Till Christine, Grandjean Philippe, Martinez-Mier E Angeles, Hu Howard, Lanphear Bruce
Faculty of Health, York University, Toronto, Ontario, Canada; email:
Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, Rhode Island, USA.
Annu Rev Public Health. 2025 Apr;46(1):253-274. doi: 10.1146/annurev-publhealth-060722-023526.
Health authorities have promoted community water fluoridation (CWF) to prevent dental caries for more than 75 years. However, growing evidence has raised questions about the safety of this public health intervention, particularly for young children who are at risk of excess fluoride intake. Divergent opinions about the risk-benefit ratio of CWF have ignited a global debate. The efficacy of topical fluoride in preventing dental caries is strong, whereas contemporary evidence for systemic administration of fluoride is weaker. Inequalities in access to dental care and topical fluorides introduce an additional layer of complexity. This review discusses evidence showing that fluoride ingestion is not essential for caries prevention, offers little benefit to the fetus and young infant, and can cause dental fluorosis and cognitive deficits. In an environment where fluoride is available from multiple sources, community-based administration of systemic fluoride may pose an unfavorable risk-benefit ratio for pregnant women and young children.
75多年来，卫生当局一直在推广社区水氟化（CWF）以预防龋齿。然而，越来越多的证据对这种公共卫生干预措施的安全性提出了质疑，尤其是对于有氟摄入过量风险的幼儿。关于CWF风险效益比的不同意见引发了一场全球辩论。局部用氟预防龋齿的效果显著，而关于全身性用氟的当代证据则较弱。获得牙科护理和局部用氟方面的不平等又增加了一层复杂性。本综述讨论了相关证据，这些证据表明摄入氟对预防龋齿并非必不可少，对胎儿和幼儿益处不大，还可能导致氟斑牙和认知缺陷。在氟可从多种来源获取的环境中，基于社区的全身性氟给药对孕妇和幼儿可能构成不利的风险效益比。
