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陳弘森 副教授 高雄醫學大學 牙醫學系 TEL: 07-3121101 轉 7008, 7020 飲水氟化 (Water Fluoridation)

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Presentation on theme: "陳弘森 副教授 高雄醫學大學 牙醫學系 TEL: 07-3121101 轉 7008, 7020 飲水氟化 (Water Fluoridation)"— Presentation transcript:

1 陳弘森 副教授 高雄醫學大學 牙醫學系 TEL: 轉 7008, 飲水氟化 (Water Fluoridation)

2 學習目標 氟化飲水的起源 氟化飲水與牙科公衛 台灣飲水氟化的歷史 飲水氟化與口腔健康 學習資源: Murray JJ: Appropriate use of fluoride for human health. WHO, Geneva, 1996

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5 Systemic fluoridation Introduction Mechanism of action of fluoride History of Water fluoridation Systemic fluoride in dental public health Risk of systemic fluoride Conclusion

6 Introduction

7 Fluorides in the environment 1. fluorides in soil % of the earth 2. fluorides in water lakes, rivers, artesian well. 3. fluorides in air from the dusts, burning of coal fires, volcanic activity

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9 Mechanism of action of fluoride

10 Table 5 FACTORS OF IMPORTANCE FOR CARIES-PREVENTIVE EFFECT OF F Systemic F supply during period of enamel mineralization and maturation F contact with erupted tooth surface (and plaque) High frequency of local F application Long duration of F contact with enamel surface F contact with newly-erupted tooth surface Protection against rapid leaching of F taken up by enamel surface Chemical conditions favoring F-apatite formation

11 Systemic Drinking water Tablet salt Milk Tablets Drops Topic Toothpaste Mouth rinses Painting solution Varnishes Sucking tablets Chewing gum

12 History of Water fluoridation

13 History of dental fluorosis(I) 1888 Kuhns discovers in Mexico 1901 Eager discover in Naples (Italy) 1916 Mackay & Black discover in Colorado (USA) 1930 Kempf & Mckay discover in Arkansas (USA)

14 History of dental fluorosis(II) 1930 Churchill 12ppm [F - ] in water 1931 Smith et al. Fluoride/dental fluorosis 1934 Dean Dental fluorosis classification 1939 Dean 1ppm for fluoridated

15 TABLE 21 Conversion table for form of fluoride SOLUTION CONCENTRATION Fluoride (F) (ppm) or (mg/L) Fluoride (umol/L) Sodium Fluoride (NaF) (ppm) or (mg/L)

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18 scientific controls: FluoridationControl City Grand Rapids, Michigan (January,1945) Muskegon, Michigan Newburgh, New York (May, 1945) Kingston, New York Brantford, Ontario (June, 1945) Sarnia, Ontario Evanston, Illinois (February, 1947) Oak park, Illinois

19 TABLE 1-7 WORLD-WIDE WATER FLUORIDATION Country Year First Adjusted Population Served by Fluoridated Water Percentage of Total Population Served by Fluoridated Water Switzerland ,0003 Syria(Natural F)1,000,00010 Taiwan197240, Thailand(Natural F)5,000,00010 UK19555,500,00010 USA ,000,00053 USSR196030,000,0011 Venezuela19524,562,80025 Yugoslavia(Natural F)3,000,00013

20 Systemic fluoride in dental public health

21 1. Mean def in Grand Rapids and Muskegon, 1951 (Arnold et al.) Age Grand RapidsMuskegon No. of children Mean def No. of children Mean def

22 Table 4. Comparing proportion of caries-free children in fluoridated and non-fluoridated areas 15 Age(years)Fluoride % of children with no caries No Fluoride % of children with no caries

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24 Table Change In Caries Experience In Some Developed Countries Country Time Interval Age GroupCaries Index Caries ExperiencePercent Change StartEnd Australia DMFT Denmark DMFS England DMFS Ireland DMFT Netherlands DMFT New Zealand DMFT Norway DMFT Scotland DMFT Sweden DFS

25 TABLE 16 Mean scores for decayed, missing, or filled surfaces by age and quartile of socioeconomic status (Bell et al. 1982) Ages in Years Non-fluoridated Lowest 25% Next to Lowest 25% Next to highest 25% Highest 25% Fluoridated Lowest 25% Next to Lowest 25% Next to highest 25% Highest 25%

26 1967 Backer Dirks fluorides 45% pit & fissure 60% proximal surfaces 75% free smooth surfaces DMF decrease 50% index

27 The fluoride intake from water will depend on : 1. the fluoride concentration of the water, 2. the age of the person, 3. climatic conditions, 4. dietary habits.

