How to improve the effectiveness of caries-preventive programs based on fluoride.

During recent years, an increasing number of reports have been published in which the observed caries-preventive effect of fluoride has been lower than could have been expected on the basis of the earlier literature. The current low levels of caries occurrence and the widespread use of fluoridated toothpastes as well as other fluoride products and methods have been suggested as reasons for the reduced relative effect of fluoride from any single source. Theoretically, one can improve the effectiveness of fluoride in caries-preventive programs by using measures that are more effective than the previous ones and still safe and feasible in everyday conditions. Another possibility is to direct fluoride-based prevention to high caries risk susceptible individuals who are most likely to benefit from it. Thirdly, one can enhance the intensity of existing fluoride prevention by increasing the frequency of applications, but this is of course worthwhile only if the recipients are lacking sufficient exposure to fluoride. In theory, people themselves could easily take care of their adequate fluoride supply by using fluoride toothpastes and/or other home use products frequently enough to maintain a sufficient salivary fluoride concentration at all times. Many people are unwilling to adopt healthy lifestyles, however, and therefore caries-preventive programs will remain necessary for the foreseeable future. Fluoride is the backbone of all such programs. Since conditions strongly determine the usefulness of caries prevention including different fluoride regimes, more research is still needed to monitor the effectiveness of caries-preventive programs and their components in variable conditions of today and tomorrow.