Fluoride and Dental Caries: Second Thoughts in View of Recent Evidence from Germany

After seventy years of controversial discussion, the reports by Dean et al. that purported to demonstrate an inverse relationship between the prevalence of tooth decay in children and the fluoride content of drinking water are still cited as strong evidence for a significant anti-caries effect of fluoride, despite their many shortcomings. In addition, major hypotheses for possible cariostatic mechanisms of fluoride action have been found to be seriously flawed. Sociodemographic factors, as presented here from a part of Germany, appear to be better predictors of caries in children than the fluoride content of water supplies, raising the question: How much does fluoride really help to prevent or reduce tooth decay, especially among the most socially deprived and less advantaged?