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8. Decay Prevention With Water Fluoridation

Contributed by:

Prof. Dr. Ishak Abdul Razak

Dept. of Community Dentistry University of Malaya Kuala Lumpur

Fluoride is one of the measures that can be undertaken to prevent dental decay. This article will look into the rationale for using fluoride, how this measure can be introduce, the manner in which it acts on the tooth as well as its total benefit.

Does Tooth Decay Warrant Water Fluoridation?

Tooth decay is by far, the most common and costly of oral health problems affecting the community. It is particularly common among children and adolescents. However even adults are not spared. As dental decay is so common, it often tends to be regarded as an inevitable part of our everyday life. It is one of the main causes of tooth extraction among all age group and the large proportion of people in the community who no longer have any natural teeth is a striking indication of its impact.

In addition to its effects in the mouth, dental caries may also affect general well-being. Tooth loss or pain arising from dental decay may interfere with optimum nutritional status. In addition it may affect emotional and social well-being through its effect on appearance and speech which may interfere with social interaction. Hence tooth decay is significant enough to warrant fluoridation. Water fluoridation is presently the most cost effective method for the prevention of tooth decay for all members of the community.

What is Water Fluoridation?

All water contains some fluoride naturally, in amounts greater or lesser than that needed for dental benefits. This happens when fluoride compounds dissolve into water as it passes through rock and soil. Water fluoridation is simply an adaptation of this natural process. Water fluoridation is the upward adjustment of the natural levels of fluoride in a water supply to an optimal concentration shown by scientific studies to bring about a reduction of dental decay yet be in compliance with the provision of a safe water supply. In areas where the concentration of fluoride far exceeds the optimum level it may be necessary to bring this level down to that of optimum through a process of defluoridation.

The optimum concentration varies according to different climatic areas. In cold countries the optimal fluoride concentration is 1 ppm (one part fluoride to one million parts of water). In hot climatic conditions the concentration needs to be lower than 1 ppm due to higher daily consumption of water. In Malaysia the optimum level has been established at 0.7 ppm.

Fluoride does not exist in natural in a free state. Instead it is combined with other elements to form fluoride compounds - substances which are widely distributed in nature and is found in many of the food we eat but the concentration vary widely. Fluoride is present in plants and animals and it has always been a component of man's body - in the fluids, tissues and skeleton.

How Does Fluoride Works?

Dental researches believe that there are several wars by which fluoride achieves its effect in preventing dental caries. It reduces the solubility of the outer surface of the tooth when it is exposed to acid produced by the interaction of oral bacteria in the plaque and food; it may also act directly on the plaque by changing its bacterial composition or reducing the ability of plaque bacteria to produce acid; and more importantly, it promotes the remineralization (healing) of enamel in early caries lesions. Most likely, fluoride works by a combination of these effects.

How Effective Is Water Fluoridation

More than 60 years of research and practical experience have shown that fluoridation is effective in reducing tooth decay by about 50 - 60%. Similarly studies in the state of Johore, malaysia have shown a reduction of about 60% and 30% in the permanent and milks teeth respectively. In addition, the number of children with no decay at all in the mouth rose by 32% following fluoridation.

Because dental decay is widespread, water fluoridation is the best method of protecting against decay because it is effective, safe and inexpensive. It benefits all sections of the community.

The reduction in incidence of tooth decay as a result of water fluoridation would also means less premature loss of milk teeth. Consequently these teeth can perform the function of maintaining sufficient space in the dental arch for the eruption of the permanent successors into the correct position.

Why Fluoride Is Important For Children?

While it is important for everyone to get enough fluoride, it is particularly important to young children. As new teeth are being formed, the fluoride is incorporated into the developing teeth, making them stronger and healthier. Children can obtain the benefits of fluoride in two ways - systematically by drinking fluoridated water or topically by having it applied directly onto the tooth surfaces by your dentist or brushed on at home. Of course, children should get daily protection by brushing with a small amount (pea size) of fluoride toothpaste and to spit it all out after brushing.

Should Fluoride Products Be Used If The Water Is Fluoridated?

These methods provide additional benefit even in fluoridated communities. Although maximum benefits are achieved if fluoride is ingested during the period of tooth formation, topical fluoride does confer additional protection on erupted teeth by acting directly on the tooth surfaces.

It should be noted however that fluoride is one of the links in the chain in avoiding dental decay. Always remember the four essential steps towards achieving good oral health. These are :-

  • Maintain good oral hygiene.
  • Use a fluoridated toothpaste.
  • Reduce or avoid sugary snacks and drinks.
  • Visit your dentist.


Malaysian Dental Association shall ensure that the collection, use and disclosure of your personal data is consistent with the Malaysian Personal Data Protection Act 2010 ( 'PDPA' ). It is acknowledged that personal data collected and processed is obtained voluntarily and with your consent.

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