Oral Health Program

Water fluoridation is considered one of the most successful public health interventions of the 20th century and salt fluoridation has proven to be a cost-effective method for reducing caries in the Latin America and Caribbean Regions. The introduction of systemic and topical fluorides have drastically reduced the rate of dental decay worldwide.

This section offers information on fluoridation facts, national programs, varying modalities of fluoride use, as well as information about the practice of adding fluoride compounds to water, salt, etc. with the intended purpose of reducing tooth decay in the general population.


Introduction and Fact Sheets

Statements from Six Leading Health Authorities Regarding Community Water Fluoridation (31.4 kB) (Statements from ADA, CDC, AMA, U.S. Surgeon General, National Institute of Dental & Craniofacial Research (NIDCR), and WHO.)

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States (CDC Morbidity and Mortality Weekly Report, 2001. Guide for dental and other health-care providers, public health officials, policy makers, and the public in the use of fluoride to achieve maximum protection against dental caries while using resources efficiently and reducing the likelihood of enamel fluorosis.)


Scientific and Technical Publications

Salt Flouridation

Promoting Oral Health: The Use of Salt Fluoridation to Prevent Dental Caries (1.21 MB)  (PAHO, 2006.  Introduction to book including salt fluoridation fact sheet, preface, press release and information about ordering a copy.)

pdf Promoción de la Salud Bucodental: El Uso de la Fluoruración de la Sal para Prevenir la caries dental (8.14 MB)  (PAHO, 2005.  Historia y ejemplo de éxito de experimentos, progreso en la Región, recomendaciones para educar comunidades sobre la fluoruración de la sal, métodos de producción y marketing de la sal y planificación estratégica para implementación de la fluoruración de la sal.)

pdf Promoting Oral Health: The Use of Salt Fluoridation to Prevent Dental Caries (7.35 MB)  (PAHO, 2005.  History and success stories of early experiments, progress in the Region, recommendations for educating communities about salt fluoridation programs, salt production methods and processing, marketing and strategic planning for salt fluoridation implementation.)

pdf Multi-Year Plan for Salt Fluoridation Programs in the Region of the Americas (Belize, Bolivia, Dominican Republic, Honduras, Nicaragua, Panama, Paraguay, Venezuela) (4.89 MB)  (PAHO, 2000. Final Report to the W.K. Kellogg Foundation Project #43225.  Program description, methodology for baseline studies, training in fluoridation techniques and quality assurance, surveillance systems and monitoring of salt fluoridation programs, general policy recommendations and legal framework.)

Water Flouridation

Populations Receiving Optimally Fluoridated Public Drinking Water - United States, 1992-2006 (CDC Morbidity and Mortality Weekly Report, 2008. Updated report on increasing fluoridation in the United States and progress toward Healthy People 2010 objective in the US.) 

pdf Fluoride in Drinking-water (1.03 MB)  (WHO, 2006.  Report on sources of fluoride, health effects, guidelines and standards, analytic methods, country data and indices of severity of dental fluorosis.) 

 Fluoride in Drinking Water: A Scientific Review of EPA's Standards (The National Academies, March 2006. A review of studies conducted in the last 10 years that warns against over-fluoridation.)

Nature's Way to Prevent Tooth Decay: Water Fluoridation (ADA, CDC, US Department of Health and Human Services, 2004.  Argues that water fluoridation benefits everyone in the community equally, is safe and cost-effective.)

pdf Defluoridation Systems for Latin America and the Caribbean (Mexico) (5.8 MB)  (PAHO & Secretaía de Salud de México 2004.  Task-Force Meeting Final Meeting. PAHO's Multi-Year Plan for Fluoridation Programs in the Region, survey of water supply, salt fluoridation and fluorosis.  International Standard Regulatory Criteria for Fluoride in drinking water and technical approach for management of acceptable fluoride exposure in ground water.)

Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. (CDC Morbidity and Mortality Weekly Report, 1999. The ten public health achievements highlighted in this MMWR series reflect the successful response of public health to the major causes of morbidity and mortality of the 20th century.)

Engineering and Administrative Recommendations for Water Fluorosis (CDC Morbidity and Mortality Weekly Report, 1995. Updated guidelines and/or recommendations for managers of fluoridated public water systems in the US.)

Milk Flouridation

Development of a Milk Fluoridation Scheme for Prevention of Dental Caries (484.5 kB) (WHO, 2001.  Feasibility study for implementation of milk fluoridation in communities for which neither water nor salt fluoridation can be implemented.)

Toothpaste Flouridation

Uso de Pastas Dentales y Consumo de Suplementos en Niños de 3-5 Años (Venezuela, Nicaragua, Honduras (1.84 MB) (OPS, 1998.  Objetivos, materiales, métodos, resultados, discusión y recomendaciones con anexos: estudio de pastas y suplementos fluorurados y formulario de encuesta.)

