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飲水氟化 (Water Fluoridation)

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Presentation on theme: "飲水氟化 (Water Fluoridation)"— Presentation transcript:

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

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 FACTORS OF IMPORTANCE FOR CARIES-PREVENTIVE EFFECT OF F
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 Topic Systemic Toothpaste Mouth rinses Painting solution Varnishes
Drinking water Tablet salt Milk Tablets Drops 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) 0.019 1.0 0.042 0.038 2.0 0.084 0.5 26.3 1.10 52.6 2.21 10.0 526.3 22.1 100.0 5250.0 220.9 250.0 552.7 1000.0 2209.2

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18 scientific controls: Fluoridation Control 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 1972 220,000 3 Syria (Natural F) 1,000,000 10 Taiwan 40,000 0.2 Thailand 5,000,000 UK 1955 5,500,000 USA 1945 123,000,000 53 USSR 1960 30,000,00 11 Venezuela 1952 4,562,800 25 Yugoslavia 3,000,000 13

20 Systemic fluoride in dental public health

21 Age Grand Rapids Muskegon No. of children Mean def 4 168 2.13 63 4.46
1. Mean def in Grand Rapids and Muskegon, 1951 (Arnold et al.) Age Grand Rapids Muskegon No. of children Mean def 4 168 2.13 63 4.46 5 853 2.27 351 5.25 6 750 2.98 294 5.67

22 Fluoride % of children with no caries
Table 4. Comparing proportion of caries-free children in fluoridated and non-fluoridated areas15 Age(years) Fluoride % of children with no caries No Fluoride % of children with no caries 6 89.3 79.8 7 66.8 49.7 8 49.4 27.5 9 33.1 14.5 10 26.6 5.7

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24 Table Change In Caries Experience In Some Developed Countries
Country Time Interval Age Group Caries Index Caries Experience Percent Change Start End Australia 12 DMFT 7.2 2.5 -65 Denmark 15 DMFS 15.9 10.8 -32 England 9.3 4.3 -53 Ireland 13-14 8.0 4.4 -45 Netherlands 8.2 5.5 -33 New Zealand 8-9 3.3 2.0 -39 Norway 16.5 -35 Scotland 8.1 5.8 -28 Sweden DFS 27.7 13.7 -51

25 Ages in Years 6 8 10 12 Non-fluoridated Lowest 25% 0.68 3.30 5.39 9.47
TABLE 16 Mean scores for decayed, missing, or filled surfaces by age and quartile of socioeconomic status (Bell et al. 1982) Ages in Years 6 8 10 12 Non-fluoridated Lowest 25% 0.68 3.30 5.39 9.47 Next to Lowest 25% 0.55 2.67 4.90 8.47 Next to highest 25% 0.52 2.46 4.16 7.23 Highest 25% 0.43 2.09 3.22 6.70 Fluoridated 2.28 3.44 5.71 0.49 1.92 3.74 4.97 0.44 1.86 3.27 5.04 0.39 1.89 2.87 4.91

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 :
the fluoride concentration of the water, the age of the person, climatic conditions, 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
1975 1978 1981 1984

30 中興新村 草屯 原飲用水中含氟量 0.07 ppm 0.08 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 (Na2SiF6) Liquid type Fluosilicic acid (H2SiF6)

33 School water fluoridation programs
by age 6 caries incidence

34 Supplemental fluoride therapy:
prenatal fluoride therapy postnatal fluoride therapy

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36 劑量建議 年齡 每日劑量 6個月~3歲 0.25 mg (=小哈氟® 1/4mg 一錠) 3~6歲
(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
Concentration of Dose % Reduction in Dental Caries Remarks Community water fluoridation 1 ppm (1 mg/liter)* 55-70 Continues into adult life School water fluoridation 4.5 ppm (4.5 mg/liter)* About 40 Only for school age children Topical application 2% NaF solution 8% stannous fluoride 1.2% acidulated phosphate fluoride, or gel 30-40 For children of all ages Mouth rinse: Home or school rinsing daily Supervised school rinsing weekly 0.05% NaF 0.2% NaF 20-50 Probably more effective under supervision Tablets 2.2 mg NaF↑ 20-40 Effective in supervised school distribution: chew, swish, and swallow Drops 2-2.2 mg NaF total of 4-12 drops Probably same as tablets Latitude in partial doses Dentrifices 0.4% stannous fluoride, 0.22 % NaF, 0.76% Na monofluorophosphate 15-30 Adults 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
Amount, concentration, duration of fluoride Stage of tooth development Individual variations Certain environmental variables

