Water fluoridation
Health and dental organizations worldwide have endorsed its safety and effectiveness. Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water. Further research showed that moderate fluoridation prevents tooth decay.
Water fluoridation
The critical period of exposure is between ages one and four years, with the risk ending around age eight. Fluorosis can be prevented by monitoring all sources of fluoride, with fluoridated water directly or indirectly responsible for an estimated 40% of risk and other sources, notably toothpaste, responsible for the remaining 60%. Compared to water naturally fluoridated at 0.4 mg/L, fluoridation to 1 mg/L is estimated to cause additional fluorosis in one of every 6 people (95% CI 4–21 people), and to cause additional fluorosis of aesthetic concern in one of every 22 people (95% CI 13.6–∞ people). Here, "aesthetic concern" is a term used in a standardized scale based on what adolescents would find unacceptable, as measured by a 1996 study of British 14-year-olds. In many industrialized countries the prevalence of fluorosis is increasing even in unfluoridated communities, mostly because of fluoride from swallowed toothpaste. A 2009 systematic review indicated that fluorosis is associated with consumption of infant formula or of water added to reconstitute the formula, that the evidence was distorted by publication bias, and that the evidence that the formula's fluoride caused the fluorosis was weak. In the U.S. the decline in tooth decay was accompanied by increased fluorosis in both fluoridated and unfluoridated communities; accordingly, fluoride has been reduced in various ways worldwide in infant formulas, children's toothpaste, water, and fluoride-supplement schedules.