ABSTRACT
Dental caries is one of the oral pathologies with greater burden of disease in the Chilean population. Fluoridation of drinking water has been used as a caries prevention strategy. However, its application as a public policy has been questioned since its implementation. The aim of this article is to analyze whether fluoridation of drinking water is a justified measure in reducing the incidence and prevalence of caries from the perspective of bioethics, taking into account the current evidence on its effectiveness. The arguments reviewed are based on the belief that water fluoridation is effective and, in general terms, ethically acceptable. A recent systematic review concludes that there is not enough evidence to support fluoridation as a public policy. There is a gap of knowledge that ought to be closed so that public health authorities can assess the significance of the intervention and make a democratic decision on its continuation or suspension based on scientific evidence. This decision should be informed and disseminated within the community.
La caries dental constituye una de las patologías orales con mayor carga de enfermedad en población chilena. Una estrategia empleada para prevención de caries ha sido la fluoración del agua potable, cuya aplicación como política pública ha sido cuestionada desde su implementación. El objetivo de este trabajo es analizar si la fluoración del agua potable resulta una medida justificada para reducir la incidencia y prevalencia de caries desde la perspectiva de la bioética, teniendo en cuenta la evidencia actual sobre su efectividad. Los argumentos revisados se basan en la convicción de la efectividad de la fluoración del agua, considerando la intervención en términos generales como éticamente aceptable. A la luz de la revisión sistemática publicada recientemente, no existiría evidencia suficiente que avale esta política pública. Actualmente existe una brecha de conocimiento que debiese ser cerrada con la finalidad de que las autoridades de salud pública puedan evaluar la trascendencia de la intervención y tomar una decisión democrática acerca de la continuidad o suspensión de la estrategia preventiva con base científica, informada y socializada con la comunidad.
Subject(s)
Humans , Bioethics , Dental Caries/prevention & control , Fluoridation/adverse effects , Fluoridation , Drinking Water , Fluorosis, Dental/etiology , Public HealthABSTRACT
Background & objectives: Endemic fluorosis resulting from high fluoride concentration in groundwater is a major public health problem in India. This study was carried out to measure and compare the prevalence of dental fluorosis and dental caries in the population residing in high and normal level of fluoride in their drinking water in Vadodara district, Gujarat, India. Methods: A cross-sectional study was conducted in Vadodara district, six of the 261 villages with high fluoride level and five of 1490 with normal fluoride level in drinking water were selected. The data collection was made by house-to-house visits twice during the study period. Results: The dental fluorosis prevalence in high fluoride area was 59.31 per cent while in normal fluoride area it was 39.21 per cent. The prevalence of dental caries in high fluoride area was 39.53 per cent and in normal fluoride area was 48.21 per cent with CI 6.16 to 11.18. Dental fluorosis prevalence was more among males as compared to females. Highest prevalence of dental fluorosis was seen in 12-24 yr age group. Interpretation & conclusions: The risk of dental fluorosis was higher in the areas showing more fluoride content in drinking water and to a lesser degree of dental caries in the same area. High fluoride content is a risk factor for dental fluorosis and problem of dental fluorosis increased with passage of time suggesting that the fluoride content in the water has perhaps increased over time. Longitudinal studies should be conducted to confirm the findings.