Source: http://www.simplesite.com/Tala/13312261
Timestamp: 2019-04-23 12:59:28+00:00

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Hakkasin neljännesvuosisadan (1965-90) päätäni seinään talousveden fluorauskysymyksessä. Vastustus oli raudanluja. Sen seurauksena hammaskaries on edelleen suurimpia kansantautejamme ja koko lääkärikunnasta joka viides on hammaslääkäri. Nyt huudetaan hammaslääkäripulaa ja avataan taas hammaslääketieteen laitos toisensa jälkeen - ja mikäpä siinä, kun maamme on rikas kuin Kroisos.
Oli kuitenkin mielenkiintoista saada tänään 23.12.2008 Yhdysvaltain kansanterveysjärjestön perusteltu julkilausuma talousveden fluoripitoisuuden optimoinnista terveydelle parhaalle tasolle.
• Promote sufficient funding for federal, state, and local CWF programs.
The following APHA policies are updated and replaced by this position paper and are archived with the adoption of this resolution: 5005, 5508, 5904, 6912, and 7402.
There is a benefit from the diffusion of fluoride from fluoridated communities to surrounding nonfluoridated communities via the export of bottled beverages and processed foods.69 This diffusion effect, also referred to as the halo effect, as well as additional sources of fluoride, have reduced the absolute and proportional benefit of water fluoridation, as measured between fluoridated and nonfluoridated communities, from approximately 60% in the 1950 to 1970 era to 18% to 40% since the 1980s. Based on 1986 to 1987 data,70 in regions where 75% of public water supplies are fluoridated, the benefit may not be apparent when measuring caries experience between fluoridated and nonfluoridated communities because of the halo or diffusion effect.71 However, in the Pacific region of the United States where less than 20% of public water supplies were fluoridated, there was a 60% difference in tooth decay experience between fluoridated and non-fluoridated communities.71 Continued CWF programs are essential to maintaining this improved oral health status.
The annual incremental mean benefit of fluoridation has been found to be 0.19 tooth surfaces (range 0.04 to 0.34). This equates to a mean of 1.9 tooth surfaces every decade, or 9.5 tooth surfaces over 50 years.76 Preventing 10 tooth surfaces from decay translates into preventing the need for 10 fillings or perhaps two molars from needing crowns (a molar has five tooth surfaces). The tooth surface index (DMFS) does not address the severity of decay in any one surface or the need for treatment, which could vary from a small filling to a root canal treatment and crown or an extraction.
Because frequent exposure to small amounts of fluoride each day will best reduce the risk for dental caries in all age groups, all people are recommended to drink water with an optimal fluoride concentration and to brush their teeth twice daily with fluoride toothpaste.78 Fluoride is the only nonprescription toothpaste additive proven to prevent dental caries.78 Because water fluoridation is not available in many countries, toothpaste might be the most important source of fluoride globally.78 There is an additive benefit of fluoride toothpaste. Combined use of fluoride toothpaste and fluoridated water offers protection greater than either used alone.78 In the United States, the standard concentration of fluoride in fluoride toothpaste is 1,000 to 1,100 ppm. Fluoride toothpaste is helpful to all age groups and should be used at least twice a day. Since 1991, manufacturers of fluoride toothpaste marketed in the United States have, as a requirement for obtaining the ADA Seal of Acceptance, placed instructions on the package label stating that children aged younger than 6 years should use only a pea-sized amount of fluoride toothpaste. This is reported to sharply reduce the role of fluoride toothpaste as a risk factor for enamel fluorosis.107 Toothpaste labeling requirements mandated by FDA in 1996 also direct parents of children aged younger than 2 years to seek advice from a dentist or physician before introducing their child to fluoride toothpaste.108 Children younger than 6 years of age should have parents supervise and apply the toothpaste so as to limit the amount that may be swallowed; fluoride toothpaste should be spit out rather than swallowed.
In 2006, the FDA’s Center for Food Safety and Applied Nutrition issued a Health Claim Notification for Fluoridated Water and Reduced Risk of Dental Caries.113 Labels on bottled water with 0.6 to 1.0 mg/L fluoride may claim “Drinking fluoridated water may reduce the risk of [dental caries or tooth decay].” In addition, the health claim is not intended for use on bottled water products specifically marketed for use by infants.
Because of the adoption of water fluoridation and widespread use of fluoride toothpaste, approximately 75% of the US public is at low risk for dental caries. Therefore, the use of any professionally applied fluoride, including fluoride varnish, should be limited to those individuals and communities deemed to be at moderate to high risk for developing dental caries.130 A targeted approach offers additional opportunities toward improving the prevention and control of dental caries.130 The use of fluoride varnish to prevent and control dental caries in young children and seniors is expanding in both public and private dental practice settings and in nondental settings that incorporate health risk assessments and counseling. These settings include Head Start programs and Special Supplemental Nutrition Programs for Women, Infants, and Children; medical offices; well-child clinics and home visits conducted by public health nurses; child care programs; and other, sometimes overlapping, community programs.
Public opinion polls have consistently shown 70% or more of the adult US population supports fluoridation.131 Several organizations provide detailed information on CWF on Web sites, including the CDC132 and ADA.133 The ADA periodically updates Fluoridation Facts, a review of fluoridation literature in question and answer format.134 In addition, ADA has a resource list of materials.135 However, a review of Web sites providing information on CWF revealed that, of 59 sites meeting specific criteria from a list of the first 100 Web sites found when searching “water fluoridation” using the Google search engine (www.google.com) on February 15, 2003, 54% recommend water fluoridation compared with 31% that oppose it.136 Armfield analyzed Web information on fluoridation from Australia in 2006 using 5 search engines—Google, Yahoo, MSN, AOL, and Ask—and found that of the first 20 results from each Web site, searching for “water fluoridation,” 29 of the sites were for fluoridation, 55 were against it, with 9 reviews and 7 others.2 Armfield stated, “Although the overwhelming majority of scientific enquiry supports the benefits of water fluoridation, members of the public who type the term ‘water fluoridation’ into any of the major search engines would immediately be presented with a disproportionate percentage of anti-fluoridation websites.”2, p3 Thus, there may be an increasing number of Web sites providing information that is in opposition to established public health policy on water fluoridation.
Dental caries (tooth decay) continues to be the most common chronic disease of childhood, and dental caries incidence for adults exceeds that of children. Although there are gross oral health disparities for minorities, eliminating health disparities is an overarching priority area for APHA. Community water fluoridation has been shown to be the most cost-effective public health measure for the primary prevention of dental caries and has been shown to be the most effective public health strategy to reduce disparities in dental caries between ethnic and racial groups. Yet, the US public is generally uninformed about the appropriate use of fluoride and community water fluoridation, and information available to the public on community water fluoridation is not always evidence based.
• Should collaborate with other professional groups to encourage the National Institutes of Health to study the efficacy and safety of low fluoride toothpastes.
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