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Fluoridation: The Good and the Not So Bad
Water fluoridation clearly prevents dental caries. As other forms of prevention (e.g., direct application of fluoride in dentists offices) are used more often, however, the advantage of this population-based approach has diminished. Moreover, questions have been raised about potential risks of fluoridation, including fluorosis (mottling of the teeth) and bone fracture. In 2 recent studies, investigators examined the effects of fluoridation.
In systematic review, researches identified 214 studies that evaluated the effects of fluoridation. Overall, fluoridation was associated with a higher proportion of children without caries and with fewer teeth affected by caries. In 19 of 30 age-group analyses, the proportion of children without caries was significantly higher in areas without fluoridation. The researchers estimated that 6 people would need to receive fluoridated water for 1 additional person to be free from caries, and that, at fluoride level of 1 part per million, an estimated 12.5% of exposed people would have aesthetically displeasing fluorosis.
In a prospective study of 9704 women, researchers found that
continuous exposure to fluoride over 20 years was associated with a slight mean
increase (about 2.5%) in bone density of the lumbar spine and proximal femur but
mean decrease of 1.9% in bone density of the distal radius. Women with continuous
fluoride had a significant decrease in the risk for hip fracture (relative risk,
0.69) and vertebral fracture (RR, 0.73) but an increase of borderline
significance in the risk for wrist fracture (RR, 1.32).
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