Dental caries of lifetime residents in Baixo Guandu, Brazil, fluoridated since 1953--a brief communication

OBJECTIVES: This study aimed to verify the dental caries prevalence in Baixo Guandu, the first Brazilian city to fluoridate its public water supplies; to compare the findings with the data from the national survey; and also to compare the prevalence in the 12-year-old age group with the data obtained before the beginning of the fluoridation. METHODS: All the lifetime residents aged 5, 12, 15 to 19, and 35 to 44 years old were clinically examined (World Health Organization). RESULTS: The means of dmft/DMFT were lower than in the Brazilian population living in fluoridated communities. The DMFT Index in 12-year-old residents decreased between 1953 and 2005 from 8.61 to 1.55. CONCLUSIONS: The addition of fluoride to public water supplies was an important ally in the improvement of the oral health of Baixo Guandu inhabitants.     

Drinking Water Fluoride Levels, Dental Fluorosis, and Caries Experience in Brazil

Objectives : The main aim of this study was to consider the association between water fluoride levels and caries prevalence in three Brazilian populations. Methods : A total of 457 6–12-year-old lifetime residents from three economically deprived groups with 2–3, 0.7, and less than 0.01 ppm F in their water supplies were examined. Dental caries was recorded on permanent upper central incisors and first molars and all primary teeth (dmft). Results : There was a significant trend ( P <.01) for the mean dmft to decrease with increasing levels of fluoride in the drinking water. Caries experience in the six permanent teeth was significantly lower ( P <.01) in the area with 0.7 ppm F than in the other two groups. For the 2–3 ppm F group significantly more caries was found in subjects with higher TF scores ( P <.05). Conclusion : Optimization of fluoride levels in the drinking water remains a valuable dental public health measure in Brazil.     

Measuring inequalities in the distribution of dental caries

Abstract – Objectives: To evaluate different measurements of prevalence and inequality in the distribution of dental caries as to their partial collinearity, and ability in expressing associations with the supply of fluoridated tap water, indices of socioeconomic status and provision of dental services. Methods: The DMFT, the Significant Caries (SiC) Index, the proportions of children with high- (DMFT ≥ 4) and rampant- (DMFT ≥ 7) caries experience, caries-free children (DMFT = 0), the Gini coefficient and the Dental Health Inequality Index (DHII) were the dental outcomes appraised in a sample comprising 18 718 oral examination records for 11- and 12-year-old schoolchildren in 131 towns of the state of São Paulo, Brazil. Spatial data analysis assessed the association between aggregate figures of dental indices and several covariates. Results: The DMFT, the SiC Index and the proportions of children with high- and rampant-caries experience presented strong linear associations (Pearson r near or higher than 0.95), and an analogous profile of correlation with indicators of socioeconomic status, dental services and access to fluoride tap water. The same was observed for the DHII, the Gini coefficient and the proportion of caries-free children. These observations involve the perception of variables in each set as interchangeable tools for ecological studies assessing factors influencing, respectively, prevalence levels and inequality in the distribution of dental disease. Conclusion: An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.     

Dental caries and enamel fluorosis among the fluoridated and non-fluoridated populations in the Republic of Ireland in 2002

BACKGROUND: A national survey of oral health of children and adolescents was carried out in the Republic of Ireland (RoI) in 2001/2002. AIMS: To compare the prevalence of caries between child and adolescent residents in fluoridated and non-fluoridated communities in the RoI whilst controlling for disadvantage. To compare caries levels amongst disadvantaged and non-disadvantaged groups with and without water fluoridation. To report the changes in caries levels between the 1960s and 2002 in RoI. To report the changes in dental fluorosis levels between 1984 and 2002. METHODOLOGY: Cross sectional oral health survey of a representative, random, stratified sample of 17,851 5-, 8-, 12- and 15-year-old children and adolescents in RoI. WHO examination criteria with the addition of visible, non-cavitated dentine caries were used for recording caries. Fluorosis was measured using Dean's Index. RESULTS: In the RoI the mean dmft/DMFT scores for 5-, 8-, 12-, and 15-year-olds were 1.2, 0.3, 1.1 and 2.3. For those with domestic water fluoridation since birth the scores were 1.0, 0.3, 1.1 and 2.1 respectively. In non-fluoridated areas of RoI the mean dmft/DMFT scores for 5-, 8-, 12-, and 15-year-olds was 1.7, 0.3, 1.3 and 3.2, respectively. For 5-, 12- and 15-year-old age groups dental caries levels were lower amongst children with fluoridated domestic water supplies (all p<0.0001). The prevalence of dental fluorosis has increased in RoI since 1984. 23% and 36% of 8- and 15-year olds respectively in fluoridated areas had Dean's Index scores at the questionable or greater level in 2002, compared with 6% and 5% respectively in 1984. CONCLUSIONS: Caries levels are lower among children with fluoridated domestic water supplies. Decay levels are much lower in 2002 than they were in 1984 and in the 1960s. The oral health of the less well off is worse than that of the rest of the population. The prevalence of dental fluorosis is higher amongst children and adolescents with fluoridated water supplies. Comparisons with 1984 data show an increase in the prevalence of fluorosis since that time.     

