Oral Health, U.S. 2002 Annual Report
Section 2: PREVENTIVE INTERVENTIONS
This section examines water fluoridation and dental sealants. There has been a tremendous reduction in the prevalence and severity of dental caries over the past several decades. The widespread use of fluoride has been a major factor in this decline (CDC, 1992; CDC, 1999). There are currently many means of fluoride delivery, including water fluoridation and professional treatments with fluoride solutions, gels, and varnishes. Fluoride is also present in a variety of processed foods and beverages, mouth washes, toothpastes, and supplements. However, fluoridation of public water is the most cost-effective method of reducing dental caries since it reaches all residents regardless of income level and educational status (CDC, 1999). Approximately $40 billion have been saved in reduced oral health care expenditures in the United States over the past 40 years due to public water fluoridation.
Fluoride is more effective on smooth surfaces than on pit and fissure surfaces (Backer et al., 1961). This has led to a change in the distribution of caries in areas where fluoridation is prevalent. At least 83% of childhood tooth caries are in pits and fissures (Brown et al., 1996). More recently, the introduction of dental sealants has led to a further reduction in dental caries. Sealants are thin plastic coatings that are applied to the pits and fissures of children's teeth, especially to the permanent first and second molars. Dental sealants are particularly effective in protecting these surfaces. Placing sealants on occlusal surfaces of these teeth shortly after eruption protects them from development of caries. A study of second-generation sealants found that 67% to 82% remained in place after 5 years (Mertz-Fairhurst et al., 1984). A 1993 analysis of previous research on sealants concluded that 71% of caries could be avoided by use of sealants (Llodra et al., 1993). Sealants may also be used in treatment of early caries. The use of sealants has increased since the 1980s, primarily among those of higher socioeconomic classes (Burt & Eklund, 1999).
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