[Relationship between fluoride levels in the public water supply and dental fluorosis.]

Rev Saude Publica. 2007 Oct;41(5):732-9

Authors: Catani DB, Hugo FN, Cypriano S, Sousa Mda L, Cury JA

OBJECTIVE: To assess the prevalence of dental fluorosis among schoolchildren subjected to different fluoride concentrations in the public water supply of their cities. METHODS: The sample comprised 386 seven-year-old schoolchildren living in two municipalities in the State of S&#xE3;o Paulo that practiced external control over the fluoridation of the water from 1998 to 2002: one with homogenous fluoride concentration and the other with oscillating concentration. Dental fluorosis was determined by dry examination of the upper permanent incisors using Dean's index. Scores classified as questionable were considered to represent fluorosis. Sociodemographic variables and questions regarding oral health were assessed using a structured questionnaire sent to the children's parents or the adults responsible for these children. Correlates of fluorosis were assessed using multivariate logistic regression (p<0.05). RESULTS: Both municipalities presented a mild degree of fluorosis. The prevalence of fluorosis in the municipality with oscillating fluoride content in the water was 31.4%, and it was 79.9% in the municipality with homogenous fluoride content. The prevalence of fluorosis was associated with the municipality with homogeneous fluoride levels in the water (OR=8.33, 95% CI: 5.15;13.45) and with not owning a car (OR=2.10, 95% CI: 1.27;3.49). CONCLUSIONS: The prevalence of dental fluorosis was higher in the city with better control of fluoride levels in the water supply, however, this higher prevalence was not related with children's satisfaction with the appearance of their teeth.

PMID: 17923894 [PubMed - in process]

[Enamel defects, caries in primary dentition and fluoride sources: relationship with caries in permanent teeth]

Gac Sanit. 2007 May-Jun;21(3):227-34

Authors: Vallejos-S&#xE1;nchez AA, Medina-Solís CE, Casanova-Rosado JF, Maupomé G, Casanova-Rosado AJ, Minaya-Sánchez M

OBJECTIVE: To examine the relationship between the presence of enamel defects, dental caries in primary teeth, and exposure to various fluoride technologies and the presence of dental caries in permanent teeth in children with mixed dentition. MATERIALS AND METHODS: A cross-sectional study was conducted in 713 children aged 6-9 years old in 4 elementary schools in Campeche, Mexico through the use of a questionnaire for the mothers and an oral examination in the children. The dependent variable was the prevalence of caries in permanent dentition. RESULTS: The mean number of decay, missing or filling teeth in primary dentition (dmft) and in permanent dentition (DMFT) was 2.48 (2.82) (deft > 0 = 58.9%) and 0.40 (0.98) (DMFT > 0 = 18.2%), respectively. The significant caries index (SiC), which is calculated in deciduous dentition, was 5.85 for 6 year-olds. Multivariate logistic regression adjusted for variables related to fluoride exposure revealed that older age (OR = 2.99), a deft of > 0 (OR = 5.46), and lower maternal educational level (OR = 1.57) were significantly associated with a higher number of dental caries in permanent teeth. An interaction between sex and enamel defects was also found. CONCLUSIONS: The number of dental caries in both primary and permanent dentitions was relatively smaller than that found in prior studies performed in Mexican populations. The results confirm that the presence of caries in primary dentition is strongly associated with caries in permanent dentition. No significant relationship was found between fluoride exposure and dental caries in permanent dentition.

PMID: 17565898 [PubMed - indexed for MEDLINE]

Bottled, filtered, and tap water use in Latino and non-Latino children.

Arch Pediatr Adolesc Med. 2007 May;161(5):457-61

Authors: Hobson WL, Knochel ML, Byington CL, Young PC, Hoff CJ, Buchi KF

OBJECTIVES: To describe bottled, filtered, and tap water consumption and fluoride use among pediatric patients; to analyze differences between ethnic and socioeconomic groups; and to describe the frequency of physician-parent discussions regarding water consumption. DESIGN: Convenience sample survey. SETTING: An urban public health clinic. PARTICIPANTS: Parents attending a public health clinic. OUTCOME MEASURES: The primary outcome measure was the prevalence of tap, filtered, and bottled water use. The secondary outcome measures were supplemental fluoride use and the percentage of patients reporting discussions of water consumption with their physician. RESULTS: A total of 216 parents (80.5% Latino and 19.5% non-Latino) completed the survey. Of the parents, 30.1% never drank tap water and 41.2% never gave it to their children. Latino parents were less likely than non-Latino parents to drink tap water (odds ratio, 0.26; 95% confidence interval, 0.10-0.67) and less likely to give tap water to their children (odds ratio, 0.32; 95% confidence interval, 0.15-0.70). More Latinos believed that tap water would make them sick (odds ratio, 5.63; 95% confidence interval, 2.17-14.54). Approximately 40% of children who never drank tap water were not receiving fluoride supplements. Of the lowest-income families (<or=$14 999 per year), 64.9% always gave bottled (32.9%) or filtered (32.0%) water to their children. Of the parents surveyed, 82.5% reported that their child's physician had never discussed the type of water they should use. CONCLUSIONS: Many Latino families avoid drinking tap water because they fear it causes illness. Unnecessary use of bottled and filtered water is costly and may result in adverse dental health outcomes. Physicians should provide guidance to families regarding the safety, low cost, and dental health benefits of drinking tap water.

PMID: 17485621 [PubMed - indexed for MEDLINE]

Knowledge and attitude on infant oral health among graduating medical students in Kerala.

J Indian Soc Pedod Prev Dent. 2006 Dec;24(4):173-6

Authors: Kumari NR, Sheela S, Sarada PN

Providing dental and oral health care to all children in Kerala remains a thorny challenge. Lack of community water fluoridation, dental workforce shortages and geographical barriers all aggravate oral health and access problems. Children from low-income and minority families and children with special needs are at particular risk. Family centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. Present study was conducted to evaluate knowledge and attitude of graduating medical students towards infant oral health qualitative methods were used to evaluate the program.

PMID: 17183179 [PubMed - indexed for MEDLINE]

Fluoride knowledge and prescription practices among dentists.

J Dent Educ. 2006 Sep;70(9):956-64

Authors: Narendran S, Chan JT, Turner SD, Keene HJ

The purpose of this study was to assess dentists' knowledge about fluorides as well as their prescription practices. The study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice on an average of 18.9 +/-6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patient's weight. The correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely tested the fluoride level in the patient's drinking water. Even though pediatric and general dentists differed in certain items, the two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in respondents' fluorides knowledge as well as prescription practices indicated a need for educational interventions.

PMID: 16954417 [PubMed - indexed for MEDLINE]

Dental fluorosis in Brazil: a systematic review from 1993 to 2004.

Cad Saude Publica. 2006 Sep;22(9):1809-16

Authors: da Cunha LF, Tomita NE

The current article proposes a reflection on several aspect pertaining to dental fluorosis in Brazil, based on a systematic review of epidemiological surveys. The authors assess the prevalence and degrees of severity found in different studies and show that in methodological terms, there is a need for progress in procedures for population-based studies on fluorosis. Despite the different data collection approaches, there is some consensus among the different studies as to the limited severity of fluorosis in Brazil, as well as its association with the independent variables age and socioeconomic status. The authors also highlight the importance of adding subjective aspects to the normative diagnosis as a contribution to public health policy decisions, since the use of exclusively clinical criteria gives dental fluorosis more space than society ascribes to it. There is a lack of empirical evidence to reassess the fluoride content in public water supplies, a method that is known to be necessary to improve dental caries epidemiological indicators.

PMID: 16917577 [PubMed - indexed for MEDLINE]

Knowledge, attitude and practices of pediatricians regarding the prevention of oral diseases in Italy.

