WATER FLUORIDATION ORAL HEALTH EQUITY.pdf

ORAL HEALTH EQUITY

1. https://www.google.co.za/search?q=water+fluoridation+in+south+africa+images&tbm=isch&source
Water fluoridation in South Africa

2. Outline
Relationship between :fluoride concentration ↔ dental caries ↔fluorosis
Dean’s graph ↔1pppm
Effectiveness of WF on 1
o
& 2
o
dentition of children including pre-eruptive effect
Advantages of Water fluoridation [WF] on adult dentition
Advantages of Water fluoridation
Water defluoridation
Main objections against WF by pressure groups
Counter arguments & scientific proof for WF
Practical challenges to WF in South Africa
Most acceptable feasible alternatives to WF in SA

3. Relationship between :
Level of fluorosis increases with an increase in
fluoride conc
Dental caries declines with an increase in fluoride
conc
Fluoride conc. of more than 1ppm results in fluorosis
Dean’s in 1938 discovered that at 1ppm there is
minimal caries and fluorosis
At 1,2ppm the occurrence of fluorosis is approximately
20%
fluoride concentration ↔dental caries ↔fluorosis

4. Dean’s graph ↔ 1ppm0
1
2
3
4
5
6
7
8
00.20.40.60.81.01.21.4
[F] in drinking water (dpm)
Caries Experience
0
10
20
30
40
50
60
70
Fluorosis
Caries
Fluorosis

5. Effectiveness of WF on 1
o
& 2
o
dentition of
children including pre-eruptive effect
Fluoride benefits the 1
o
& 2
o
dentition
Further benefit to smoothsurface in comparison to pits
& fissures
Caries in fluoridated regions have minimal effect
Pre-eruptive effects of fl is altered pits & fissures
Post eruptive effects : remineralization, ↑↑enamel
resistance, maturation of enamel and metabolic effects
on m.o
Review of 113 studies showed 40-50% caries reduction in
1
o
and 50-59% in 2
o
dentition

6. Advantages of WF
It reduces the occurrence of dental caries by between 50%-70%,
including root caries.
Restorative dentistry is simpler as the lesions are smaller,
especially in children.
Increases retention of teeth and people are healthier as they are
able to obtain adequate nutrition.
The most cost-effective preventive measure against caries.
The average yearly cost = USA is $.51 per person ≈ R5.00
Administration is simple and well-controlled.
It has both systemic and topical cariostatic actions.
It reaches an entire community.
It is passive prevention.

7. Advantages of WF on Adult Dentition
Adults gain as much from WF
Exposed root surfaces due to abrasion, recession
or periodontitis gain from WF.
Studies have shown WF plays a role in the
prevention of root caries

8. Water defluoridation
Defluoridationis the process of removal of fluoride
ion in drinking water
Basically four methods used:
based on some kind of chemical reaction with fluoride
based on adsorption process
based on ion-exchange process
1.Adsorption methods, e.g. bone char , activated alumina.
2.Ion exchange methods
3.Precipitation methodse.g. lime & alum
4.Miscellaneous methods e.gsunflower plant dry
powder and leaf plant powder

9. Water defluoridation cont…
E.gs.: Activated carbon; Bone meal; Hydroxy apatite found in
bone char; Lime and activated aluminium(AA)
AA process appears to be the most suitable of a
relatively high fluoride-exchange capacity.
Used in South Africa in the 1980s.
Cost intensive

10. Adsorption Precipitation/Flocculant

11. Main objections against WF by
pressure groups
Toxicity of fluoride
Fluoride can cause cancer, genetic deviations,
heart diseases,bone fractures and interfere with
growth
Forced medication
People with imparted kidney adversely affected
Immoral and undemocratic
Enrich politicians and dentists

12. Counter arguments
Conc of fluoride in WF is small
Fluoride has not been proved to cause cancer and its safety
confirmed by studies
Beneficial to all people and prevent root caries .
People with impaired kidneys not adversity affected by fluoride
in drinking water
Its democratic and legal as state can approve measures for the
benefit of the population
Water suppliers and not dentists control the process

13. Practical challenges to
implementation of WF
Lack of central sources
Multiple sources need consensus.
Natural fluoride levels too high in other areas.
Danger of fluoride pollution from fertilizer & aluminium
industries.
Emotional demonstrations by anti-fluoride groups .
Different and yet unknown usage patterns of home care products
with fluoride content.
High illiteracy and associated lack of knowledge of water
fluoridation

14. WF as an option in South Africa
Commission of Inquiry 1965
1995 NFC investigated desirability of WF and ruled in
favour
2000 Minister of Health approved fluoridation of water
suppliers
Heterogenic Community with both developed and
developing community
1988/89 survey showed DMFT lower in Gauteng and OFS
than the coast

15. WF as an option in SA cont..
i.22% of population have matric (grade 12)
ii.16,2% earn more than R3500.00
iii.Majority unemployed
Based on the above three ,majority are low socio-economically
( relationship between Caries and SES)
Caries incidence highest between 12-20 years of age.
Evans report in 1991 in Hongkongled to 0,7ppm of FL
For South Africa o,7ppm of Flwill benefit people that afford
toothpaste and the majority who can’t
It cost less than R5.00 per person per year for WF

16. Most acceptable feasible alternatives to WF in SA
In general, there are five alternatives to WF which
use either topical or systemic fluorides
1.Fluoride gels (professionally applied)
2. Fluoride mouth rinses
3. Fluoride dentifrices (toothpastes)
4.Fluoride tablets
5. Fluoride drops
TOPICAL
SYSTEMIC