Caution needed in altering the 'optimum' XXXX concentration in drinking water.

@entity1 @entity1388 @entity3296
UNASSIGNED: The US Public Health Service has finalized its recommendation relating to community water fluoridation (Federal Panel on Community Water Fluoridation, US Department of Health and @entity1 Services, 2015). It recommends an optimal concentration of 0.7 mg/l F based on their argument that this concentration provides the best balance of protection from dental caries while limiting the risk of dental @entity3296 . The rationale for this recommendation can be questioned, particularly given the contrasting etiologies and impact on the community. Uncertainty surrounds the key evidence considered by the panel. This study argues that the panel should have exercised more caution and called for further research before reducing the 'optimal' concentration of @entity1388 in water supplies. Up-to-date data on caries and @entity3296 trend by age group or birth cohort, analyses on attributable risk for @entity3296 , data on individual and population impact of caries and @entity3296 , water intake over an extended period across the seasons, and the curvilinear relationship of @entity1388 concentration in water supplies and caries protection would have all been desirable to inform the panel, given the foreshadowing of the recommendation in late 2011. Further, a wider range of policy directions to achieve the best balance of protection from dental caries while limiting the risk of dental @entity3296 are available from the international literature. Assessment of these should have been more evident. There is a public health policy responsibility to monitor water fluoridation programs so as to achieve a near maximum reduction in dental caries without unacceptable levels of dental @entity3296 . However, recommendations to alter existing policy need to be cognizant of the balancing of risk and protective exposures across the entire population and potentially all ages and to be based on recent data that are purposefully collected, critically analyzed and carefully interpreted.