BMC Public Health. 2006;6:176

Authors: Di Giuseppe G, Nobile CG, Marinelli A, Angelillo IF

BACKGROUND: Pediatricians are in an ideal position to advise families about the prevention and management of oral diseases in children. The objective of the study was to determine knowledge, attitude, and practices regarding the prevention of oral diseases among pediatricians in Italy. METHODS: A systematic random sample of 1000 pediatricians received a questionnaire on socio-demographic and practice characteristics; knowledge on risk factors; attitude and practices towards the prevention of oral diseases. RESULTS: A total of 507 pediatricians participated. More than half knew the main risk factors for oral diseases and this knowledge was higher in primary care pediatricians (p = 0.007), in those with a higher number of hours worked per week (p = 0.012), and who believed that oral diseases may be prevented (p = 0.017). Pediatricians with higher knowledge about the main risk factors (p = 0.006) believe that they have an important role in preventing oral diseases and that they can perform an oral examination. Almost all (89%) prescribed fluoride supplements and those younger (p = 0.016), with a higher number of patients seen in workday (p = 0.001), with longer practice activity (p = 0.004), those who believe that fluoride is effective in preventing caries (p < 0.0001), and who learned about prevention from scientific sources (p = 0.002) were more likely to prescribe fluoride. One-fourth and 40.6% provides and recommends a dental visit once a year and primary care pediatricians (p = 0.014) and those who believed that routine visit is important in preventing oral diseases (p < 0.0001) were more likely to recommend a dental visit once a year. CONCLUSION: The results showed a lack of knowledge among pediatricians although almost all believed that they had an important responsibility in preventing oral diseases and provided an oral examination.

PMID: 16822318 [PubMed - indexed for MEDLINE]

[Cost of fluoridating the public water supply: a study case in the city of São Paulo, Brazil, 1985-2003]

Cad Saude Publica. 2006 Jun;22(6):1237-46

Authors: Frias AC, Narvai PC, Araújo ME, Zilbovicius C, Antunes JL

The aim of this study was to estimate the cost of fluoridating the public water supply in the city of São Paulo, Brazil, from 1985 to 2003. Cost calculation for fluoridation of the public water supply used the following: capital cost of initial installation, chemical product (hydrofluosilicic acid), system's operational cost (maintenance, electricity, and human resources), and monitoring fluoride levels. Fluoridation was effective, since there was a decrease of 73% in dental caries in 12-year-olds--mean DMF was 6.47 (6.12-6.82) in 1986, having decreased to 1.75 (1.48-2.92) in 2002. In this age group, 40% of children presented DMF = 0 in 2002. Average cost per inhabitant/year for 2003 was R$ 0.08 (USD 0.03). The accumulated cost for 18 years of implementation and maintenance of the fluoridation system was R$ 1.44 (USD 0.97) per capita.

PMID: 16751963 [PubMed - indexed for MEDLINE]

[Dental fluorosis in schoolchildren 12 and 15 years of age in Salvador, Bahia, Brazil, in 2001 and 2004]

Cad Saude Publica. 2006 Jun;22(6):1201-6

Authors: Oliveira Junior SR, Cangussu MC, Lopes LS, Soares AP, Ribeiro Ade A, Fonseca Lde A

This article compares the results of two surveys in Salvador, Bahia State, Brazil, on prevalence and severity of dental fluorosis in 12 and 15-year-olds. The article discusses the survey methodologies in relation to their sampling process, calibration of examiners, and data collection procedures, comparing the resulting differences using chi-square and 95% confidence intervals obtained with the Dean index. A total of 3,313 adolescents 12 and 15 years of age were analyzed in 2001 and 1,032 in 2004. Both surveys used examiner calibration, and the samples were population-based. In the second survey there were a higher proportion of students from public schools for both ages, as compared to 2001 (p < 0.001). There was no significant difference in the fluorosis rate at 12 years, with a prevalence of 32.64% in 2004 and 31.4% in 2001. For 15-year-olds, the prevalence in 2004 (16.83%) was lower than in 2001 (27.6%). No increase was observed in the prevalence or severity of fluorosis in Salvador from 2001 to 2004.

PMID: 16751959 [PubMed - indexed for MEDLINE]

[Declining caries rate in a municipality in northwestern São Paulo State, Brazil, 1998-2004]

Cad Saude Publica. 2006 May;22(5):1035-41

Authors: Martins RJ, Garbin CA, Garbin AJ, Moimaz SA, Saliba O

This study analyzes the DMF and DEF indices, SiC index, and percentage of caries-free public schoolchildren in the municipality of Bilac, São Paulo State, Brazil, in 1998, 2000, 2002, and 2004. The same methodology was employed (WHO-1997) in all the surveys. Kappa test was carried out at each stage, and the minimal and maximum inter-examiner agreement values obtained were 0.86 and 0.89, respectively, while minimal intra-examiner agreement values were 0.91. DEF indices decreased slightly in the years 1998 and 2004. There was a continuous reduction in the DMF index, as well as the phenomenon of polarization at 12 years of age. The rate was 5.28 in 1998, decreasing to 4.11 in 2000, 3.47 in 2002, and 2.62 in 2004. Inversely, the proportion of caries-free 5-year-olds increased from 37.9% in 1998 to 40% in 2000 and 2002 and 45.3% in 2004. In conclusion, there has been a decrease in dental caries in 12 year-old public schoolchildren in the municipality.

PMID: 16680356 [PubMed - indexed for MEDLINE]

Dental self-care and dietary characteristics of remote-living Indigenous children.

Rural Remote Health. 2006 Apr-Jun;6(2):503

Authors: Jamieson LM, Bailie RS, Beneforti M, Koster CR, Spencer AJ

INTRODUCTION: Indigenous children in remote communities carry a disproportionate amount of the dental disease burden among Australian 4-12 year-olds. However, there have been no reports of dental service use, dental self-care or dietary characteristics among remote-living Indigenous children. This information may provide insight into behaviours linked with the high levels of dental disease observed. The purpose of this study was to examine such behaviours among Indigenous children in three remote communities in the Top End of the Northern Territory of Australia. The study is part of a wider investigation involving the implementation and monitoring of water fluoridation plants in two of the communities, and the collection of clinical dental data from children in these three and other remote communities. METHODS: In 2003, small-scale fluoridation plants were installed in two remote communities (Communities A and B) in the Top End of the Northern Territory with naturally low fluoride levels in the water and with a high prevalence of child dental disease. Another community (Community C) was selected as a comparison site (natural levels of water fluoride low). A convenience sample of carers of children from all communities completed a questionnaire that sought information on carer education and their children's age, sex, use of dental services, dental self-care behaviours, dietary characteristics, household water source and water consumption. The questionnaires were administered by a project worker and community residents once consent had been obtained. Data were analysed using SPSS version vers.13.0 (SPSS Inc; Chicago, IL, USA). RESULTS: Some 214 carers completed the questionnaire for 409 children aged 4-12 years; 131 (32.0%) from Community A, 158 (38.6%) from Community B and 120 (29.3%) from Community C. The response rates for the child survey based on Census data (generally regarded as an undercount) was 55% across the three communities. Approximately one-third of carers had had no secondary schooling or could not recall their level of educational attainment. Child age was reasonably spread over the target age-range and there were no significant differences between communities by sex. Approximately one-third of children were reported to have had their teeth checked every year by a dental therapist and most children were reported to use a toothbrush. While most children were also reported to use toothpaste, only 20% of such children reportedly used it every day. Time of toothpaste use was evenly distributed between morning and evening, with a small proportion of children reportedly using it twice a day. The most common age that toothpaste use began was 4 years and most children had never taken fluoride supplements. Over three-quarters of children who reportedly consumed softdrinks, cordial, milk or flavoured milk in the evenings drank such beverages at least a few evenings each week. Over 90% of children across the three communities who reportedly drank tea, and approximately three-quarters of those who consumed sweet snacks, did so at least a few evenings each week. Almost all houses were connected to the community water supply. Most children sourced their drinking water from a tap and approximately two-thirds were reported to drink more than 4 cups of water a day. CONCLUSIONS: Our study showed there were low levels of preventive dental care, irregular use of dentrifices, negligible implementation of alternative fluoride sources, high consumption of sweetened snacks and drinks in the evenings, and almost universal connection of houses to the public water supply among remote-dwelling Indigenous children. The findings provide some insights into factors contributing to the poor and declining state of such children's dental health, and should aid in the planning and implementation of oral health promotion initiatives.