28 Water Fluoridation in Taiwan 1971 – Dec. Kaohsiung City (0.5 ppm) 1972 – May Chung-Hsing New Village (0.6 ppm ) 1986 – Oct. Discontinue

29 Evaluation of the effect of 12 year’s water fluoridation

30 中興新村草屯 原飲用水中含氟量 0.07 ppm0.08 ppm 添加氟化鈉後含氟量 0.6 ppm 未添加 乳齒齲齒減少 40% 增加 19% (3 歲組 ) 恆牙齲齒前者較草屯減少 66% (12 歲組 )

31 The experience of using fluoride in Taiwan 1971/Dec – 1972/Dec Kaohsiung City/0.5 ppm 1972/May – 1986/Oct Chung-Hsing New Village (0.6 ppm) 1992/July – 1997/June School mouth-rinsing program 1993 Fluoride tooth-brushing (tooth paste) 1994 Encourage using fluoride by DOH

32 Water fluoridation Powder type Sod. fluoride (NaF) Sod. fluorosilicate (Na 2 SiF 6 ) Liquid type Fluosilicic acid (H 2 SiF 6 )

33 School water fluoridation programs 1. by age 6 2. caries incidence

34 Supplemental fluoride therapy : prenatal fluoride therapy postnatal fluoride therapy

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36 劑量建議 ( 參照美國兒童牙科醫學會 AAPD 之氟攝取建議量 ) 年齡每日劑量 6 個月 ~3 歲 0.25 mg (= 小哈氟 ® 1/4mg 一錠 ) 3~6 歲 0.5 mg (= 小哈氟 ® 1/4mg 二錠 ) 6~16 歲 1 mg (= 小哈氟 ® 1mg 一錠 ) * 每晚睡前含著即可。

37 Effectiveness of Various Modes of Administering Fluorides in Improving Dental Health ModeConcentration of Dose% Reduction in Dental Caries Remarks Community water fluoridation1 ppm (1 mg/liter)*55-70Continues into adult life School water fluoridation4.5 ppm (4.5 mg/liter)*About 40Only for school age children Topical application2% NaF solution 8% stannous fluoride 1.2% acidulated phosphate fluoride, or gel 30-40For children of all ages Mouth rinse: Home or school rinsing daily Supervised school rinsing weekly 0.05% NaF 0.2% NaF 20-50Probably more effective under supervision Tablets2.2 mg NaF↑20-40Effective in supervised school distribution: chew, swish, and swallow Drops2-2.2 mg NaF total of 4-12 drops Probably same as tablets Latitude in partial doses Dentrifices0.4% stannous fluoride, 0.22 % NaF, 0.76% Na monofluorophosphate 15-30Adults and children: may be used in fluoridated areas * Dosage in a temperate climate. ↑ No vitamin fluoride mixtures have been accepted by the ADA Council on Dental Therapeutics because they lack flexibility in altering fluoride dosage.

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39 Risk of systemic fluoride

40 Skeletal fluorosis Dental fluorosis

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42 Prevalence and severity of fluorosis 1. Amount, concentration, duration of fluoride 2. Stage of tooth development 3. Individual variations 4. Certain environmental variables

43 Table 4-4 Dean’s dental fluorsis classification CategoryDental fluorosis score Description of enamel Normal0.0Smooth, glossy, pale cream-white translucent surface Questionable0.5A few white flecks or white spots Very mild1.0Small opaque, paper-white areas covering less than 25% of the tooth surface Mild2.0Opaque white areas covering less than 50% of the tooth surface Moderate3.0All tooth surfaces affected; brown stain; marked wear on biting surfaces Severe4.0All tooth surfaces affected; brown stain; discrete or confluent pitting Date from Dean 34 Source: Leske, G.S.; Rpa, L.W.; and Leske. M.C. Dental Public Health (chap. 43). In Maxcy-Rosenau Public Health and Preventive Medicine 11 th ed. J.M. Last. ed., pp New York: Appleton-Century-Crofts. 1980

