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Fluoridated Salt: A Measure Of Public Health In France

Dr. Patrick Hescot, President of UFSBD (French Union for Oral Health)

In France, a decree was signed by the Health Minister on October 31, 1985 and implemented on January 13, 1986. This decree allows the introduction of potassium fluoride in a proportion of 250 milligrams per kilo with a tolerance plus or minus 15 per cent in table salt.

Fluoridation of table salt has been chosen because:

1. The use of salt in food is regular and stable. It is from 3 to 4 grams per capita per day.

2. The price of a kilogram of table salt is law and the increase of it, due to fluoration has no effect on consumption.

3. The risks of absorbing large quantities of sodium chloride are very low for the population.

Producers are compelled to fill a yearly form supplemented by a technical report which presents detailed information on manufacturing conditions and controls carried out.

The control of manufacturing which is made by the Civil Service is at two levels:

* At the pre-production stage.

* At the packaging stage (At least two samples taken per 5 tons).

Selection of the sampling method and fluoride analysis methods have been defined by the European Council for salt studies. These are:

* Electrometric method with specific electrodes.

* Spectrocolometric method.

Government Health agencies make analyses to check them.

Fluoridated salt is packed in cardboard boxes and polyethylene bags and dispensers from 100 grams to one kilogram. There is also salt without fluor into consumers to choose. French regulations do not allow imposition of a single kind of salt to be sold; it is compulsory to let the consumer choose by himself. As far as labeling is concerned, salt follows the regulations for foodstuffs.

The superior council for public health requires the labeling to include two specifics sentences. The first is: "Do not absorb if drinking water contains more than 0,5 milligrams of fluoride per liter". The second aims to emphasize the role of fluorine: "Fluoridated salt is favorable for the dental prevention".

Statistical analysis of salt consumption requires some precautions. The average of food salt consumed in France is 7-8 g/day/capita. The principal sources of ingested salt are:

* Salt naturally present in food (1-2 g/day),

* Salt in foods (3-4 g/day),

* Salt added during cooking or a table (2-3 g/day).

The experts of the Health department estimated a use of 3 to 4/day/capita. It is advisable to deduct from this figure the proportion of fluoridated salt used in cooking and excreted before absorption (60-75% according to JAMES).

On the other hand, a large number of French population lunch in company restaurant and canteens (8 millions). The calculations made by the Health department end up at the result that there is an ingestion of about 1g/day/capita of fluoridated salt, so an additional absorption of fluorine of 0.25 mg/day/capita.

Moreover, a study on urinary excretion among 4 groups of children of 10 to 14 years old has permitted us to compare the rate of urinary fluoride in children who have consumed fluoridated salt and children who have taken sodium fluoride tablets. This study has enabled us to show that there is no risk of overdose and that fluoridated salt is an efficient method as adapted for France.

The concept of introducing fluoridated salt has been well understood by the dental profession since it was recommended by the French Union for Oral Health.

At the consumer level, there were no large advertising campaigns because of a lack of financial means. However we notice little by little that consumers buy fluoridated salt since today, it amounts to around 50% of salt sales.

In order to evaluate the effects of this measure the Health Minister has asked UFSBD to conduct a national epidemiological survey. The purpose of which is to establish the level of dental health among children aged 6, 9 and 12 in 1987, the date of the introduction of fluoridated salt in the market, in 1990 and in 1993. A representative sample of all schoolchildren in France has been obtained with the help of the Education Minister.

The results of this survey has showed that the DMF for 12 year old children has declined from 4,2 in 1987 to 3,02 in 1990, to 2,07 in 1993. This improvement is similar for 9 year old, for whom the DMF for permanent teeth is 0,72 and it was 1,27 in 1990. These children are 12 years old today and have a score for DMF equal to 2,07

This significant improvement in DMF is particularly noticeable in dental surgery where there fewer and fewer children to treat; and it is noticeable at all levels by socioprofessional category, by geographic area, by sex, for public and private schools. Today in France, children are in good dental health because caries has decreased in incidence and the number of caries-free children and the number of children fully treated have increased.

Only Fluoridated salt is an effective measure in France because it is not only measure. In fact in the Frame work of the public health project in France which the French mission for oral health has selected, there are also a lot of preventive actions for "health and the individual".

The French Union for Oral Health is the single official organization for dental prevention recognized by both French Health and Education state departments. It is composed of more than 15,000 dentists throughout over France.

UFSBD implements all the means for introducing dental preventive actions at school in companies, in every work place and at home. Its objective is to male the individual conscious of his own responsibility towards his own health by adding individual preventive actions to collective preventive actions.

For this, UFSBD uses communication and marketing techniques adapted to Public Health, that is in particular, the use of auxiliary support (teachers for children for example) and the adopdon of appropriate messages to the largel audience.

This working method is possible because it associates all the actors in Public Health and in the media.


"Dental Health in France - 1993 - DMF scores for 6,9 and 12 old-years" this document is available on a simple demand to:

The French Union For Oral Health

6 rue Guillaume Tell

75017 - Paris - France Mailing Address:

UFSBD (French Union For Oral Health)

6, Rue Guillaume Tell * 75017 Paris

Phone.: (033) (1) 44 010291

Fax: (033) (1) 47 549794

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