PMID: 16646637 [PubMed - indexed for MEDLINE]

Oral health beliefs in adolescence and oral health in young adulthood.

J Dent Res. 2006 Apr;85(4):339-43

Authors: Broadbent JM, Thomson WM, Poulton R

According to theory, health beliefs are related to health behaviors. We investigated whether individuals who hold favorable oral-health-related beliefs over time have better adult oral health than those who do not. Beliefs about the efficacy of water fluoridation, keeping the mouth clean, avoiding sweet foods, visiting the dentist, using dental floss, and using fluoridated toothpaste were assessed in a birth cohort at ages 15, 18, and 26 years. At each age, the majority of participants endorsed the importance of each practice. However, there was also evidence of instability across time. Individuals who held stable favorable dental beliefs from adolescence through adulthood had fewer teeth missing due to caries, less periodontal disease, better oral hygiene, better self-rated oral health, and more restorations. Dental beliefs can change between adolescence and young adulthood, and these changes are related to oral health. In particular, unfavorable dental health beliefs are related to poorer oral health.

PMID: 16567555 [PubMed - indexed for MEDLINE]

[Association between primary dental care and municipal socioeconomic indicators]

Rev Saude Publica. 2005 Dec;39(6):930-6

Authors: Fernandes LS, Peres MA

OBJECTIVE: To test associations between primary dental care indicators and municipal socioeconomic and dental service provision indicators. METHODS: An ecological study was carried out in the 293 municipalities of the State of Santa Catarina, Brazil, between 2000 and 2003. The primary dental care indicators utilized were: (1) coverage; (2) the ratio between preventive dental procedures and the size of the population aged zero to 14 years; and (3) the ratio between the numbers of extractions of permanent teeth and individual dental procedures within primary dental care. The variables investigated were: number of dentists per 1,000 inhabitants; number of dentists within the public health service per 1,000 inhabitants; fluoridation of the water supply; child development index; human development index; and the size of the population in the municipality. Analyses were performed using the Kruskall-Wallis and Chi-square tests. The Spearman test was used to evaluate correlations between the variables. RESULTS:The coverage was 21.8%, the ratio of preventive dental procedures among the population aged zero to 14 years was 0.37 and the proportion of tooth extractions in relation to the total number of individual dental procedures was 11.9 %. Lower rates of tooth extraction were associated with higher numbers of dentists within the public health service (p<0.01). Higher rates of tooth extraction were associated with lower human development indices for the municipalities (p<0.01). CONCLUSIONS: Greater coverage was associated with higher numbers of dentists within the public health system. Municipalities with worse socioeconomic conditions were associated with greater tooth extraction rates. Oral health policies must target municipalities that present worse socioeconomic indicators.

PMID: 16341403 [PubMed - indexed for MEDLINE]

The effective use of fluorides in public health.

Bull World Health Organ. 2005 Sep;83(9):670-6

Authors: Jones S, Burt BA, Petersen PE, Lennon MA

Dental caries remain a public health problem for many developing countries and for underprivileged populations in developed countries. This paper outlines the historical development of public health approaches to the use of fluoride and comments on their effectiveness. Early research and development was concerned with waterborne fluorides, both naturally occurring and added, and their effects on the prevalence and incidence of dental caries and dental fluorosis. In the latter half of the 20th century, the focus of research was on fluoride toothpastes and mouth rinses. More recently, systematic reviews summarizing these extensive databases have indicated that water fluoridation and fluoride toothpastes both substantially reduce the prevalence and incidence of dental caries. We present four case studies that illustrate the use of fluoride in modern public health practice, focusing on: recent water fluoridation schemes in California, USA; salt fluoridation in Jamaica; milk fluoridation in Chile; and the development of "affordable" fluoride toothpastes in Indonesia. Common themes are the concern to reduce demands for compliance with fluoride regimes that rely upon action by individuals and their families, and the issue of cost. We recommend that a community should use no more than one systemic fluoride (i.e. water or salt or milk fluoridation) combined with the use of fluoride toothpastes, and that the prevalence of dental fluorosis should be monitored in order to detect increases in or higher-than-acceptable levels.

PMID: 16211158 [PubMed - indexed for MEDLINE]

[Dental fluorosis in schoolchildren in a county in the mountainous region of Rio Grande do Sul State, Brazil]

Cad Saude Publica. 2005 Mar-Apr;21(2):652-5

Authors: Toassi RF, Abegg C

The aim of the present study was to determine the prevalence and severity of dental fluorosis in all schoolchildren (ages 4 to 18 years, n = 259) from the town of Santa Tereza, Rio Grande do Sul, Brazil, and to investigate associated factors. Data were obtained through a questionnaire and by means of clinical tests. Dean's index was used to determine fluorosis occurrence. Prevalence of fluorosis was 63.7%. The predominant category was very mild (43.6%), followed by mild (12.0%), moderate (7.7%), borderline (7.3%), and severe (0.4%). Approximately 85.0% of the schoolchildren currently have, or have had, access to other topical sources of fluoride. Significant associations were found between place of residence and previous or ongoing fluoride mouth rinsing and prevalence and severity of fluorosis (p < 0.05). There was also a significant association between dental fluorosis and parents' level of schooling, frequency of brushing teeth, fluoride rinsing, and use of fluoride gel (p < 0.05).

PMID: 15905927 [PubMed - indexed for MEDLINE]

Does caries in primary teeth predict enamel defects in permanent teeth? A longitudinal study.

J Dent Res. 2005 Mar;84(3):260-4

Authors: Broadbent JM, Thomson WM, Williams SM

The notion that caries in primary teeth causes developmental defects of enamel in permanent teeth has been recently revived. The research objective was to test this hypothesis through analysis of data from the Dunedin Multidisciplinary Health and Development Study, a longstanding prospective cohort study. The maxillary incisors of 663 children were assessed for existing restorations and dental caries at age five and for developmental defects of enamel at age nine. Where a primary tooth had been carious, the permanent successor was more likely to have a demarcated opacity after adjustment for gender, family socio-economic status, years of exposure to water fluoridation, trauma to primary teeth, and early loss of primary teeth (unadjusted OR = 2.3, 95% CI 1.3, 4.1; adjusted OR = 2.2, 95% CI 1.1, 4.3). These findings support a time-ordered association between dental caries in primary maxillary incisors and demarcated opacities in their permanent successors.

PMID: 15723867 [PubMed - indexed for MEDLINE]

[Variations in tooth decay rates among children 5 and 12 years old in Minas Gerais, Brazil]

Cad Saude Publica. 2005 Jan-Feb;21(1):55-63

Authors: Lucas SD, Portela MC, Mendon&#xE7;a LL

The aim of this ecological study was to analyze to what extent World Health Organization goals were met in relation to dental caries in 2000 in Minas Gerais State, Brazil, identifying factors associated with variation in DMFT and the occurrence of DMFT < or = 3 among 12-year-old children and in the percentage of caries-free 5-year-olds. Secondary data from different sources were used. Linear regression and multiple logistic regression techniques were applied to the analysis of the numerical and dichotomous dependent variables. Socioeconomic and dental services supply/utilization indicators were used as potential explanatory variables. The goals expressed by DMFT < or = 3 at 12 years and a minimum of 50% caries-free 5-year-olds were met by 37% and 9% of the State's municipalities, respectively. In general the dependent variables were associated with socioeconomic level, and no associations were identified with dental care. The results should not be generalized, but they do suggest inequities in oral health and the role played by socioeconomic factors and water fluoridation.