44 Dental fluorosis EDDE Cervical portion EDDE(Buccal surface)

45 Dental Fluorosis 0-4 yrs yrs Over 6 yrs88 88

46 History of dental fluorosis(Taiwan) 1952 黃茂卿 台南縣 卜茂源 台南縣、高雄縣、澎湖縣 1987 Akiniwa 台灣中部地區

47 Tainan County --- 仁德鄉 80% DF Penghn County --- 白沙鄉 70% DF Taichung County --- 龍井鄉 50% DF Nantou County --- 中興新村 20% DF

48 Water fluoridation Growth & development Cancer death rate Down’s syndrome Mortality rate

49 TABLE 7 FLUORIDE-CANCER CORRELATION Positive CorrelationNo or Negative Correlation Yiamouyiannis and Burk,1977Hegen et al Heasman and Martin, 1962 Kinlen, 1975 Hoover et al., 1976 Kuzma et al., 1977 Erickson, 1978 Rogot et al., 1978 Raman, 1978 Glattre and Wiese, 1979

50 Fluoride ingestion by man 1. fluorides in solid food range from mg of F/kg 2. fluorides in drinks

51 飲料名稱樣本數平均值標準差最小值最大值 咖啡類 果汁類 可樂汽水類 運動飲料、健康飲料類 鮮奶、牛奶、調味乳類 奶茶類 紅茶類 綠茶類 烏龍茶類 其他茶類 表 23 :各類飲料氟含量 (ppm) 的情形

52 ★必須礦物質與其缺乏症 類別缺乏時所引起的主要疾病 鈣骨質疏鬆症 磷骨骼疾病 鉀肌肉無力症、心律不整 硫礦毛髮、指甲的發育障礙 鈉肌肉痛、痙攣 鎂心臟疾病、失眠、糖尿病、老人癡呆症 鐵貧血、失眠 鋅掉髮、皮膚疾病、味覺障礙 銅貧血 錳骨骼病變 碘甲狀腺腫 硒心臟疾病、關節障礙、動脈疾病 鉬痛風 ( 尿酸代謝障礙 ) 鈷惡性貧血 鉻葡萄糖耐受異常

53 Antifluoridation Public health aspects Environment aspects Caries prevention aspects

54 Conclusion

55 反對飲水氟化的理由 氟非營養素或維他命。 氟為老化因子。 齲齒是缺乏鈣、鎂、磷。 牙科公衛調查不確定。 飲用水是食品,非藥水。 添加物不得超過中毒量百分之一。

56 結論 評量氟化飲水對人類健康的考量

57 Thank You For Your Listening!

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59 Evaluating dental fluorosis color hypoplastic changes

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61 Table II Recommended adjustment in optimal fluoride level according to air temperature of the community Average annual maximum daily air temperature Recommended optimal fluoride level ℃℉ ppm

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66 Table 58 Ratios of Observed to Expected Numbers of Cancers in Certain Organs in Areas with Different Levels of Fluoride in Water in Great Britain (Royal College of Physicions,1976) Site of cancerHigh F (1 ppm) High-medium F ( ppm) Low F (0.2 ppm) Very low F (0.1 ppm) Thyroid1.05 (45)*0.79 (54)1.27 (57)1.02 (84) Kidney1.01 (129)1.00 (198)1.02 (131)0.98 (233) Stomach0.88 (375)1.15 (733)0.90 (327)1.05 (815) Oesophagus0.87 (73)1.02 (131)0.87 (73)1.13 (177) Colon0.96 (386)1.03 (618)0.99 (385)1.00 (719) Rectum0.93 (273)1.11 (486)0.94 (264)0.99 (519) Bladder1.00 (430)0.96 (632)1.06 (444)1.00 (786) Bone1.00 (18)1.06 (30)1.02 (19)0.94 (31) Breast0.92 (567)1.06 (999)1.08 (650)0.97 (1105) Total Population *The total numbers of cancers observed are given in parentheses

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68 Table 3 Supplemental Fluoride Dosage Schedule (mg/day*) Age Concentration of fluoride in drinking water (ppm) < >0.7 2 weeks-2 years years years From American Academy of Pediatrics Committee on Nutrition : Fluoride Supplementation: Revised dosage schedule, Pediatrics 1979; 63:150. *2.2 mg sodium fluoride contains 1 mg fluoride

69 Antifluoridationist strategies 1. not effective 2. harmful 3. no choice

70 Defluoridation of water Additive methods Adsorptive methods

71 Additive methods: Calcium oxide (lime) Magnesium compounds (dolomite) Aluminum sulfate (alum)


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