General Information:

  • Dental caries is the most common childhood chronic disease that occurs five to eight times as frequently as asthma
  • If not treated early, dental caries is irreversible.
  • Dental caries is an infectious, multifactorial disease that is a major concern in the United States.
  • Although there has been a reduction of dental caries in the United States over the past three decades, dental caries is still a significant problem
  • Dental caries can result in loss of tooth structure, pain, and tooth loss and can progress to an acute systemic infection
  • Healthy People 2010 set a goal to prevent and control oral and craniofacial diseases, conditions, and injuries and improve access to related services
    • Two objectives that Healthy People 2010 formulated to help accomplish their goal:
      • (21-1) Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth
      • (21-9)Increase the proportion of the U.S. population served by community water systems with optimally fluoridated water

Where is it found?

  • Fluoride:
    • is an ionic form of the element fluorine
    • has a negative charge
    • combines with ions that are positively charged, for example calcium
  • Fluorides are found naturally in the environment in water and air
  • Common sources of fluoride:
    • fluoridated drinking water
    • beverages
    • processed foods
    • fluoride toothpaste
    • fluoride mouth rinse
    • dietary fluoride supplements
    • professionally applied fluoride compounds
    • fluoride gel and foam
    • fluoride varnish
    • fluoride paste
  • Other sources of fluoride are food that is grown or processed with fluoridated water:
    • certain types of fish and seafood
    • bone products like bone meal and gelatin
    • tea
    • soups
    • shellfish
    • cooked veal
    • cooked wheat cereal
    • cows milk
    • fruits and vegetables grown in manufacturing areas where the fluoride level is high

Who is affected?

  • Nearly 20 percent of children between the ages of 2 and 4 have detectable caries
  • By the age of 17, almost 80 percent of young people in the United States will have had a cavity, a late sign of dental caries infection
  • People with increased risk for dental caries:
    • low socioeconomic status (SES)
    • low levels of parental education
    • lack of regular dental care
    • lack of dental insurance
    • individual factors such as active dental caries
    • impaired ability to maintain oral hygiene
    • reduced salivary flow related to medications
    • radiation treatment
    • disease

What can we do about this issue and statistics:

  • To reduce oral disease, communities that do not have fluoridated water should highly consider community water fluoridation.
  • Over 100 million people in the United States are not served by fluoridated water supplies that are adjusted to optimal levels
  • Antifluoridation activities and insufficient resources inhibit the extension of optimal fluoridation into many communities
  • Community water fluoridation:
    • Is a safe, effective and inexpensive way to prevent dental caries
    • Benefits persons in all age groups and of all socioeconomic status, including those difficult to reach through other public health programs and private dental care
    • Is the most cost-effective way to prevent tooth decay among populations living in areas with adequate community water supply systems
    • Continuation of community water fluoridation for populations with community water fluoridation and adoption of community water fluoridation in additional U.S. communities are the foundation for sound caries-prevention programs
  • Areas in the local area receiving fluoridated water:
    • Montgomery County, Virginia
      • only 69.2% of the county population
    • Roanoke County, Virginia
      • 92% of the county population
    • Pulaski County, Virginia
      • 78% of the population
    • Alleghany County, Virginia
      • 80.5% of the county population
    • Floyd County, Virginia
      • 0% of the county population
  • For effective dental caries prevention, fluoride concentrations in drinking water must be maintained at optimal levels
  • The Center for Disease Control (CDC) provides guidelines and recommendations at the state and local level
    • To help establish and maintain appropriate fluoride concentrations
    • Optimum level of fluoridation of drinking water in Virginia is 0.90 p.p.m.

Drinking water fluoride levels of the local community:

Area Year Report Fluoride level in p.p.m
Christiansburg 2004 0.70
City of Salem 2004 0.91 (plant 1); 0.93 (plant 2)
City of Radford 2004 0.3
Carvins Cove 2005 Western Virginia Water Authority 0.09
Falling Creek 2005 Western Virginia Water Authority 0.9
Crystal Spring 2005 Western Virginia Water Authority 0.8
City of Salem 2005 Western Virginia Water Authority 0.92

Fluoridate with Caution:

  • Ideal fluoride levels in different areas of the U.S. based upon regional climates must be established
  • An excess of systemic fluoride can result in fluorosis
    • This is the staining of the teeth which can be mild to severe
    • Severe forms of fluorosis only occur when young children consume excess fluoride during critical periods of tooth development
    • Concerns regarding the risk for enamel fluorosis are limited to children aged < 8 years
      • enamel is no longer susceptible once its preeruptive maturation is complete
    • Children who are < 6 years old are at risk for fluorisis
      • they are at the stage of enamel development
      • their swallowing reflex has not sufficiently developed yet in order to control inadvertent swallowing of fluoride toothpaste and mouth rinse
  • Adhere to the recommendations regarding appropriate use of fluoride in children ≤ 6 years to reduce the prevalence and severity of enamel fluorosis
  • Picture of Fluorosis: http://gjne.com/fluoride/images/h20%20f%20=%20fluorosis.JPG


  • The most effective and widely used approaches in prevention and control of dental caries have included the use of fluoride
  • Fluoride is a reliable preventive measure to control dental caries
  • Widespread use of fluoride has been a major factor in the decline in the prevalence and severity of dental caries in the United States
  • Fluoride decreases the occurrence of dental caries and slows down or reverses the progression of existing lesions
  • Fluoride is mainly effective after teeth have erupted


  • Fluorides can be measured in:
    • Urine
    • Plasma
    • Saliva
    • Tooth enamel
    • Nails
    • Bone
    • Other tissues

Interesting Facts:

  • Children are exposed to fluorides primarily through:
    • their diets
    • use of dental products (particularly toothpaste)
  • Human breast milk contains very little fluoride
  • Fluoride may be an important mineral for babies born prematurely
    • Prematurity is associated with an increased incidence of dental caries
    • Note: Recommendations for fluoride intake are only available for full-term infants
  • Fluoride-containing dust may be brought home in the clothing of parents working in industries where they are exposed to fluoride
  • Recycled tin is so pure that it is used to make stannous fluoride, the ingredient in tooth paste that fights cavities.
  • Tooth Facts for Kids: http://www.adha.org/kidstuff/facts.htm

Bright Futures in Practice: Oral health:
Potential for human exposure:
Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries:
Promoting oral health pdf:
Recommendations for Using Fluoride to Prevent and Control Dental Caries in
the United States:
Fluoride Health Effects:
Developed by:  Jane-Claire Bailey, Susan Dillera, Caleb Hild, and Lauren Torbett

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