PMID: 15692638 [PubMed - indexed for MEDLINE]

Fluoride analysis of foods for infants and estimation of daily fluoride intake.

Bull Tokyo Dent Coll. 2004 Feb;45(1):19-32

Authors: Tomori T, Koga H, Maki Y, Takaesu Y

The mean daily fluoride intake in infants was estimated on the basis of their intake of commercial foods for infants in Japan and evaluated in order to establish the effectiveness and safety criteria for water fluoridation, which is practiced as a preventive measure for dental caries suitable in life stages from children to the elderly. Based upon the intakes of foods for infants, the mean daily fluoride intake was estimated to be 0.166 mg in infants aged 3-4 months, 0.202 mg in those aged 5-6 months, and 0.266 mg in those aged 7-8 months. The mean daily fluoride intake per kg of body weight at these ages was in the range of 0.023-0.029 mg/kg, which was about half of the standard daily fluoride intake for infants and children advocated by Ophaug et al., as 0.05-0.07 mg/kg. From our results, the daily fluoride intake of infants from foods in Japan is estimated to be equivalent to or lower than the values of previous reports in non-fluoridated areas. Consequently, our data support the argument that water fluoridation and the appropriate use of fluoride for dental caries prevention in Japan are needed on the basis of scientific criteria in terms of fluoride exposure related to food intake during tooth formation.

PMID: 15346881 [PubMed - indexed for MEDLINE]

Perceptions of desirable tooth color among parents, dentists and children.

J Am Dent Assoc. 2004 May;135(5):595-604; quiz 654-5

Authors: Shulman JD, Maupome G, Clark DC, Levy SM

BACKGROUND: As part of a large-scale fluoridation cessation study, standardized examiners assessed 8,281 school-aged children for dental fluorosis using the Thylstrup Fejerskov index, or TFI, in which scores range from 0 (no fluorosis) to 9 (severe loss of enamel with change of anatomical appearance). METHODS: Dentists, parents and children were asked to respond to a statement, "The color of these teeth (mine or my child's) is pleasing and looks nice." Agreement or disagreement with the statement was indicated on a five-level scale, with a rating of 1 representing total agreement with the reference statement. The authors used repeated-measures analysis of variance to ascertain differences in satisfaction with the esthetic appearance of the subject's tooth color across dentists', parents' and subjects' perceptions. RESULTS: Girls were more critical of their tooth color than were boys; however, parents and dentists were more critical of boys' tooth color than of girls'. While younger subjects were more critical than older subjects, parents of younger subjects were less critical than those of older subjects. Dentists' ratings were not significantly associated with subjects' age group. Subjects with a TFI score of 1 or 2 were not significantly more critical than subjects with a TFI score of 0, while those with a TFI score of 3 of higher were. Similarly, only parents of subjects with a TFI score of 3 of higher had significantly different ratings. CONCLUSIONS: The three stakeholders in the esthetic treatment of children-parents, dentists and patients-appear to see the potential outcome of such treatment differently. CLINICAL IMPLICATIONS: Dentists should ensure that parents and children agree about the course of treatment, the rationale for undertaking it and the results that could reasonably be expected.

PMID: 15202751 [PubMed - indexed for MEDLINE]

[Dental caries experience in children at public and private schools from a city with fluoridated water]

Cad Saude Publica. 2004 Mar-Apr;20(2):522-8

Authors: Hoffmann RH, Cypriano S, Sousa Mda L, Wada RS

The aim of this study was to verify the relationship between type of school as a measure of socioeconomic conditions and caries prevalence among preschoolers and schoolchildren in Rio Claro, S&#xE3;o Paulo State, Brazil, a city with fluoridated water supply. The data were secondary, from a sample of 888 children 5 to 12 years old enrolled in private and public schools. Caries was measured by the dmft and DMFT indices as well as the Care index. Qui-square and Mann-Whitney tests were utilized with 5% significance. In 5-year-old children, mean dmft was 2.50, and 42.20% were caries-free. At age 12, mean DMFT was 2.70 and 28.90% were caries-free. Caries prevalence rates in public schoolchildren as compared to private were 74.50% and 61.20%, respectively (p < 0.0001), and the dmft and DMFT scores were the highest in public schoolchildren (p < 0.05). The Care Index was higher in private schoolchildren (71.20%) as compared to public (52.80%). Highest caries rates were found among public schoolchildren, so the variable type of school proved sensitive for discriminating different oral health conditions; however limitations need to be recognized, suggesting that other variables should be assessed.

PMID: 15073632 [PubMed - indexed for MEDLINE]

Associations between Intakes of fluoride from beverages during infancy and dental fluorosis of primary teeth.

J Am Coll Nutr. 2004 Apr;23(2):108-16

Authors: Marshall TA, Levy SM, Warren JJ, Broffitt B, Eichenberger-Gilmore JM, Stumbo PJ

OBJECTIVE: We describe associations between primary tooth fluorosis status and intakes of beverages and fluoride from these beverages during infancy. METHODS: Subjects (n = 677) are members of the Iowa Fluoride Study, a cohort of young children followed from birth. Food and nutrient intakes were obtained from 3-day diet records. Diets were analyzed at 6 weeks, 3, 6, 9, 12 and 16 months and cumulatively for 6 weeks through 16 months of age. Primary tooth fluorosis was assessed at 4.5-6.9 years of age and defined as present or absent. Multiple logistic regression analyses were used to develop models to predict fluorosis status. RESULTS: Water-based beverage intakes were higher in subjects with fluorosis than in those without. Specifically, higher intakes of water used to reconstitute formulas at 3, 6 and 9 months; any intake of water as a beverage at 16 months; and higher intakes of combined 100% juice and miscellaneous beverages at 16 months were positively associated with fluorosis (p < 0.05). Fluoride intakes from water sources were also higher in subjects with fluorosis than in those without. Specifically, higher intakes of fluoride from water used to reconstitute formulas at 3, 6, 9 and 12 months and for 6 weeks through 16 months, and higher intakes of fluoride from water as a beverage at 16 months and for 6 weeks through 16 months were positively associated with fluorosis (p < 0.05). CONCLUSION: Infant beverages, particularly infant formulas prepared with fluoridated water, can increase the risk of fluorosis in primary teeth.

PMID: 15047676 [PubMed - indexed for MEDLINE]

[Association of the DMFT index with socioeconomic and dental services indicators in the state of Paraná, Brazil]

Cad Saude Publica. 2004 Jan-Feb;20(1):143-52

Authors: Baldani MH, Vasconcelos AG, Antunes JL

This ecological study investigated the associations between dental caries, socioeconomic indicators, and the supply of dental services in the State of Paraná, Brazil, for the year 1996. Two types of information were collected: (1) data on caries prevalence (DMFT at 12 years) for the municipalities (or counties) in the State; (2) data on socioeconomic conditions and the supply of dental services. Based on simple linear regression analysis, the study demonstrated a significant correlation between the caries index in municipalities and various social and dental services supply indicators. Results of the analysis of multiple linear regression showed that one indicator of income inequality remained significantly associated with dental caries, demonstrating that the worst oral health conditions cannot be dissociated from income disparities. A significant negative correlation was observed between DMFT and the proportion of the population that received fluoridated water, principally in the municipalities with the worst income inequality indicators. This highlights the importance of fluoridation for the reduction of caries rates, as well as to attenuate the impact of socioeconomic inequalities on the prevalence of dental caries.

PMID: 15029315 [PubMed - indexed for MEDLINE]

The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994.