43 Dental fluorosis score
Table 4-4 Dean’s dental fluorsis classification Category Dental fluorosis score Description of enamel Normal 0.0 Smooth, glossy, pale cream-white translucent surface Questionable 0.5 A few white flecks or white spots Very mild 1.0 Small opaque, paper-white areas covering less than 25% of the tooth surface Mild 2.0 Opaque white areas covering less than 50% of the tooth surface Moderate 3.0 All tooth surfaces affected; brown stain; marked wear on biting surfaces Severe 4.0 All tooth surfaces affected; brown stain; discrete or confluent pitting Date from Dean34 Source: Leske, G.S.; Rpa, L.W.; and Leske. M.C. Dental Public Health (chap. 43). In Maxcy-Rosenau Public Health and Preventive Medicine 11th ed. J.M. Last. ed. , pp New York: Appleton-Century-Crofts. 1980

44 Dental fluorosis ED DE Cervical portion (Buccal surface)

45 Dental Fluorosis 0-4 yrs 621 126 4-6 yrs 754 457 Over 6 yrs 8

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 No or Negative Correlation Yiamouyiannis and Burk ,1977
TABLE 7 FLUORIDE-CANCER CORRELATION Positive Correlation No or Negative Correlation Yiamouyiannis and Burk ,1977 Hegen et al. 1954 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
fluorides in solid food range from mg of F/kg 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 9 0.09 0.04 0.15 果汁類 21 0.08 0.03 0.02 0.16 可樂汽水類 14 0.06 0.14 運動飲料、健康飲料類 鮮奶、牛奶、調味乳類 22 0.05 0.24 奶茶類 0.57 0.38 0.84 紅茶類 15 0.65 0.42 1.78 綠茶類 10 0.52 0.33 1.15 烏龍茶類 0.79 0.31 0.4 1.43 其他茶類 0.48 0.1 1.28 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 巨量礦物質 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 肌肉痛、痙攣 心臟疾病、失眠、糖尿病、老人癡呆症 微量礦物質 貧血、失眠 掉髮、皮膚疾病、味覺障礙 貧血 骨骼病變 甲狀腺腫 心臟疾病、關節障礙、動脈疾病 痛風 (尿酸代謝障礙) 惡性貧血 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 Average annual maximum
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 1.2 1.1 1.0 0.9 0.8 0.7

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66 *The total numbers of cancers observed are given in parentheses
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 cancer High F (1 ppm) High-medium F ( ppm) Low F (0.2 ppm) Very low F (0.1 ppm) Thyroid 1.05 (45)* 0.79 (54) 1.27 (57) 1.02 (84) Kidney 1.01 (129) 1.00 (198) 1.02 (131) 0.98 (233) Stomach 0.88 (375) 1.15 (733) 0.90 (327) 1.05 (815) Oesophagus 0.87 (73) 1.13 (177) Colon 0.96 (386) 1.03 (618) 0.99 (385) 1.00 (719) Rectum 0.93 (273) 1.11 (486) 0.94 (264) 0.99 (519) Bladder 1.00 (430) 0.96 (632) 1.06 (444) 1.00 (786) Bone 1.00 (18) 1.06 (30) 1.02 (19) 0.94 (31) Breast 0.92 (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 Concentration of fluoride in drinking water (ppm)
Table 3 Supplemental Fluoride Dosage Schedule (mg/day*) Age Concentration of fluoride in drinking water (ppm) <0.3 >0.7 2 weeks-2 years 0.25 2-3 years 0.50 3-16 years 1.00 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
not effective harmful 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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