Oral health policy--time to broaden our perspective?

and severity of dental caries among children in the Republic of Ireland has declined dramatically since the 1960s. Much of this decline has been attributed to the availability of fluoride, through water fluoridation and also through the home use of fluoride toothpastes. 1,2 However, in spite of the overall improvement in dental health, caries remains a very common disease among Irish children, affecting between 37% and 55% of five-year-olds in fluoridated and non-fluoridated areas, respectively, approximately one-fifth of eight-year-olds, half of all 12-year-olds and three-quarters of all 15-year-olds. 1 While water fluoridation has been the cornerstone of caries prevention for decades in the Republic of Ireland, it is important to highlight that Government reports, 3-5 national health and health promotion strategies 6-8 and, more recently, the evidence-based guideline 'Strategies to prevent dental caries in children and adolescents' 9 clearly recommend that water fluoridation should be supplemented by oral health promotion initiatives, targeted caries-preventive interventions involving the use of topical fluorides, and improved access to dental services. That these other measures have not been implemented in any structured manner nationally perhaps reflects an unrealistic expectation on the part of decision-makers and budget holders that water fluoridation alone is sufficient to solve all our oral health problems, in spite of evidence to the contrary.