Public Health Topics
Oral Health Evidence Briefs
Publication Date: 12/07/2009
The Problem:
Tooth decay, also known as dental caries, remains a major public health problem. Fifty-nine percent of persons aged 12 to 19 suffer from tooth decay. CDC: Dental Caries Fact Sheet. Advanced tooth decay can cause significant pain and loss of the teeth, and can be costly to treat. CDC: Oral Health: At a Glance: 2009
The Law:
Milk fluoridation is required or authorized in various countries in Europe and elsewhere. In the US, milk fluoridation is not currently legal because it lacks FDA approval. However, for US jurisdictions without community water fluoridation, fluoridated milk may be a promising alternative source of fluoride.
The Evidence:
In a systematic review, Yeung et al. reviewed two randomized trials evaluating the effectiveness of milk fluoridation programs on reducing dental caries. Yeung A, et al. Fluoridated milk for preventing dental caries. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.:CD003876. Both trials compared the effects of fluoridated milk with non-fluoridated milk on community dental health. Effectiveness was measured by changes in decayed, missing, or filled teeth. One of the studies found a significant association between fluoridated milk and reduction in tooth decay; the other found a much less substantial association over a longer time period. Based on these findings and the limited number of primary studies, the reviewers concluded that milk fluoridation may be a promising intervention, but that there is currently insufficient evidence to establish its effectiveness as a measure aimed at improving oral health.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is insufficient evidence to establish the effectiveness of milk fluoridation as a public health intervention aimed at reducing tooth decay.
Publication Date: 11/14/2009
The Problem:
Tooth decay, also known as dental caries, remains a major public health problem. Fifty-nine percent of persons aged 12 to 19 suffer from tooth decay. CDC: Dental Caries Fact Sheet. Advanced tooth decay can cause significant pain and loss of the teeth, and can be costly to treat. CDC: Oral Health: At a Glance: 2009
The Law:
State and local laws authorize or require community water fluoridation (CWF). Fluoride is a mineral that has been proven effective at preventing tooth decay. The American Dental Association and the Centers for Disease Control have endorsed water fluoridation as safe, cost effective and beneficial to the entire community. CDC & ADA: Nature’s Way to Prevent Tooth Decay: Water Fluoridation. Yet, fluoridation remains controversial. For an example of a state law authorizing CWF, see 111 MGL 8c (Massachusetts). For an example of a state law requiring CWF, see Minnesota Statutes § 144.145 (Minnesota).
The Evidence:
A Community Guide Task Force systematically reviewed 21 studies assessing the effectiveness of CWF in reducing the incidence of tooth decay. Task Force on Community Preventive Services. Recommendations on selected interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev Med 2002;23(1S):16-20. The publication dates of the studies ranged from 1956 to 2000 and covered a wide range of geographic locations, including the UK, the Netherlands, Finland, Japan, and Australia. The studies examined children ranging from age 4-17 years old, were longitudinal in design, and controlled for access to dental care and dentist-to-patient ratios, socio-economic status, and total number of persons living in an area, among other factors. Based on the underlying studies, the Community Guide reviewers observed that starting or continuing CWF is effective in reducing dental caries by as much as 30-50 percent in both the primary and permanent teeth of children. Discontinuing CWF in regions where other sources of fluoride are insufficient, the reviewed observed, results in an increase in dental caries.
The Bottom Line:
In the judgment of a Community Guide expert panel, there is significant evidence to support water fluoridation as an effective public health intervention aimed at reducing tooth decay.
Additional Information:
The Center for Disease Control provide online access to information on community water fluoridation,
Additional Resources: Centers for Disease Control and Prevention
