolutions (3-5). A WHO Expert Committee Report on fluorides and oral health published in 1994 (6) detailed the scientific evidence available for use of fluoride and the recommendations for its use in public health programmes. The World Oral Health Report (2003) (2) further underlined the need for integrating oral disease prevention with national and community health programmes based on common risk factor approaches, and incorporating fluoride programmes for the prevention of dental caries.
Dental caries can be prevented by joint action of communities, professionals and individuals aimed at reducing the impact of sugar consumption and emphasizing the beneficial impact of fluoride. In many low- and middle-income countries, however, the number of oral health professionals and access to oral health services are limited. For these reasons professionally applied fluorides have little public health relevance in these countries. Across the world the most important approaches to the effective use of fluorides are automatic fluoridation through water, salt or milk, and self-applied fluoride through use of affordable fluoridated toothpaste (6,7).
It is anticipated that presently only 20% of the world's population benefit from the sound knowledge about the caries preventive effect of fluoride. The WHO Oral Health Programme, jointly with the FDI World Dental Federation (FDI) and the International Association for Dental Research (IADR), have embarked on an action plan for the promotion of using fluoride, particularly focusing on the disadvantaged and under-served population groups.
The Global Consultation on "Oral Health through Fluoride" is an essential component of this joint project.
The aim and objectives of the Consultation were to:
- Review and highlight successes in promoting oral health through the use of fluoride.
- Identify barriers for making fluoride available to all;
- Explore effective strategies for making fluoride available and affordable to all;
- Develop an action plan for fluoride promotion and advocacy.
STRUCTURE OF THE GLOBAL CONSULTATION
The Global Consultation took place over three days, one day in WHO Headquarters, Geneva and two days in Ferney-Voltaire organized by the FDI and IADR, the two non-governmental organizations in official relations with WHO.
The first day of the Consultation at WHO Headquarters examined the evidence in use of fluoride for public health based on country experiences and focused on WHO policies on effective use of fluoride.
The meetings of the second and third days were based on working groups that focused on three key areas of discussion.
- Identification of the problems/needs associated with their particular working topic;
- Examination of possible solutions to the problems (what works - the evidence for action).
- Suggested actions that could be undertaken to resolve the identified problems and needs (taking action - essential steps needed for success. Partners, resources including funding, organization etc.).
- Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral disease and risks to oral health. Bulletin of the World Health Organization, 2005; 83: 661-669.
- World Health Organization. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme. Geneva, WHO, 2003.
- World Health Organization. Fluoridation and dental health. WHA22.30 Geneva: 23 July 1969.
- World Health Organization. Fluoridation and dental health. WHA28.64 Geneva: 29 May 1975.
- World Health Organization. Fluorides and the prevention of dental caries. WHA31.50 Geneva: 24 May 1978.
- World Health Organization. Fluorides and oral health. Technical Report Series No. 846. Geneva: WHO, 1994.
- Petersen PE, Lennon MA. Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach. Community Dent Oral Epidem 2004; 32: 319-21.