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Effekten og virkningsmekanismen af salt-fluoridering på caries: En oversigtsartikel

ABSTRACT

Oversigtsartikel Dato: 04.08.2008

Cariesprævalensen i Grønland er stadig høj sammenlignet med Danmark og andre nordiske lande. For at reducere cariesforekomsten er der truffet en politisk beslutning om at introducere et landsdækkende saltfluorideringsprogram i Grønland i 2008. Formålet med denne oversigtsartikel er at dokumentere effektiviteten af saltfluoridering. Artiklen præsenterer data fra undersøgelser foretaget i perioden 1960 til 1990 rundt omkring verden. Resultaterne tyder på, at saltfluoridering har en cariesforebyggende effekt. Analyser, foretaget på børn og unge, viser også, at saltfluoridering udskyder cariesproblemerne med et par år på de enkelte individer. Saltfluorideringsstudierne er dog lavt placeret i evidenshierarkiet. Oplysninger fra international litteratur samt data fra et pilotstudie foretaget på Fagområdet for Cariologi og Endodonti på Tandlægeskolen i København indikerer, at saltfluoridering har sin cariesreducerende effekt ved at øge koncentrationen af fluorid i saliva, mens man spiser og ganske kort derefter. Det konkluderes, at saltfluoridering i Grønland ikke bør være eneste nye cariesforebyggende initiativ, men kombineres med eksempelvis generel instruktion til befolkningen i tandbørstning og brug af 1.500 ppm fluortandpasta.

The effect of salt fluoridation on caries: an overview: Objective: Dental caries has decreased among children and adolescents in many countries over the last decades but there are still societies with a high caries prevalence e.g. Greenland. Thus, a preventive program based on fluoridated salt has been considered and will be implemented in the near future. The aim of this review was to examine the clinical evidence for the effectiveness of salt fluoridation on caries experience in countries which have implemented this strategy. A second aim was to report the findings from a pilot study estimating the salivary fluoride levels after consumption of fluoridated (250 ppm) salt. Methods: A systematic search for relevant literature was conducted in the Cochrane library and Pub Med database through 2007. To be included, studies were required to have a controlled design and reporting DMFT/S as endpoint. Results: Eight studies from 9 countries were assessed but no randomized clinical trials were identified. Data from 12-year-old school children showed a prevented fraction between 0 and 70% with a median value of 45%. The caries progression rate seemed to be delayed by 33% per year which is a similar reduction as for other fluoride products. The pilot study displayed significantly elevated fluoride concentrations in the morning saliva after regular intake of fluoridated salt. Conclusion: There is insufficient evidence for a caries preventive effect of fluoridated salt in children and therefore, the implementation of fluoridated salt should not be the only new initiative against caries in Greenland. Moreover, children under 2 years of age have a very low salt intake and early childhood caries, which is a major problem in Greenland, is not likely to be dramatically reduced by the introduction of fluoridated salt.