Epidemiological

Epidemiology of Fluoride and Fluorosis

Mechanism of Action of Fluoride

1.1. Effects on Teeth:

• Strengthens enamel by forming fluorapatite (FAP) instead of hydroxyapatite (HAP).

• Increases crystal size and stability of enamel.

• Reduces risk of caries development.

1.2. Effects on Bacteria:

• Inhibits plaque bacteria by blocking enolase enzyme → prevents acid production.

• Interferes with bacterial metabolism.

• Prevents Demineralization & Enhances Remineralization

• Alters Crown Morphology (shallower pits and fissures reduce plaque accumulation).

2. How Fluoride Prevents Tooth Decay

2.1. Teeth and bones primarily contain calcium hydroxyapatite.

2.2. Fluoride replaces the hydroxyl ion → forms calcium fluoroapatite.

2.3. Fluoroapatite is chemically more stable in acidic environments, reducing tooth dissolution.

3. Fluoride Delivery Methods

3.1. WHO 2007: Declared universal fluoride access a basic human right.

3.2. Three Delivery Methods:

3.2.1. Self-Administered: Toothpaste, mouth rinses.

3.2.2. Community-Based: Fluoridated water, salt, milk.

3.2.3. Professionally Administered: Fluoride gels, varnishes.

3.3. Special Considerations:

3.3.1. Not used in Brunei due to risk of accidental ingestion.

3.3.2. Fluoride varnish adheres to teeth, minimizing swallowing risk

4. Community-Based Fluoridation Programs

4.1. Goal: Maintain constant low fluoride levels in populations for dental protection.

4.2. Caries Reduction Data:

4.2.1. Milk: 15-65% reduction in different countries.

4.2.2. Water: 40-50% (primary teeth), 50-60% (permanent teeth).

4.2.3. Salt: 50% reduction in Switzerland and Hungary.

4.2.4. Mineral water: 46% reduction in Bulgaria.

5. Worldwide Fluoridation Programs