J Am Dent Assoc. 2004 Jan;135(1):55-66

Authors: Dye BA, Shenkin JD, Ogden CL, Marshall TA, Levy SM, Kanellis MJ

BACKGROUND: As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children. METHODS: The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years. RESULTS: The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth. CONCLUSION: Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children. PRACTICE IMPLICATIONS: Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

PMID: 14959875 [PubMed - indexed for MEDLINE]

[Oral health of schoolchildren residing in areas with or without water fluoridation in Sorocaba, São Paulo State, Brazil]

Cad Saude Publica. 2003 Jul-Aug;19(4):1063-71

Authors: Cypriano S, Pecharki GD, de Sousa Mda L, Wada RS

This study describes dental caries data and fluorosis in seven municipalities in the Sorocaba region, S o Paulo State, Brazil, comparing those with fluoridated as opposed to non-fluoridated water. Criteria were those proposed by the World Health Organization (WHO, 1997), adapted by the School of Public Health, University of S o Paulo. The sample was selected at random, without replacement, and was calculated by age, accepting a design error of 2 and a sampling loss of 20% (n = 96 per age). There were six trained examiners, with accepted agreement percentage above 89% for all variables. In the Sorocaba region, the dmft index in 5 year-old children was 3.1, and 37.6% were caries-free (DMFT = 0). At age 12, 32.3% were caries-free (DMFT = 0), and the DMFT index in the region was 2.6, thus characterizing the area as having a low prevalence of caries. In areas with fluoridated water, the proportion of caries-free children at 12 years was higher than in those without fluoridated water (p = 0.019), and the DMFT was lower (p = 0.001). Prevalence of fluorosis at age 12 was 12.7% in the Sorocaba area and did not pose a public health problem according to the community fluorosis index (CFI).

PMID: 12973571 [PubMed - indexed for MEDLINE]

Addressing disparities in children's oral health: a dental-medical partnership to train family practice residents.

J Dent Educ. 2003 Aug;67(8):886-95

Authors: Mouradian WE, Schaad DC, Kim S, Leggott PJ, Domoto PS, Maier R, Stevens NG, Koday M

Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Family-centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested.

PMID: 12959162 [PubMed - indexed for MEDLINE]

Water fluoridation in Ireland--a success story.

J Dent Res. 2003 May;82(5):334-7

Authors: Clarkson J, McLoughlin J, O'Hickey S

PMID: 12709497 [PubMed - indexed for MEDLINE]

[Polarization of dental caries in a city without fluoridated water]

Cad Saude Publica. 2003 Jan-Feb;19(1):237-43

Authors: Cardoso L, R&#xF6;sing C, Kramer P, da Costa CC, da Costa Filho LC

Increased overall exposure of the Brazilian population to fluoridated water and fluoridated dentifrices has been identified as the main factor in the reduction of caries prevalence. Thus, the objective of the present study was to evaluate the distribution of caries in a group of 437 children ranging from 6 to 12 years of age, residing in a city without a water supply fluoridation system and without a preventive dentistry program, with the aim of orienting future health measures towards improved cost-effectiveness. Clinical examination was performed on all the children, focusing on the indices defs (decayed, extracted, and filled primary dentition surfaces) and DMFS (decayed, missing, and filled permanent dentition surfaces), representing the number of dental surfaces that were either decayed, missing or with extraction indicated, or restored. Analysis of accumulated disease frequency in relation to the population showed that 37% of the children presented 70% of all the tooth disease, with a mean defs + DMFS of 28.6. This distribution demonstrates the phenomenon of polarization, in which most of the disease and treatment needs are concentrated in a small portion of the population.

PMID: 12700803 [PubMed - indexed for MEDLINE]

Fluorosis development in seven age cohorts after an 11-month break in water fluoridation.

J Dent Res. 2003 Jan;82(1):64-8

Authors: Burt BA, Keels MA, Heller KE

This study used an 11-month break in water fluoridation to identify the time when developing incisors are most sensitive to fluorosis development. The study was based in Durham, NC, where an interruption to water fluoridation occurred between September, 1990, and August, 1991. A total of 1896 children was dentally examined. Fluorosis was measured by the TF index, and parents or guardians completed a questionnaire on demographics and fluoride history. Age cohorts ranged from those born 5 years before the break, to those born 1 year after the resumption of fluoridation. Fluorosis prevalence for seven age cohorts whose birth years ranged from 1985-86 to 1991-92 was 57.1, 62.3, 33.0, 32.3, 39.8, 30.2, and 36.8%, respectively. Children aged from birth to 3 years at the break, and those born 1 year after it, had less fluorosis than those aged 4-5 years at the break.

PMID: 12508048 [PubMed - indexed for MEDLINE]

[Self-perception of fluorosis due to fluoride exposure to drinking water and dentifrice]

Rev Saude Publica. 2002 Dec;36(6):752-4

Authors: de Menezes LM, de Sousa Mda L, Rodrigues LK, Cury JA

The impact of dental fluorosis in children exposed to fluoride in drinking water and dentifrice was evaluated. Dental fluorosis was found in 72% of the children, but the children's well-being was not affected. It was concluded that although dental fluorosis due to the intake of optimally fluoridated drinking water and dentifrice did not affect the dental aesthetics of this studied population sample, there is a need of further studies on the subject.

PMID: 12488944 [PubMed - indexed for MEDLINE]

Fluorosis: is it really a problem?

J Am Dent Assoc. 2002 Oct;133(10):1405-7

Authors: Bowen WH

BACKGROUND: Scientists have noted an association between mottled enamel and fluoride exposure since the early 1900s. By the mid-1900s, they also recognized that fluoride intake was related to lower caries incidence. To harness the protective effect of fluoride while limiting the occurrence of fluorosis, dental researchers have recommended that the fluoride level in chinking water be 1 part per million or less. OVERVIEW: Despite the recognition that fluoride levels in water can be controlled to offer caries protection with minimal risk of fluorosis, the cosmetic defect continues to appear. However, although the word "fluorosis" conjures up images of brown stained and pitted enamel, such severe cases rarely are seen in the United States. Children in this country are exposed to fluoride from numerous sources and the appearance of mild fluorosis is not unusual. CONCLUSIONS AND PRACTICE IMPLICATIONS: In most cases, fluorosis is a minor cosmetic defect that should not be cause for alarm. Dentists should educate their patients about the optimal range of fluoride intake for caries protection, sources of fluoride and the possibility of fluorosis.

PMID: 12403544 [PubMed - indexed for MEDLINE]

[An epidemiological profile of dental caries in 12-year-old children residing in cities with and without fluoridated water supply in the central western area of the State of São Paulo, Brazil]

Cad Saude Publica. 2002 Sep-Oct;18(5):1281-8

Authors: Sales-Peres SH, Bastos JR

This study aimed to analyze the epidemiological profile of dental caries in the central western region of the State of São Paulo, Brazil, focusing on 12-year-old children by gender, comparing the DMFT index in fluoridated and non-fluoridated cities. The study used data from the Epidemiological Surveys in the State of São Paulo, 1998, pertaining to the 10th Regional Health Directorate, including 8 cities. The sample consisted of 485 schoolchildren, both boys and girls, distributed by city. In Pederneiras (a medium-sized city with a fluoridated water supply), DMFT was 7.06, higher than the Brazilian national mean for 1986. Boys showed a higher prevalence of dental caries than girls, showing a new trend for dental caries in the region. There was no statistically significant difference between DMFT in municipalities of the same size, regardless of the presence or absence of fluoride in the water supply, thus suggesting a "convergence" phenomenon, possibly due to the intake of other sources of fluoride and the presence of a "halo" effect. Prevalence of caries in the region was "high", with a DMFT of 4.82, thus failing to reach the goals set for the year 2000.

PMID: 12244360 [PubMed - indexed for MEDLINE]

Trends in caries among adults 18 to 45 years old.

