Natural fluoride isn't quite enough. (Dental Health).

The reunification of East and West Germany in 1990 has had some consequences for dental health, researchers have found.

Decades ago, health officials in many countries, including East Germany, added fluoride to public water sources to reduce tooth decay. After Germany reunified in 1990, however, the country's eastern states suspended fluoridation, which hadn't caught on with their western counterparts.

To test how natural variations in the amount of fluoride in water influenced dental health in their country, Gudrun Beyer and Joachim Kugler of Dresden Medical School analyzed the frequencies of common dental problems in 46,875 school children in the eastern German state of Saxony. They also determined the average background fluoride concentration in drinking water in each of the state's 29 districts. For most districts, the natural fluoride concentration was between 0.1 and 0.4 milligram per liter, well below the 1 mg/l concentration mandated by these districts before reunification.

The researchers found that differences in fluoride concentrations among the districts explained 24 percent of the variation they found in the children's dental health, including the number of cavities, pulled teeth, and fillings. That finding is consistent with observations from the days before artificial fluoridation: Communities' dental health correlated with the background concentration of fluoride in their water. Those observations led health officials to fluoridate water supplies in the first place, says John P. Brown of the University of Texas Health Science Center in San Antonio.

The new study underscores the lesson that sufficient amounts of fluoride in drinking water are important for public health, says Brown. Germany's lack of a fluoridation policy suggests "some people need to relearn that lesson," he says.