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In spite of decades of research on fluoride and the recognition of its role as the cornerstone of dental caries reduction in the last fifty years, questions still arise on its use at community, self-applied and professional application levels. Which method of fluoride delivery should be used? How and when should it be used? How can its benefits be maximized and still reduce the risks associated with its use? These are only some of the challenging questions facing us daily. The aim of this paper is to present scientific background to understand the importance of each method of fluoride use considering the current caries epidemiological scenario, and to discuss how individual or combined methods can be used based on the best evidence available.

These comments on the need for revision of the National Primary Drinking Water Regulations for fluoride are submitted to the US Environmental Protection Agency in response to the March 29, 2010 request for public comments.

This document provides several comments intended for readers who are considering a review of the data on the hazards and benefits of community water fluoridation.

Water fluoridation studies of the past 2 decades consistently show variations around the “no effect” mark. In other words, there are an equal number of studies showing small benefits as there are showing no effect or disbenefits (dental fluorosis, fluoride bombs, increased tooth fractures, increased gingivitis) The earlier studies showed an apparent benefit for water fluoridation but reanalysis demonstrates that this may be due to a lack of control of many “confounding” factors. An important confounding variable that requires attention is the issue of delayed eruption of teeth potentially caused by fluoride.

Municipal water fluoridation has notably reduced the incidence of dental caries and is widely considered a public health success. However, ingested fluoride is sequestered into bone, as well as teeth, and data on the long-term effect of exposure to these very low doses of fluoride remain inconclusive. Epidemiological studies suggest that effects of fluoride on bone are minimal. We hypothesized that the direct measurement of bone tissue from individuals residing in municipalities with and without fluoridated water would reveal a relationship between fluoride content and structural or mechanical properties of bone. However, consonant with the epidemiological data, only a weak relationship among fluoride exposure, accumulated fluoride, and the physical characteristics of bone was observed. Analysis of our data suggests that the variability in heterogenous urban populations may be too high for the effects, if any, of low-level fluoride administration on skeletal tissue to be discerned.

Anaemia in pregnancy and low birth weight babies, a serious public health problem, troubles India and several other nations. This article reports the results of a approach to address the issue. Women up to 20 week pregnancy with haemoglobin (Hb) 9.0 g/dl or less, those with urinary fluoride beyond 1.0 mg/l and not suffering from any other ailments, were selected. Out of the 205 pregnant women attending antenatal clinics (ANCs) during 1st and 2nd trimesters, the sample and control groups were selected through computerized random sampling procedure. Ninety pregnant women formed the sample group and 115 formed the control group. The sample group was introduced to two interventions, viz.: (1) removal of fluoride from ingestion through drinking water, food and other sources, (2) counselling based intake of essential nutrients, viz. calcium, iron, folic acid, vitamins C, E and other antioxidants through dairy products, vegetables and fruits. No intervention was introduced for the control group. Sample and control groups were monitored for urinary fluoride and Hb until delivery during their visits to ANC. Birth weight of the babies were recorded from the labour room register. Results reveal that (1) the urine fluoride levels decreased in 67% and 53% of the pregnant women respectively, who attended ANCs during 1st and 2nd trimester of pregnancy. (2) An increase in Hb upon withdrawal of fluoride followed by nutritional intervention in 73% and 83% respectively has also been recorded. (3) Body mass index (BMI) also enhanced. (4) The percentage of pre-term deliveries was decreased in sample group compared to control. (5) Birth weight of babies enhanced in 80% and 77% in sample group women who attended ANC in 1st and 2nd trimester respectively as opposed to 49% and 47% respectively in the control group. (6) The number of low birth weight babies was reduced to 20% and 23% respectively in sample as opposed to 51% and 53% in control groups.

BACKGROUND:
This article presents evidence-based clinical recommendations for the prescription of dietary fluoride supplements. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following questions: when and for whom should fluoride supplements be prescribed, and what should be the recommended dosage schedule for dietary fluoride supplements?

TYPES OF STUDIES REVIEWED:
A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry, conducted a MEDLINE search to identify publications that addressed the research questions: systematic reviews as well as clinical studies published since the systematic reviews were conducted (June 1, 2006).

RESULTS:
The panel concluded that dietary fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is deficient in fluoride.

CLINICAL IMPLICATIONS:
These recommendations are a resource for practitioners to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences. Providers should carefully monitor the patient’s adherence to the fluoride dosing schedule to maximize the potential therapeutic benefit.