J Am Dent Assoc. 2002 Jul;133(7):827-34

Authors: Brown LJ, Wall TP, Lazar V

BACKGROUND: This article focuses on changes in the caries status of adults 18 to 45 years old in the United States during the periods of 1971-1974 (the First National Health and Nutrition Examination Survey, or NHANES I) and 1988-1994 (the Third National Health and Nutrition Examination Survey, or NHANES III). METHODS: Using data from NHANES I and NHANES III, the authors based this study on analyses of data regarding the trends in total caries, untreated caries and filled caries among adults 18 to 45 years old. RESULTS: There was a decrease of 27.26 percent in the total number of carious surfaces among adults aged 18 to 45 years, or a decline from 38.30 surfaces in NHANES I to 27.86 surfaces in NHANES III. The number of untreated caries also declined from 3.64 to 1.82, a decrease of 50.0 percent. CONCLUSIONS: These caries improvements may be associated with birth cohort effects. Young adults 18 to 25 years old in NHANES I grew up before widespread fluoridation, while people the same age in NHANES III grew up when fluoridation and preventive dentistry were more widely available. Practice Implications. The reduction in caries previously demonstrated in children has extended to adults. The impact is a decline in the need for restorative dentistry.

PMID: 12148675 [PubMed - indexed for MEDLINE]

[Dental fluorosis in Brazil: a critical review]

Cad Saude Publica. 2002 Jan-Feb;18(1):7-15

Authors: Cangussu MC, Narvai PC, Castellanos Fernandez R, Djehizian V

This paper discusses dental fluorosis as a relevant public health problem, using a review of epidemiological studies published in the last 10 years on the disease's prevalence, severity, and risk factors. The results suggest that there are already more cases than expected, although few studies refer to major severity. Thus, measures are needed for the prevention and surveillance of dental fluorosis.

PMID: 11910420 [PubMed - indexed for MEDLINE]

Populations receiving optimally fluoridated public drinking water--United States, 2000.

MMWR Morb Mortal Wkly Rep. 2002 Feb 22;51(7):144-7

Authors:

Dental caries (i.e., tooth decay) is a transmissible, multifactor disease that affects 50% of children aged 5-9 years, 67% of adolescents aged 12-17 years, and 94% of adults aged > or = 18 years in the United States. During the second half of the 20th century, a major decline in the prevalence and severity of dental caries resulted from the identification of fluoride as an effective method of preventing caries. Fluoridation of the public water supply is the most equitable, cost-effective, and cost-saving method of delivering fluoride to the community. In the United States during 2000, approximately 162 million persons (65.8% of the population served by public water systems) received optimally fluoridated water compared with 144 million (62.1%) in 1992. This report presents state-specific data on the status of water fluoridation in the United States and describes a new surveillance system designed to routinely produce state and national data to monitor fluoridation in the public water supply. The results of this report indicate slow progress toward increasing access to optimally fluoridated water for persons using public water systems. Data from the new surveillance system can heighten public awareness of this effective caries prevention measure and can be used to identify areas where additional health promotion efforts are needed.

PMID: 11905481 [PubMed - indexed for MEDLINE]

Prevalence and trends in enamel fluorosis in the United States from the 1930s to the 1980s.

J Am Dent Assoc. 2002 Feb;133(2):157-65

Authors: Beltr&#xE1;n-Aguilar ED, Griffin SO, Lockwood SA

BACKGROUND: The National Survey of Dental Caries in U.S. School Children: 1986-1987 conducted by the National Institute of Dental Research, or NIDR, remains the only source of national data about the prevalence of enamel fluorosis. The authors analyze these data and describe changes in the prevalence of enamel fluorosis since the 1930s, as reported by H. Trendley Dean. METHODS: A sample of children comparable to those described in the 1930s was selected from the NIDR data set among children living in households served by public water systems during the child's first eight years of life. The type of water system (that is, natural, optimal and suboptimal) for each household had been recorded in the NIDR data set using data from the 1985 U.S. Fluoridation Census. The NIDR data set included information about the children's history of fluoride exposure obtained from parents. RESULTS: In the 1986-1987 period, the prevalence of enamel fluorosis (ranging from very mild to severe) was 37.8 percent among children living in residences with natural fluoride (0.7 to 4.0 parts per million fluoride ions, or F-), 25.8 percent in the optimal fluoride group (0.7 to 1.2 ppm F- and 15.5 percent in the suboptimal fluoride group (< 0.7 ppm F-). The largest increase in fluorosis prevalence from the 1930s to the 1980s was in the suboptimal fluoride group (6.5 to 15.5 percent). CONCLUSIONS AND CLINICAL IMPLICATIONS: Exposure to multiple sources of fluoride may explain the increase in enamel fluorosis from the 1930s to the 1980s. The exposure to fluoride from sources such as dietary supplements has decreased since the 1980s because of reductions in the recommended dosage, but these changes occurred too late to have an effect on the study cohort. Evidence of simultaneous use of systemic fluorides indicates the need to reinforce guidelines for the appropriate use of fluorides and promote research on measuring total fluoride exposure.

PMID: 11868834 [PubMed - indexed for MEDLINE]

[Fluoride intake by children from water and dentifrice]

Rev Saude Publica. 2001 Dec;35(6):576-81

Authors: Lima YB, Cury JA

OBJECTIVE: To determine the total fluoride dose to which children were exposed during the critical age of developing dental fluorosis, in an optimally fluoridated region, having diet (liquids and solids) and dentifrice as fluoride sources. METHODS: For the pilot study, 39 children (aged 20 to 30 months) were selected from a day care center in Piracicaba, Brazil. They drank and ate food prepared with fluoridated water. To determine the total dose of fluoride exposure, duplicate-plate samples and products from tooth brushing were collected for two consecutive days, in four periods of the year. Fluoride was determined using an ion specific electrode. A 5% level of significance variance analysis (Anova) was carried out. RESULTS: Children were exposed to a total fluoride dose of 0.090 mg/day/kg of body weight, of which 45% came from the diet and 55% from dentifrice. CONCLUSIONS: Assuming 0.07 mg/kg as a threshold value of fluoride systemic exposure, children were exposed to a risk dose for dental fluorosis. Thus, measures to reduce fluoride intake at the studied age range would be recommended. Reducing the amount of dentifrice used for tooth brushing seems to be the best measure, given the risk/benefits of fluoride use from the public health perspective.

PMID: 11799472 [PubMed - indexed for MEDLINE]

Founders' and Benefactors' lecture 2001. Preventing the preventable--the enigma of dental caries.

Br Dent J. 2001 Nov 10;191(9):478-82, 485-8

Authors: Rugg-Gunn A

PMID: 11726061 [PubMed - indexed for MEDLINE]

An Oral Health Survey in Southern China, 1997: background and methodology.

J Dent Res. 2001 May;80(5):1453-8

Authors: Schwarz E, Zhang HG, Wang ZJ, Lin HC, Lo EC, Corbet EF, Wong MC

Relatively limited information is available about the oral health in the Guangdong Province of Southern China, the closest neighbor to Hong Kong. The study intended to explore the oral health status, knowledge, attitudes, and dental care utilization in the Guangdong population as a basis for formulating strategies for oral health prevention and treatment. Through multi-stage stratified and quota-sampling, individuals from urban as well as rural communities were selected (5- to 6-; 12-; 35- to 44-; and 65- to 74-year-olds; total N = 6251). Structured interviews and clinical examinations were performed. Inter-examiner reliability was high (kappa = 0.60-0.96). Samples of community water were taken for fluoride assessment. Overall, the sample surveyed was acceptably representative of the population, with some under-representation of rural residents and agricultural workers. Re-weighting was performed in appropriate analyses. The data analysis model used in the Second International Collaborative Study was used as a guide for the present data analysis. This approach has not previously been used on a Mainland Chinese population.

