Salt Fluoridation

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Overview

The addition of fluoride to salt in order to prevent dental caries began in Switzerland in the mid 1950s and has currently expanded to around 50 countries worldwide [1]. The European Union has approved the addition of both potassium fluoride and sodium fluoride to salt for caries prevention, and salt fluoridation programmes are currently available across Europe and South and Central America [2].

Use and Application

This community-based measure is available for the consumer as table salt for domestic use and also for use in commercial food production. The addition of fluoride to certain brands of salt gives the consumer the choice to supplement their diet or use alternative products. The fluoride content is normally 200-250 ppm F. Children less than three years old have a low intake of salt and are unlikely to benefit from salt fluoridation.

Effectiveness and Efficacy

Although substantial caries reductions (50% or more) in schoolchildren from Latin America have been reported, systematic reviews have graded the confidence in the evidence as very low [3]. It is commonly reported that the effectiveness of salt fluoridation equals that of water fluoridation amongst those who use it.

Safety

Salt fluoridation is considered safe with a minimal risk of harm and virtually no increase in the prevalence of enamel fluorosis. The combination of salt fluoridation and water fluoridation is not recommended.

Cost Effectiveness

Salt fluoridation, like other community fluorides, is cost effective in school schemes. A cost-effectiveness analysis of seven dental caries prevention programmes among schoolchildren in Chile concluded that salt fluoridation was the most cost-effective when measured as dental caries averted over a 6-year period when compared with no intervention [4].

Recommendations

Salt fluoridation offers a freedom-of–choice and could be considered as an inexpensive and practical alternative where water-fluoridation is not socially accepted or feasible.

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Key Further Reading