EXAM Q!!: The forum of fluoridation made certain recommendations in respect of water fluoridation in Ireland.

List these and explain the scientific basis for these recommendations Forum Fluoridation Summary: Recommendations: 1. Water fluoridation policy aspects Piped public fluoridated water supplies should continue Optimal level of F in drinking water: 0.6-0.8ppm (from 0.8-1) o Target value: 0.7ppm o Target value lowered due to increased dental fluorosis Drinking F water in combination with F toothpaste to achieve meaningful reduction in decay while reducing occurrence of fluorosis 2. Water fluoridation technical aspects Ongoing quality assurance of all aspects of water fluoridation process o Should take into account both Irish and International research External audit procedures for fluoridation plants o Standards and quality of each fluoridation plant assessed Fluoride monitoring updated to reflect modern technologies 3. Fluoride toothpaste Recommends continued use of fluoride toothpaste o In both fluoridated and non-fluoridated areas o Additive benefit from combination of F water and F toothpaste Parents advised not to used F toothpaste before age 2 o Prior can brush with toothbrush and tap water o F toothpaste on used <2 if child is considered high risk of decay Parents should supervise brushing children age 2-7 o Pea-size amount of F tp o Swallowing tp avoided Paediatric tp with low F require further research before recommendation 4. Oral health care industry Industry should make effort to reduce risk of inappropriate use of fluoridated products by consumers: o Labeling fluoride products easily understood by general population o Use clear and understandable instructions symbols/pictures to describe amount of tp to be used o Provision of child resistant containers prevents inappropriate ingestion of mouth rinses and fluoride supplements 5. Infant formula Infant formula should be continued to be reconstituted boiled tap water Use of bottle water to reconstitute not recommended unless suitability indicated on the label

6. Fluoride research Future research undertaken as outlined in Health Research Strategy Expert body should prioritize designated research in area relevant to fluoride o Appropriate funding should be made available Fluoride research should include collection of relevant data on general health Future research should be developed to augment the world body of information on fluoride and benefit for all Current 10-year cycle of adult and child dental health surveys should continue o Rolling program of oral health surveys every second year for selected age group should be implemented 7. Education, information & public participation It is essential to provide general public and special interest groups with factual information on all aspects of water fluoridation o Media analysis and discussion in press to ensure widespread dissemination of findings of the forum o Further information from report and website o National and local radio and television coverage o Short video presentation main issues, explanatory leaflets available to schools and local libraries Regional public meetings present information and respond to questions and concerns Surveys or other methods to measure public response Aim: increase public awareness of water fluoridation and elicit public attitudes and values 8. Public health & professional practice Oral health as integral part of general health All public health professionals (PHP) should be become familiar with the findings of this forum give balanced and scientific information to public PHP should deliver advice on oral health with advice on general health care matters Other notes: 1. Dental decay Process o Bacteria in plaque react with surgary foods to form acids which in turn dissolve tooth enamel o Dynamic process: decay formation alongside tooth repair Cost o Total annual non-capital spending on primary care dental services in Ireland estimated: 127 million 100 million of that spent on treating decay Measurements

o DMFT index Number of decayed, missing and filled teeth o Health board surveys (conducted since 1984) have consistently shown children who have been lifetime residents of fluoridated communities have considerably lower decay than those of non-F communities o 1963 8-year olds 1.5 DMFT northern Ireland 0.6 DMFT ROI o Conclusion: Dental decay dynamic process F plays key role in prevention Prevalence of decay has fallen considerably over past 40 years in developed countries? Similar picture emerged in Ireland greater reductions in fluoridated areas Prevalence of dental decay 30-50% lower in fluoridated areas of ROI compared with non-F areas 2. Dental decay control methods Fluorides o F water, salt or milk o F tablets/drops o F toothpaste o F mouthrinse o F gels, varnish o OH toothbrushing, flossing etc Fissure sealants o F not effective in controlling decay in pits & fissures o FS effective for molars Dietary choice o Frequent consumption of sugary foods more pronounced in lower socioeconomic groups o Diet is also becoming deficient in calcium may result in osteoporosis o Regular professional dental care improves dental health Invidually focused preventative program Early diagnosis of decay and other diseases Chewing gum o Increases salivary flow reduction in dental decay o Sugar-free chewing gum ideal Conclusions o Only real alternative to community F water delivery is salt fluoridation Concern: role of salt in heart disease o Further research required on milk fluoridation o F toothpaste excellent adjunct to community F systems o Remaining F alternatives are expensive to delivery not as effective as community systems

o Dietary and plaque control education programs on a community basis have not been shown to be effective 3. Provision of oral health care services Mixture of public and social insurance funded systems o Delivered by salaried dentist and general dental practitioners on a fee per item basis, together with core of private practice? Children care delivered mainly through salaried dentists in health boards Community preventative programs water fluoridation are administered through health boards Salaried dentists delivery care to special needs groups with assistance from dental hospitals and tertiary care centres Private dentists contracted to health boards on fee per item basis provide care for adults over 16 years with medical cards o Scheme funded by Department of Health and Children 4. 5. 6. 7. 8. 9. Fluoridation status worldwide Public water supplies Monitoring drinking water Application of fluoride Water fluoridation: benefits & risks Controlling dental fluorosis