Training Materials

pdf Recomendaciones Administrativas y Técnicas para la Fluoruración del Agua (3.32 MB)  (OPS & US Dept. of Health and Human Services, 1997. Recomendaciones para comunidad y escuelas fluoruradas: administración, supervisión, requisitos técnicos y procedimientos de seguridad.)

Fluoruración del Agua: Un Manual para Ingenieros y Técnicos (8.74 MB)  (OPS, US Dept. of Health and Human Services, & CDC, 1997.  El propósito de este manual es ayudar al personal de servicio de agua en el correcto funcionamiento de los sistemas de fluoruración para diseñar o planificar una instalación de fluoruración de agua de manera que los clientes puedan disfrutar de todos los beneficios de fluoruración.)

Monitoring of Renal Fluoride Excretion in Community Preventative Programs on Oral Health (3.19 MB) (WHO, 1999. Study design, guidelines for tabulating and processing urine fluoride data and conclusions.)


Additional Resources:


Active ImageDevelopmental disorders involve teeth and the craniofacial structures. Oftentimes, these are associated with genetic disorders affecting other parts of the body. Other times, they are due to developmental problems during birth. Thus, it is suggested that both genes and environmental factors play a role in these defects. The most common defect is the cleft lip and palate.

This section will provide information on many of the common developmental disorders in the LAC region, scientific literature and links to associations and foundations that are working to help those inflicted.

Introduction and Fact Sheets

International Collaborative Research on Craniofacial Anomalies

WHO. Introduction to Craniofacial Anomalies

Cleft Lip and Palate

NIH.  Brief introduction to Cleft Lip and Palate (also called Harelip).

Treacher Collins Syndrome, Crouzon Syndrome, Apert Syndrome, Stickler syndrome 

NIH Genetics Home Reference.  Introductory information these developmental disorders.

Global Strategies to Reduce the Health Care Burden of Craniofacial Anomalies: Report of WHO Meetings on International Collaborative Research on Craniofacial Anomalies  (57.19 kB) 

WHO, 2002. Discussion on potential of the global model for tackling the big questions in craniofacial anomalies, be they concerned with cause, treatment, or prevention.

Scientific and Technical Publications

Advice Given to Women in Argentina about Breast-feeding and the Use of Alcohol (90.72 kB)

Panamerican Journal of Public Health, 2004. Study demonstrating the need for professional development strategies that will address women's awareness of the risks of alcohol consumption and alcohol usage.

pdf Global Strategies to Reduce the Healthcare Burden of Craniofacial Anomalies (1.99 MB)  

WHO, 2002. Report of WHO meetings on International Collaborative Research on Craniofacial Anomalies Geneva, Switzerland, 5-8 November 2000 & Park City, Utah, USA, 24-26 May 2001. Findings from WHO five-year project designed to take forward an international research strategy on treatment, gene/environment interaction, genetics, and prevention of craniofacial anomalies.

Training Materials        

Guidelines for Identifying and Referring Persons with Fetal Alcohol Syndrome

CDC Morbidity and Mortality Weekly Report, 2005. Recommendations, referral considerations, services for people with FAS, alcohol during pregnancy. 

Additional Resources:

Sources - Database:

General Health Sicience: LILACS, MEDLINE /International Agencies:  PAHO- Pan American Health Organization, WHOLIS - World Health Organization / Cochrane Library: Cochrane systematic reiews, Protocols of Cochrane systematic reviews, CENTRAL, Abstracts by INAHTA, economic studies and critically appraised, abstracts of quality assessments / BBO -Brazilian Dentistry Bibliography  / MEDCARIB - Caribbean Health Sciences Literature / Bandolier / Ibero-American Clinical Trials, Evidence. Updating in ambulatory, Reports / HIL- Internet Resources.

Foundations and Centers:

Austin Smiles is a nonprofit 501(c)3 organization which provides reconstructive plastic surgery, primarily cleft lip and palate repairs, to the children of Austin and the 10 county area surrounding Austin and in various locations in Latin America.

The mission of CPF is to provide the essential information and research that enhances the quality of life for individuals affected by cleft lip and palate and other facial birth defects.

La Fundación del Paladar Hendido (CPF) es una organización sin fines de lucro dedicada a ayudar las personas con defectos de la cabeza y el cuello, y sus familias.

For  38 years, FACES: The National Craniofacial Association has been dedicated to assisting children and adults who have craniofacial disorders resulting from disease, accident, or birth.

