Adding Fluoride to Sugar—a New Avenue to Reduce Dental Caries,or a "Dead End"?

Abstract

A study group was formed in 1989 by the Oral Health Program of WHO, Geneva, to consider the possibility of reducing dental caries by adding fluoride to sugar. Although a few promising clinical reports were available for review, the group found that information was too scarce for field trials to be recommended at this stage. Among the many items to be considered was what concentration of fluoride in sugar could reasonably be regarded as cariostatic. Thus, the committee decided to initiate studies to obtain further background information. Unlike fluoridated salt, the concept of fluoridated sugar does not involve trying to give the individual a certain daily amount of fluoride, since daily consumption varies considerably. Instead, the idea is to elaborate on recent fluoride research showing that low concentrations of fluoride may also be beneficial, particularly for remineralization, if present at the sites where caries occurs.

This paper is an introduction to a set of papers describing the background for the project, attempting to define optimal concentrations for a clinical trial, and concluding that, although dental caries prevalence continues to decrease in industrialized countries, the potential for large increases remains in the huge populations in developing countries. All avenues must be searched for a system which optimizes preventive efficiency. However, the possible introduction of fluoridated sugar on the market is not related only to oral health. Safety aspects are of high priority, and several ethical, political, and economic factors must also be considered. These papers attempt to present the issue for broad discussion and to stimulate researchers to conduct further studies which can guide decisions on whether fluoridated sugar may be an avenue worth testing on a broader scale, or whether the idea should be abandoned.