Background: The World Health Organization (WHO) emphasizes that dental caries is a severe public health problem across the world. The current global and regional patterns of dental caries reflect distinct risk profiles of countries which relate to the structure of the society, living conditions, lifestyles, and the existence of preventive oral health programmes. Research conducted in high income countries documents that systematic use of fluoride reduces the burden of dental caries; such research is scarce in low and middle income countries.

Objectives: This article reviews the evidence on effective use of fluoride, highlights the public health approach to fluoridation, and clarifies how automatic fluoridation contributes to breaking social inequities in dental caries.

Data collection: Scientific publications on fluoride administration stored in PubMed/Medline and caries data from the WHO databank.

Outcome: Dental caries identified from national surveys or country relevant data; extraction of scientific reports is based on their public health relevance.

Conclusions: The article outlines the history of fluoridation programmes and describes the sound evidence on automatic fluoridation through water, salt and milk, or from the use of high quality fluoridated toothpastes (1000-1500 ppm F). The experiences from the implementation of programmes in various countries are discussed and the potential for breaking the social inequalities in the burden of dental caries is clarified. Finally, the role of WHO in the development and implementation of fluoridation schemes is explained; WHO technical assistance in the outcome evaluation and assessment of fluoride exposure is enlightened.