Fluorides and Other Preventive Strategies for Tooth Decay

We focus on scalable public health interventions that prevent and delay development of caries and enhance resistance to dental caries lesions. These interventions should occur throughout the life cycle, and need to be age-appropriate. Mitigating disease transmission and enhancing resistance are achieved through use of various fluorides, sugar substitutes, mechanical barriers such as pit-and-fissure sealants, and antimicrobials. A key aspect is counseling and other behavioral interventions that are designed to promote use of disease transmission-inhibiting and tooth resistance-enhancing agents. Advocacy for public water fluoridation and sugar taxes is an appropriate dental public health activity.

Key Points

• Intensive public health caries prevention efforts for mothers and other frequent caretakers of children in high risk communities should start during the first year of the child’s life.
• Intensive public health caries prevention efforts for children in high risk communities should start during the first year of life.
• Scarce resources are being deployed during preschool (e.g. Head Start, 3-5 years old), based on the sometimes-mistaken notion that this is primary prevention, but the disease has already manifested by this age.
• School programs would be more effective if they employed strategies to atraumatically arrest lesions instead of merely screening and making largely ineffective referrals.
• The risk and the need for primary prevention are not static but change across the life course.
• Public water and salt fluoridation, and taxes on sugar consumption are cost effective approaches to decrease disease risk and increase resistance to disease. Fluoride toothpaste should be distributed widely.
• Fluoride is not sufficient to control dental caries. Topical therapies and dietary modifications that decrease transmission of cariogenic bacteria or impact dental plaque (e.g. antimicrobials) should be widespread.