An interesting study. If considered carefully, it undermines the argument that addition of fluoride to drinking water is necessary. Indeed, the idea of an “optimal” level has become a myth.
Steinmeyer R. [Influence of natural fluoride concentration in drinking water on dental health of first class pupils in an area with enhanced fluoride content at the beginning of the 21st century]. Gesundheitswesen. 2011 Aug;73(8-9):483-90. doi: 10.1055/s-0030-1255076. [Article in German]
BACKGROUND: Since the end of the first half of the 20 (th) century it is well-known that fluoride concentrations in drinking water of about 1 ppm reduce the prevalence of dental caries by about 40-60%. This knowledge led to the fluoridation of drinking water during the second half of the 20 (th) century in many countries, including East Germany. Although the natural F (-) content in drinking water in Germany is usually very low, the eastern Eifel is one of the few larger areas in Germany with (nearly) optimal (0.7-1.0 ppm) or moderately enhanced (0.3-0.7 ppm) natural fluoride concentrations in drinking water. 30 years ago, in 1977, the caries prevalence of children of various age groups in the fluoride-rich areas of the eastern Eifel was established by Einwag to be about 40% lower than in adjacent fluoride-poor regions (0.1 ppm). Meanwhile fluoride has become available from many different sources for children of any age: e. g., toothpaste (with 500 ppm fluoride even for very young children who just got the first tooth), fluoridated salt, professional fluoride applications (paid by health insurances), the rising consumption of mineral waters (many of which have a fluoride content >0.3 ppm). This poses the question of the current influence of enhanced natural drinking water fluoride concentrations on caries prevalence in children.
METHOD AND RESULTS: The results of the dental examinations of 9 555 pupils (6 or 7 years old) of the first classes of all 63 primary schools in the Landkreis Mayen-Koblenz from 5 years (2004/2005-2008/2009) are compared to the fluoride content of the drinking water. The data show no obvious correlation between dental health and fluoride concentration for any of the dental health parameters investigated. However, in spite of the low geographic resolution of social parameters, there was a notable connection between dental health status and sociodemographic indicators for the respective region.
DISCUSSION: 30 years after the study by Einwag in the same region, the natural fluoride content of drinking water either had no influence on dental health at all, or this influence is so diminutive that it is exceeded by far by sociodemographic factors. Obviously there is much more fluoride available from other sources nowadays compared to 30 years ago. The results may also have implications for the administration of fluoride tablets and support the recommendations of the DGZMK (Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde) from the year 2000, restricting the administration of fluoride tablets to special situations following an individual anamnesis of fluoride uptake.
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