PMID: 11437219 [PubMed - indexed for MEDLINE]

The impact of universal access to dental care on disparities in caries experience in children.

J Am Dent Assoc. 2001 Mar;132(3):295-303

Authors: Ismail AI, Sohn W

BACKGROUND: The authors investigated the association between socioeconomic status and the severity of dental caries in 6- and 7-year-old children who had had access to dental care throughout their lives. The children had lived since birth in Nova Scotia, Canada, a province with a universal publicly financed dental care program. METHODS: The authors selected a representative sample of first-grade children using a stratified multistage sampling method of primary schools (n = 1,614). The response rate was 78.8 percent. Two dentists were trained to diagnose dental caries using modified World Health Organization criteria. Intra- and interexaminer reliability was excellent (kappa > or = 0.88). Of the children who were examined (n = 1,271), 955 were lifelong residents of Nova Scotia, Canada, and so were included in this analysis. Data were weighted and adjusted for clustering (design) effects. RESULTS: Only 8.4 percent of the children had visited a dental office before the age of 2 years, and 88.5 percent of the children had their first dental visit between the ages of 2 and 5 years. Children whose parents had completed a university education had a significantly lower mean number of decayed, missing and filled surfaces, or dmfs, in their primary teeth than did children whose parents had a lower education level. A Poisson regression model indicated that parents' high education status, optimal fluoride concentration in schools' water supplies, daily toothbrushing and dental visits for checkup were significantly associated with low dmfs scores. CONCLUSION: Having access to a universal publicly financed dental insurance program since birth did not eliminate the disparities in caries experience. PRACTICE IMPLICATIONS: This analysis of a highly utilized universal dental insurance program suggests that disparities in oral health status cannot be reduced solely by providing universal access to dental care. Focused efforts by professional and governmental organizations should be directed toward understanding the socioeconomic, behavioral and community determinants of oral health disparities.

PMID: 11258086 [PubMed - indexed for MEDLINE]

Community socioeconomic status and children's dental health.

J Am Dent Assoc. 2001 Feb;132(2):216-22

Authors: Gillcrist JA, Brumley DE, Blackford JU

BACKGROUND: Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children. METHODS: An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation. RESULTS: Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities. CONCLUSION: The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES. PRACTICE IMPLICATIONS: Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.

PMID: 11217596 [PubMed - indexed for MEDLINE]

Systematic review of water fluoridation.

BMJ. 2000 Oct 7;321(7265):855-9

Authors: McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J

OBJECTIVE: To review the safety and efficacy of fluoridation of drinking water. DESIGN: Search of 25 electronic databases and world wide web. Relevant journals hand searched; further information requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. MAIN OUTCOME MEASURES: Decayed, missing, and filled primary/permanent teeth. Proportion of children without caries. Measure of effect was the difference in change in prevalence of caries from baseline to final examination in fluoridated compared with control areas. For potential adverse effects, all outcomes reported were used. RESULTS: 214 studies were included. The quality of studies was low to moderate. Water fluoridation was associated with an increased proportion of children without caries and a reduction in the number of teeth affected by caries. The range (median) of mean differences in the proportion of children without caries was -5.0% to 64% (14.6%). The range (median) of mean change in decayed, missing, and filled primary/permanent teeth was 0.5 to 4.4 (2.25) teeth. A dose-dependent increase in dental fluorosis was found. At a fluoride level of 1 ppm an estimated 12.5% (95% confidence interval 7.0% to 21.5%) of exposed people would have fluorosis that they would find aesthetically concerning. CONCLUSIONS: The evidence of a beneficial reduction in caries should be considered together with the increased prevalence of dental fluorosis. There was no clear evidence of other potential adverse effects.

PMID: 11021861 [PubMed - indexed for MEDLINE]

Intra-oral distribution of dental fluorosis in Newburgh and Kingston, New York.

J Dent Res. 2000 Jul;79(7):1508-13

Authors: Kumar J, Swango P, Haley V, Green E

Previous studies of intra-oral distribution of dental fluorosis in low-fluoride areas reported that teeth that formed later in life were more frequently affected compared with the early-forming teeth. The steady increase of plasma fluoride with age, even under constant fluoride exposure, has been suggested as a possible mechanism for this clinical manifestation. To determine the intra-oral distribution of Dean's Index scores and the effect of fluoride exposure on early- and late-forming teeth, we analyzed data collected on 2193 seven- to 14-year-old lifelong residents of fluoridated or non-fluoridated areas. Logistic regression procedures were used to determine the effects of fluoridation, early brushing, daily supplements, and other socio-demographic variables on early- and late-forming teeth. The results show that the occurrence of very mild or greater levels of fluorosis in the upper anterior teeth was 7 to 10% in the fluoridated area and 5 to 9% in the nonfluoridated area. In the fluoridated area, the occurrence of fluorosis increased from anterior to posterior teeth. Both early- and late-forming teeth were affected by exposure to fluoridation, daily fluoride supplement use, or brushing before the age of two years. This analysis showed that the esthetic consequence of exposure to multiple sources of fluoride was less dramatic, as evidenced by the lower frequency in upper anterior teeth compared with posterior teeth. The longer maturation process of the posterior teeth and the thicker enamel appear to be the likely explanation for the higher occurrence of dental fluorosis in posterior teeth.

PMID: 11005736 [PubMed - indexed for MEDLINE]

Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional.

J Am Dent Assoc. 2000 Jun;131(6):746-55

Authors: Pendrys DG

BACKGROUND: Few studies have evaluated the impact of specific fluoride sources on the prevalence of enamel fluorosis in the population. The author conducted research to determine attributable risk percent estimates for mild-to-moderate enamel fluorosis in two populations of middle-school-aged children. METHODS: The author recruited two groups of children 10 to 14 years of age. One group of 429 had grown up in nonfluoridated communities; the other group of 234 had grown up in optimally fluoridated communities. Trained examiners measured enamel fluorosis using the Fluorosis Risk Index and measured early childhood fluoride exposure using a questionnaire completed by the parent. The author then calculated attributable risk percent estimates, or the proportion of cases of mild-to-moderate enamel fluorosis associated with exposure to specific early fluoride sources, based on logistic regression models. RESULTS: In the nonfluoridated study sample, sixty-five percent of the enamel fluorosis cases were attributed to fluoride supplementation under the pre-1994 protocol. An additional 34 percent were explained by the children having brushed more than once per day during the first two years of life. In the optimally fluoridated study sample, 68 percent of the enamel fluorosis cases were explained by the children using more than a pea-sized amount of toothpaste during the first year of life, 13 percent by having been inappropriately given a fluoride supplement, and 9 percent by the use of infant formula in the form of a powdered concentrate. CONCLUSIONS: Enamel fluorosis in the nonfluoridated study sample was attributed to fluoride supplementation under the pre-1994 protocol and early toothbrushing behaviors. Enamel fluorosis in the optimally fluoridated study sample was attributed to early toothbrushing behaviors, inappropriate fluoride supplementation and the use of infant formula in the form of a powdered concentrate. CLINICAL IMPLICATIONS: By advising parents about the best early use of fluoride agents, health professionals play an important role in reducing the prevalence of clinically noticeable enamel fluorosis.

PMID: 10860326 [PubMed - indexed for MEDLINE]

The effects of a break in water fluoridation on the development of dental caries and fluorosis.