The website for the Collaboration for Craniofacial Development and Disorders (CCDD) was created for families, physicians, and scientists. The mission is to care for patients, educate, and perform research on craniofacial disorders. Information is provided about services available at Johns Hopkins University and providers around the world.

Oral Health, Clinical Trials, Research, Grants & Funding, Careers & Training

Basic information on Cleft Lip and Cleft Palate for kids.

Operation Smile mobilizes a world of generous hearts to heal children's smiles and transform lives across the globe. Our network of volunteers works worldwide to repair childhood facial deformities including cleft lips and cleft palates.

Operation Rainbow is dedicated to performing free orthopedic surgery for indigent children and young adults worldwide.

Nossa missão, além da correção estética, funcional e emocional é de prover uma oportunidade e um ambiente especial de trabalho, onde as pessoas com deformidades faciais e dificuldades especiais adquiram experiência de trabalho, confiança e auto-estima para poderem enfrentar dignamente o competitivo mercado de trabalho.

Active ImageAtraumatic Restorative Treatment (ART or PRAT in Spanish) is a simple method to treat dental caries in situations where traditional cavity preparations are not feasible. The technique was developed over 10 years ago and has been proven to be an effective treatment option. It involves the removal of soft, demineralized tissue followed by the restoration of the tooth with fluoride-releasing glass ionomer.

ART/PRAT systems have been successfully employed all over the world as it does not require electricity, running water, or anesthesia. PAHO, with the support of the Inter-American Development Bank (IADB), demonstrated the cost-effectiveness of ART/PRAT compared to amalgam restorations in three LAC countries over three years. Longer-term studies are currently underway. Results of this study can be found under the Related Methods section.

This section reviews the history, research and development of the technique, practical purposes, and current studies and trends.

Scientific and Technical Publications

pdf  La Salud Oral de los Niños de Bajos Ingresos. Procedimientos para el Tratamiento Restaurativo Atraumático. (979,08 kB)  

OPS. BID. 2009. Informe final. Saskia Estupiñán-Day, Trevor Milner, Marisol Téllez

En el presente estudio, las técnicas básicas de evaluación económica, particularmente las técnicas de análisis costo-efectividad (ACE), se utilizaron para evaluar la práctica de la técnica PRAT. La investigación tuvo como objetivo introducir la técnica PRAT en los servicios de atención dental del gobierno en Panamá, Ecuador y Uruguay como una modalidad de tratamiento restaurador para el tratamiento de caries tanto en los dientes primarios como permanentes, ampliando así la cobertura de los servicios bucodentales a nuevas poblaciones de niños, incluidos los que actualmente carecen de acceso a tratamientos convencionales en base a Amalgamas.

pdf Atraumatic Restorative Treatment (ART) to the Rural Population: A GOI - WHO Collaborative Programme (913.55 kB)

WHO, Mahatma Gandhi Post graduate Institute Of Dental Sciences & Government of Puducherry Institution, 2007. Report of use of ART in rural Puducherry grammar schools and colleges. Evaluation of cost effectiveness, and retention of fillings.

pdf Oral Health of Low Income Children: Procedures for Atraumatic Restorative Treatment (PRAT) (2.6 MB)

PAHO, 2006. Basic techniques of cost-effectiveness analysis (CEA), PRAT in government dental care facilities in Panama, Ecuador and Uruguay, thus extending coverage of oral services to those without access to conventional Amalgam-based treatment.

Training Materials                                                               

pdf Atraumatic Restorative Treatment (ART) for Tooth Decay: How to organize and run an ART training course (4.77 MB)

WHO, 2000. Educational material for facilitators of ART training based on experience gained in over 30 countries.

pdf Practica de Restauracion Atraumatica (PRAT) para la Caries Dental - Como Organizar un Curso PRAT (2.68 MB)

OMS, Escuela de Odontología de la Universidad de Nijmegen, 2001. Materiales educativas para entrenar facilitadores en la técnica PRAT basado en experiencia recibido en más que 30 países. 

Additional Resources


El acuerdo fue firmado el 9 de Febrero por la Representante de la OPS/OMS en Colombia,  doctora Ana Cristina Nogueira, y el Rector de la Universidad, Padre Joaquín Emilio Sánchez García, S.J., en las instalaciones de la Universidad en Bogotá.   El acuerdo hace parte de la iniciativa Comunidades Libres de Caries de OPS/OMS, una estrategia que tiene como objetivo la integración de salud oral en los servicios de APS, como un punto crítico para el diagnóstico y prevención de enfermedades orales.

Water Fluoridation Promotes Oral Health across Communities

Hailed as one of 10 great public health achievements of the 20th century by the CDC, water fluoridation has been preventing tooth decay in communities since 1945. This section highlights an overview on community water fluoridation and its benefits for oral health from the Center for Disease Control