Fluoride toothpaste is used all over the world, but for the poor, the relatively high cost means it is difficult to afford, and so it is not used. It should therefore only be used as a public health measure where water fluoridation is not practicable. A programme of subsidization will be required to improve the availability of fluoride toothpaste’s to those communities most in need. Cost-saving measures such as the removal of VAT, and providing supplies of un-packaged toothpaste to schools and community clinics, will need to be used.

The effectiveness of fluoridated salt is about the same as that of water, but only when appropriate concentrations and patterns of use occur. It could be considered at a later stage in specific areas, after appropriate studies are carried out on the patterns of salt intake, manufacture and distribution.

Fluoride can also be applied topically to the teeth by oral health professionals, and fluoride rinses, drops and tablets are also available. But these other forms of supplementing fluoride do not guarantee a consistent intake, and are much more expensive than water fluoridation. The greatest reductions in tooth decay have been shown where water fluoridation is available in addition to topical fluorides, toothpaste, and fluoride rinses.

The medical effects of fluoride

There are absolutely no proven problems with fluoride at the correct, small levels needed to prevent tooth decay. Fluoride in large doses, over long periods of time, can have an effect on teeth and bone. In the teeth, dental fluorosis only occurs during the time the teeth are forming. When they erupt, small white patches and lines may appear, but most dental fluorosis is difficult to detect, even by oral health professionals. In extremely high fluoride concentrations, brown mottling of the tooth enamel occurs, and bone may become more dense, although this does not always happen.

For these reasons, those areas that have existing levels of fluoride higher than recommended, will require some form of defluoridation, so the beneficial effects of fluoride can be retained, without experiencing fluorosis.

Fluoridation: safety first

We know that fluoride at the right level succeeds in reducing tooth decay by as much as 60%. Since tooth decay is one of our most common diseases, that’s good news. But naturally we need to know whether it is safe to drink water with this level of fluoride, and so it is necessary to examine the evidence. Fortunately, there is a very large body of scientific literature that has been devoted to this over the last 50 years, and many individuals and communities have been carefully and scientifically studied.

One of the reasons that several thousand references on the biological properties of fluorides and the effect of fluoride on bones and teeth now exist, is that some people have made some strange claims about fluoridation, none of which have been shown to be true. This has even been tested in courts of law: a few years ago, after the longest civil court case in British history, the judge concluded that fluoridation was both beneficial and safe. The US courts, as well as the British, have also ruled that fluoridation does not impinge on a fundamental right, does not violate a recognized constitutional right to privacy, and does not constitute compulsory medication.

As far back as 1962, US court findings were summarized in a comment that is still valid to-day: “it may be safely concluded that every argument which the ingenuity of the opponents of fluoridation has found has been heard and answered by the courts. It is now a settled principle of law that a community has the inherent right to fluoridate the public water supplies. In so doing it is not practising medicine, engaging in socialized medicine, giving mass medication or violating the pharmaceutical laws. The individual’s rights, which are protected under the Constitution, do not extend to prevent public programs of this kind. In view of this unanimity and comprehensiveness of judicial opinion, it is unlikely that there will be any decisions in the future adverse to fluoridation of public water supplies”.

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