J Dent Res. 2000 Feb;79(2):761-9

Authors: Burt BA, Keels MA, Heller KE

Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children. Study participants were continuously-resident children in Kindergarten through Grade 5 in Durham's elementary schools. There were 1696 children, 81.4% of those eligible, for whom a questionnaire was completed and clinical data recorded. Age cohorts were defined by a child's age at the time that fluoridation ceased. Caries was recorded in children in the Birth Cohort through Cohort 3, and fluorosis for children in Cohorts 1 through 5. Caries was assessed in the primary first and second molars according to the decayed-filled index; fluorosis on the labial surfaces of the upper permanent central and lateral incisors was assessed by the Thylstrup-Fejerskov (TF) index. Mother's education was associated with caries; higher education of the mother had an odds ratio of 0.53 (95% CI 0.40, 0.76) for caries in the child. No cohort effects could be discerned for caries. Overall prevalence of fluorosis was 44%. Prevalence in Cohorts 1, 2, 3, 4, and 5 was 39.8%, 32.3%, 33.0%, 62.3%, and 57.1%, respectively. These cohort differences remained statistically significant in regression analysis. It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years.

PMID: 10728978 [PubMed - indexed for MEDLINE]

Streptococcus mutans, early childhood caries and new opportunities.

J Am Dent Assoc. 1999 Dec;130(12):1787-92

Authors: Slavkin HC

PMID: 10599184 [PubMed - indexed for MEDLINE]

Water fluoridation and costs of Medicaid treatment for dental decay--Louisiana, 1995-1996.

MMWR Morb Mortal Wkly Rep. 1999 Sep 3;48(34):753-7

Authors:

Treatment costs for dental decay in young children can be substantial, especially if extensive dental procedures and general anesthesia in a hospital operating room (OR) are needed. Because caries in the primary dentition disproportionately affect children from low-income households, the cost for care frequently is reimbursed by state Medicaid programs. To determine whether the average treatment cost for Medicaid-eligible children in Louisiana differed by community fluoridation status, the Louisiana Department of Health and Hospitals (LDHH) and CDC analyzed Medicaid dental reimbursements and Medicaid eligibility records from July 1995 through June 1996 for children aged 1-5 years. Findings suggest that Medicaid-eligible children in communities without fluoridated water were three times more likely than Medicaid-eligible children in communities with fluoridated water to receive dental treatment in a hospital OR, and the cost of dental treatment per eligible child was approximately twice as high.

PMID: 10499787 [PubMed - indexed for MEDLINE]

The effect of water fluoridation and social inequalities on dental caries in 5-year-old children.

Int J Epidemiol. 1999 Apr;28(2):300-5

Authors: Riley JC, Lennon MA, Ellwood RP

BACKGROUND: Many studies have shown that water fluoridation dramatically reduces dental caries, but the effect that water fluoridation has upon reducing dental health inequalities is less clear. The aim of this study is to describe the effect that water fluoridation has upon the association between material deprivation and dental caries experience in 5-year-old children. METHODS: It is an ecological descriptive study of dental caries experience using previously obtained data from the British Association for the Study of Community Dentistry's biennial surveys of 5-year-old children. This study examined the following data from seven fluoridated districts and seven comparable non-fluoridated districts in England: 1) dental caries experience using the dmft (decayed, missing, filled teeth) index; 2) the Townsend Deprivation Index of the electoral ward in which the child lived; 3) whether fluoride was present at an optimal concentration in the drinking water or not. RESULTS: A statistically significant interaction was observed between material deprivation (measured by the Townsend Deprivation Index) and water fluoridation (P < 0.001). This means that the social class gradient between material deprivation and dental caries experience is much flatter in fluoridated areas. CONCLUSION: Water fluoridation reduces dental caries experience more in materially deprived wards than in affluent wards and the introduction of water fluoridation would substantially reduce inequalities in dental health.

PMID: 10342695 [PubMed - indexed for MEDLINE]

Fluorosis of the primary dentition: what does it mean for permanent teeth?

J Am Dent Assoc. 1999 Mar;130(3):347-56

Authors: Warren JJ, Kanellis MJ, Levy SM

BACKGROUND: The prevalence of fluorosis of the permanent teeth has increased during the past few decades in the United States and Canada. However, primary-tooth fluorosis has been largely overlooked, because it is often difficult to recognize. This article describes primary-tooth fluorosis, both as characterized in the literature and as seen clinically. METHODS: The authors review and summarize previous studies of primary-tooth fluorosis and discuss its etiology. In addition, the authors describe the condition, based on findings from the literature, and their own experiences in characterizing it as part of a longitudinal investigation of fluoride exposures, dental fluorosis and dental caries. RESULTS: Several studies indicate that primary-tooth fluorosis can be prevalent and severe in areas of very high water fluoride concentrations. In these areas, primary-tooth fluorosis is likely the result of both pre- and postnatal exposures. Studies have documented that primary-tooth fluorosis does occur in areas with optimal or suboptimal water fluoride concentrations, and that in these settings primary-tooth fluorosis is most likely caused by postnatal exposures and is seen most commonly in the primary molars. Primary-tooth fluorosis, however, is often more difficult to identify than fluorosis in permanent teeth, and clinicians may be unfamiliar with its characteristics and may not recognize its somewhat subtle appearance. CONCLUSIONS: Primary-tooth fluorosis may be related to occurrence of fluorosis in the permanent dentition, so that its recognition by the clinician should raise awareness of possible increased risk for the permanent dentition. CLINICAL IMPLICATIONS: The detection of primary-tooth fluorosis in a young child should prompt the clinician to carefully review the child's past fluoride exposures and current fluoride practices, as well as those of any younger siblings.

PMID: 10085657 [PubMed - indexed for MEDLINE]

Changes in dental fluorosis and dental caries in Newburgh and Kingston, New York.

Am J Public Health. 1998 Dec;88(12):1866-70

Authors: Kumar JV, Swango PA, Lininger LL, Leske GS, Green EL, Haley VB

OBJECTIVES: This study sought to determine whether the prevalence of dental fluorosis and dental caries had changed in a fluoridated community and a nonfluoridated community since an earlier study conducted in 1986. METHODS: Dental fluorosis and dental caries data were collected on 7- to 14-year-old lifelong residents (n = 1493) of Newburgh and Kingston, NY. RESULTS: Estimated dental fluorosis prevalence rates were 19.6% in Newburgh and 11.7% in Kingston. The greatest disparity in caries scores was observed between poor and nonpoor children in nonfluoridated Kingston. CONCLUSIONS: The prevalence of dental fluorosis has not declined in Newburgh and Kingston, whereas the prevalence of dental caries has continued to decline.

PMID: 9842391 [PubMed - indexed for MEDLINE]

Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers' decision to reduce the fluoride concentration of infant formula.

Am J Epidemiol. 1998 Nov 15;148(10):967-74

Authors: Pendrys DG, Katz RV

This case-control study investigated risk factors for enamel fluorosis in optimally fluoridated children, born after the US infant formula industry voluntarily reduced the fluoride content of their products. Analysis was performed on 233 children, aged 10-14 years. Case-control status was determined using the Fluorosis Risk Index (FRI). Risk factor exposure was ascertained via a mailed questionnaire. Logistic regression analyses revealed a strong association between mild-to-moderate enamel fluorosis on early forming (FRI classification I) enamel surfaces and both fluoride supplement use (odds ratio (OR)=5.95, 95% confidence interval (CI) 1.06-33.53), and early fluoride toothpaste use (OR=6.35, 95% CI 1.21-33.40). The authors found a suggestive, but nonsignificant, association between fluorosis on these enamel surfaces and infant formula in the form of powdered concentrate (OR=4.33, 95% CI 0.73-25.66). There was a strong association between mild-to-moderate fluorosis on later forming (FRI classification II) enamel surfaces and infant formula use in the form of powdered concentrate (OR=10.77, 95% CI 1.89-61.25), fluoride supplement use (OR=10.83, 95% CI 1.90-61.55), and early fluoride toothpaste use (OR=8.37, 95% CI 1.68-41.72). No association was observed between the use of ready to feed infant formula and enamel fluorosis.

PMID: 9829868 [PubMed - indexed for MEDLINE]