The future of water fluoridation.

Recently, questions have been raised about the possible reduced effectiveness and cost-effectiveness of water fluoridation in the prevention of dental caries in developed countries. The increase in environmental fluorides since water fluoridation was first introduced in 1945 (particularly from fluoride toothpastes, mouthrinses, and from foods and drinks) generally provided the basis for these questions. A related phenomenon which might decrease the efficiency of water fluoridation is the reduced caries levels in many developed countries. It has also been suggested that excessive fluoride intake, especially in fluoridated communities where there is widespread use of fluoride toothpastes, is likely to manifest itself in an increased dental fluorosis prevalence. In this paper, recent data from Ireland which are similar to those recorded in many developed countries are used to answer these questions in part. It is concluded that water fluoridation continues to be an effective and cost-effective strategy for caries prevention in areas where the overall caries level has declined and where the cost of water fluoridation implementation has increased. Also, there is no evidence of excessive fluoride intake in fluoridated communities where fluoride toothpastes are widely used.