title: Increasing the public health effectiveness of fluoridated salt.
abstract: This paper aims at assessing the public health potential of salt fluoridation schemes. There is now solid evidence which shows that the cariostatic effectiveness of universal salt fluoridation is equivalent to that of water fluoridation in both the permanent and primary dentition. In countries of continental Europe, only domestic salt is fluoridated, and its consistent use may be expected to warrant a 30% reduction of caries prevalence. However, the effectiveness in the population at large is lower because only part of the population uses the fluoridated domestic salt. Under these conditions, it must be assumed that the effectiveness is further reduced because families in low S-E strata use fluoridated salt (FS) less frequently than those in the higher S-E strata who are known to use preventive methods like toothbrushing twice a day with a fluoride dentifrice more regularly. Model calculations tend to show that in Germany, where FS has reached a market share of 60%, the overall effectiveness is 14% instead of 30%. For France with a market share of 30% of the fluoridated domestic salt, model calculations lead to an overall effectiveness of 8%. In order to obtain a substantial decline of caries in the entire population, it is important to aim for a high market share of the FS of 80%, or preferably 90%. This goal can be reached with a relatively small budget. The task of health ministries would be to promote the switch from unfluoridated salt to FS; however, such promotion is often withheld by health ministries. It is possible, through modest price increases of salt, to finance effective campaigns inducing the majority of the population to use the fluoridated variety. On a world wide scale, fluoridation of salt has established itself as an efficient public health measure. It may be particularly beneficial for developing countries because it is by far the cheapest method and it is compatible with the use of fluoridated toothpastes.
authors.affiliation: Clinic for Preventive Dentistry, Periodontology and Cariology, Dental Center, University of Zurich. tmarthal@zui.unizh.ch
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Marthaler
mesh_terms: D002327:Cariostatic Agents / Q000008:administration & dosage*; D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000517:prevention & control* / Q000523:psychology; D005457:Fluoridation / Q000523:psychology; D005459:Fluorides / Q000008:administration & dosage*; D006267:Health Education, Dental; D006801:Humans; D011636:Public Health Dentistry / Q000379:methods; D040241:Social Marketing; D017673:Sodium Chloride, Dietary
chemical_list: D002327:Cariostatic Agents; D017673:Sodium Chloride, Dietary; D005459:Fluorides