Biomedical subjects

Thomas M Marthaler

Publications and source records attributed to Thomas M Marthaler.

7 recordsLinked to original sources

PubMed2005

Overview of salt fluoridation in Switzerland since 1955, a short history.

After an early start in 1955, the introduction and acceptance of fluoridated salt (FS) for domestic use was slow in Switzerland because up to around 1980 there was no consistent strategy for the support of the use of FS. Part of the dental community still supported water fluoridation, while others criticized the insufficient concentration of fluoride in the salt (90 ppm). All Swiss cantons have a historical monopoly on salt trade, and until 1983 most cantonal governments resolved to authorize the sale of fluoridated domestic salt. Some of the cantonal governments made fluoridated salt the only available type of "kitchen salt" in 1-kg packages. After the concentration had been increased to 250 ppm in 1983, the use of FS gained further acceptance. A temporary setback occurred in 1992-1994, but was successfully met with by making the FS available in several package sizes, while other types of salt (with or without iodine) were available in 500 g packages only. By 2004, the market share of fluoridated domestic salt reached 88%. Further endeavours aim at increasing the use of FS by large kitchens. FS is available in portions of 12.5 kg (since 2001) and 25 kg (since 1976).

Cariostatic Agents↗

PubMed2005

Salt fluoridation in Central and Eastern Europe.

For decades Central European countries have been interested in preventive dentistry. Water fluoridation played a major role in the former German Democratic and Czechoslovak Republics and a minor one in Poland. These schemes were abandoned after 1989. Extensive research on all aspects of salt fluoridation was conducted in Hungary from 1966 to 1984 but attempts to introduce it in the country have had little success. Salt fluoridation was implemented in the Czech and the Slovak Republics in the mid-nineties. The market share of the fluoridated domestic salt appears to have reached 35% in the Czech Republic; it became eventually part of a preventive strategy comprising school-based dental health education including topical fluoride. Another four countries have been considering salt fluoridation but schemes did not materialize. Antifluoridation activities occasionally impeded caries prevention, and for years some respected dentists declared their position against fluorides. Caries prevalence in 12-year-old children is by 1 to 3 DMFT higher than in Western Europe. For many years to come, modern fluoride-containing toothpastes and dentifrices may not be affordable for the lower socio-economic strata of the populations in Central and Eastern Europe. It is concluded that salt fluoridation, which is by far the cheapest means of lowering caries prevalence, could markedly improve the oral health situation even if the economical situation is slow to improve.

Cariostatic Agents↗

PubMed2005

Monitoring salt fluoridation programs through urinary excretion studies.

This paper reviews problems associated with urinary collection for the estimation of fluoride exposure and recent findings in this context. After intake of a salted meal at noon, children aged 9 to 14 excreted on average 45 microgF/h. Morning and nocturnal excretions were only 16 microgF/h with the exception of those children who ate bread made with fluoridated salt (25 microF/h). Fluoride excretions in children consuming drinking water with 0.6 to 0.8 ppmF were similar, but the variations within the 24 h period were smaller. When it is not feasible to obtain reliable 24 h urinary collections, fairly precise extrapolations of 24 h excretions can be obtained from three separate collections lasting about 16 hours, which should cover morning, early afternoon and the whole night. Three- to six-year-old children benefitting from optimal fluoride supply through water or milk excreted approximately 0.35 to 0.40 mgF/24 h; this range seems to correspond to an optimal usage of fluorides. Studies on urinary fluoride excretion, like those on total fluoride intake, cannot be carried out on random samples. Due to the necessity of close cooperation of parents and children, such studies were done with "convenience" samples. In westernized countries with now low caries prevalence, intermittent high urinary excretions occur frequently. Possible sources are fluoride intake from concentrated oral care products (fluoride gels, fluoride chewing gums) or from dentifrices (containing 1000 to 1500 ppmF), mineral waters, industrial tea preparation or fluoride tablets (or other supplements). These problems do not affect the amount of fluoride in fingernail clippings which appear to be suitable for the routine monitoring of fluoride exposure.

Adolescent↗

PubMed2005

Cost aspects of salt fluoridation.

