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Press Kit

2005, 128 pp.
ISBN 92 75 11615 6
Code: SP 615
Price: US$ 28.00/
US$ 20.00 in Latin America and the Caribbean
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Promoting Oral Health. The Use of Salt Fluoridation to Prevent Dental Caries

A new book from the Pan American Health Organization (PAHO) shows how salt fluoridation has proven to be one of the most cost-effective public health interventions in history and shows countries how to implement programs of their own.

Promoting Oral Health: The Use of Salt Fluoridation to Prevent Dental Caries was written by Saskia Estupiñán-Day, head of PAHO's Oral Health Program. The book traces the history of salt fluoridation, first used in Switzerland in the 1950s and later elsewhere in Europe and the Americas. It explains why the practice is better suited to countries in Latin America and the Caribbean than fluoridation of water.

Experience has shown that putting fluoride in salt can reduce dental caries by as much as 84 percent at a cost of 6 cents per person per year. The practice is extremely cost effective, saving an average of $250 per person per year in dental treatment for every $1 spent. It is also highly equitable, benefiting equally rich and poor, young and old, urban and rural dwellers, those with access to professional dental services and those without.

The book provides step-by-step guidance on how to plan, promote, launch, operate, monitor and evaluate salt fluoridation programs. It discusses in detail how the salt industry operates, including its manufacturing and marketing practices, and shows how to win the industry's cooperation. The book also provides blueprints for legislation, epidemiological surveillance, and biological monitoring that are necessary for carrying out successful programs.

The publication was funded by the Kellogg Foundation, which has supported salt fluoridation efforts throughout Latin America and the Caribbean.


Preface (40 KB)

Foreword (37.5 KB)
Acknowledgments (37.5 KB)
Introduction (37.5 KB)

PART 1. SALT FLUORIDATION HISTORY AND SUCCESS STORIES
Overview
References
The Early Experiments, 1955-1980
Switzerland
Hungary
Colombia
Evidence Summary
References
Progress and Success, 1980-2000
Caries, Fluorides, and Enamel Fluorosis
Differences among Population, Racial, and Ethnic Groups
Multiyear Plan to Prevent Caries in the Americas
Costa Rica
Jamaica
Mexico

Effectiveness of Programs in Costa Rica, Jamaica, and Mexico
Enamel Fluorosis
References
PART 2. PLANNING, LAUNCHING, AND RUNNING SALT FLUORIDATION PROJECTS
Educating Communities about Salt Fluoridation
Why Educate about Salt Fluoridation?
Who Needs to be Educated about Salt Fluoridation?
Principles and Methods for Educating about Salt Fluoridation
Using Plain Language
Methods Applicable to Educating about Salt Fluoridation
What to Teach about Fluorides
What to Teach about Salt Fluoridation
Who Should Provide Education about Salt Fluoridation
The Role of Health Professionals in Educating about the Need for and Benefits of Fluoridating Salt
The Need for Continuous Education about Salt Fluoridation
Planning and Strategy Development
Summary
Salt Production and Technology Development for Salt Fluoridation
Introduction
Global and Regional Salt Production
Salt Production Methods
Salt Processing
Production of Fluoridated Salt
Fluoridation Chemicals
The Dry Method
The Wet Method
Choosing between the Wet and Dry Methods
Quality Control Issues with Both Methods
Box: Venezuela's Successful Salt Industry

Marketing of Salt
National Salt Flows and Balance
Internal Marketing of Salt
Salt Prices
Bibliography
Strategic Planning for the Implementation of Salt Fluoridation Programs
Phase I: Feasibility and Program Implementation
Institutional Analysis and Cost-benefit Study of a Salt Fluoridation Program
Baseline Studies
Surveillance Systems and Quality Control

Phase II: First Evaluation
Plant Equipment for the Production of Fluoridated Salt, by Production Method
Training of Personnel for the Program
Development of Monitoring Inffrastructure
Mass Communication Strategy
Initiation of Epidemiological Surveillance
Chemical Monitoring
Quality Control in the Productio and Distribution of Fluoridated Salt
Safety Aspects in the Production of Fluoridated Salt

Phase III: Long-term Evaluation and Consolidation
Epidemiological Surveillance Elements
Quality Control in Production and Distribution

References
Epidemiological Surveillance
General Considerations
Epidemiological Surveillance Requirements
Epidemiological Surveillance Measurement
Organization of Epidemiological Surveillance
Planning and Monitoring

Biological Monitoring
Oral Health Surveys for Determining DMFT and Dental Fluorosis in Children 6-8, 12, and 15 Years Old
Determining Fluoride Excretion in Urine in Children 3-5 Years Old
Monitoring the Nutritional Status of Preschool Children

Chemical Monitoring
Determining Fluoride in Drinking Water?Wells and Water Supply Networks
Determining Fluoride in Water Supplies

Monitoring Fluoride Concentration in Salt in the Distribution Network
Quality Control of the Salt Plant's Productions Process
Quality Control of the Plant's Distribution
Quality Control of Distribution by Health Authorities

Monitoring Fluoridated Salt in Plants, Warehouses, and Points of Sale
Sampling in the Plant by Health Workers
Sampling at Points of Sale and Warehouses by Health Workers
Fluoride Determination in Salt

Monitoring the Marketing and Use of Fluoridated Supplements (drops and tablets)
Monitoring the Use of Fluoridated Toothpaste in Preschool Children
References
PART 3. TOOL-KIT FOR DECISION-MAKERS, HEALTH PLANNERS, LEGISLATORS, EPIDEMIOLOGISTS, AND HEALTH WORKERS
PAHO's Recommendations for Setting up and Orchestrating a Successful Salt Fluoridation Program
Reference

A Legal Framework ffor Mandatory Iodization and Fluoridation of Salt
Standardized Research Protocols
    1. Examination Procedures and Coding for Visual-tactile Oral Health Surveys
    2. Determining Fluoride Concentration in Drinking Water
    3. Determining Urinary Fluoride Excretion in Children: Time-control Urine Sampling
    4. Determining the Extent of Use of Fluoride-containing Product


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