The cost of salt fluoridation in a given country depends primarily on the number of salt factories and on the technical level available in the country. Equipment required may cost U.S. dollars 400,000 for large plants producing at least 20,000 tons/year providing salt for populations of several millions. Reliable batch mixers have been built locally for U.S. dollars 3000 to U.S. dollars 10,000, with one such mixer capable of producing 10 batches of one metric ton/day or 2000 to 3000 tons a year for a population of 350,000 to 500,000. Frequently 85-90% of the costs are devoted to infrastructure; in combination with salt iodization, the cost for fluoride equipment is 30-50% less. loIization is promoted by WHO, UNICEF, other international organizations and national aid agencies which can indirectly support salt fluoridation. With respect to running costs, the expense for the fluoride chemical is the major factor in small plants producing for example 6000 tons of salt, i. e U.S. dollars 0.015 to 0.03 per year and capita. The cost for personnel necessary for addition of fluoride and quality control is approximately U.S. dollars 0.008/capita/year in small plants and even less in large ones. With adequate implementation, salt fluoridation affords a cariostatic effectiveness equal to that of water fluoridation. When its cost is compared to that of water fluoridation, there may not be much difference regarding initial cost for equipment except in the case of small salt factories where local production of batch mixers may lower initial expenses substantially. Running costs for salt fluoridation are 10 to 100 times lower because the amount of fluoride chemical needed and its handling are up to 100 times less than with water fluoridation. In practice, the cost of salt fluoridation is often so low that many producers did not raise the price of fluoridated salt; this has been the case in Switzerland since 1955 and also in several countries in the Americas today.

Americas↗

PubMed2005

Increasing the public health effectiveness of fluoridated salt.

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.

Cariostatic Agents↗

PubMed2004

[History of fluoride prevention: successes and problems (literature review)].

Fluoride prevention has a significant role in complex caries prevention, together with the appropriate diet and oral hygiene. The aim of the present review is--considering mainly the public health aspects--to give information on changes of the methods of fluoride prevention, and the changing views on pathomechanisms, as well as statements in the course of the last 50 years, based on present scientific evidence. The first great breakthrough in caries prevention was the introduction of water fluoridation between 1945-1950 in the USA and Canada. The measure was adopted in other countries and resulted in significant caries reduction. In the fifties and sixties fluoride tablets were widely used in many countries and brought good results, mainly in well-controlled smaller communities. Salt fluoridation has been initiated in Switzerland in 1955, and introduced in numerous countries in the eighties. The concept of a strong protective systemic effect of fluorides in the early eighties gave place to ideas on mainly topical effects, playing a decisive role in toothpastes, gels, acting topically on the enamel of the erupted teeth. Therefore many water fluoridation projects, mainly in Central- and Eastern Europe--where the prevalence of dental caries is still very high--were cancelled after 1990. Tablet fluoridation became questionable due to the fear of the possibility of dental fluorosis. Recent scientific views, however, confirmed a weak pre-, and peri-eruptive, as well as a strong posteruptive effect of systemically applied fluorides. In countries where caries prevalence is high, but the majority of the population cannot afford fluoridated toothpastes due to low socio-economic conditions, the introduction and extension of salt fluoridation to the whole population is well founded and recommended from a public health view.

Canada↗

PubMed2002

Dentistry between pathology and cosmetics.

In ancient and medieval times, the prevalence of caries and periodontal disease varied. There were no treatments for dental hard tissue, but dental cosmetics played an important role. In the late 19th century, caries levels reached a maximum in Europe and North America after refined sugar became a cheap staple food. Toothlessness became frequent even in young adults. Caries prevention, effective on a public health scale, began with the introduction of water fluoridation in the 1940s. By 1985, dental academia had acknowledged that substantial declines could also be obtained in entire populations through topical fluorides, mainly in toothpastes. While decreasing caries prevalence is irrefutable in affluent countries, the specific reasons of the decline are still a matter of debate. In countries where caries has declined substantially, activities of dentists are shifting towards cosmetic dentistry. However, caries continues to be a problem for the lower socioeconomic strata, even in affluent countries, and is a serious problem in developing countries. Thus, water fluoridation is still important, and salt fluoridation should be considered where water fluoridation is not feasible. Both measures are extremely cheap to implement. Controlled fluoridation has a great potential for developing countries and low social strata of affluent countries. Its reduced effectiveness in high socioeconomic strata of affluent countries, due to the widespread usage of fluoride in toothpastes and other oral care products, should not detract from the public health value of fluoridation.

Dental Caries↗