Cereal availability and dental caries

The present study examines the relation between three cereals: wheat, rice, and maize, to dental caries in 12-year-old children in 47 nations of the world. DMFT data were obtained from the World Health Organization's Oral Epidemiology Bank; data on cereal supplies were obtained from the Food and Agriculture Organization (Rome). The relation between these functions was examined by the methods of correlational and rank order analysis. The data show that: 1) the relation of each of the cereals to caries is different; 2) the consumption of wheat is positively correlated to the DMFT values obtained for the 47 nations: 3) maize consumption is negatively associated with caries; and 4) the consumption of rice shows no correlation. In keeping with these observations, nations in the upper quintile of caries prevalence consumed more wheat and less maize than those in the lower quintile. Although these findings do not ipso-facto demonstrate any cause and effect relationships between cereal availability and caries, they do suggest that starch in the form of wheat may contribute to the prevalence of dental caries in nations throughout the world.     

The dental health of 12-year-old children whose diets include canned fruit from local factories: an added risk for caries?

OBJECTIVE: To determine the dental health of 12-year-old children from households that are supplied with sweetened canned fruit from local factories. METHODS: The DMFS and DMFT indices were determined for 12-year-old pupils from 6 schools, 3 of which are situated in communities with fruit canning factories. Subjects were questioned about the workplace of household members and supplies of sweetened canned fruit from factories. To compare indices we used a two-way analysis of variance, for multiple comparisons the Bonferroni Test and for proportions the Chi-Squared Test. Fluoride content of the drinking water was measured for each school. RESULTS: The fluoride content for all schools was less than 0.1 ppm. In only 2 schools were the majority of pupils from households that were supplied regularly with canned fruit from factories. An analysis of the DMFT data of the children in all the schools showed that there were significantly fewer children with a DMFT = 0 and significantly more with a DMFT = 4+ in the 2 schools. The mean DMFS and DMFT of children in households supplied with canned fruit were significantly higher than those children without the supply. CONCLUSION: The supply of sweetened canned fruit to households may be an added risk to dental health for the children in that household.     

Decline in caries prevalence in6–14-year-old schoolchildren during1975–85 in Shizuoka, Japan

The purpose of this study was to examine changes in caries prevalence during 1975-85 in Japanese schoolchildren who did not have an apparent change in fluoride exposure. A total of 2872 schoolchildren aged 6-14 yr in two primary schools and one junior high school in Shizuoka city, Japan, were examined in 1985. The caries prevalence in 1985 was then compared with data which had been collected in a longitudinal survey on schoolchildren in the same primary and junior high schools by Katayama in 1970-75. The results indicated that DMFT and DMFS indices in 1985 were significantly lower than those in 1970-75 in all the examined ages (P < 0.01). The DMFT indices at age 12 were 3.60 in 1985 and 5.47 in 1970-75. Remarkable decreases in DMFT at age 12 were observed in maxillary incisors (50%), followed by maxillary molars (24%) and mandibular molars (22%). The decline in caries prevalence in the examined area may be mainly attributed to several factors other than use of fluoride, such as changes in dietary pattern, an increasing dental awareness and promotion of dental health care. But the percentage decrease per annum of DMFT index at age of 12 in the examined population was relatively low (-4.1%) in comparison with other industrial countries. Comparing the results with data from national dental surveys, it can be considered that rural areas in Japan do not exhibit a similar decline of caries prevalence as in Shizuoka city, but there will be a lot of districts exhibiting significant reduction in caries prevalence in the near future.     

����ʡ12��15����Ⱥ������ȣ����������鱨�棨2015—2016�꣩

??Objective??To explore the caries status of permanent teeth among 12-15-year-old population in Liaoning Province??and provide data support for the prevention and treatment of dental caries. Methods??A total of 3836 urban and rural residents aged 12??13??14 and 15 in Liaoning Province were selected by multi-stage stratified equal capacity random sampling. According to the criteria of clinical dentition examination of the Fourth National Epidemiological Survey of Oral Health??the crown caries of permanent teeth in the whole mouth were examined using CPI probe. And then the prevalence??the mean DMFT??decayed-missing-filled tooth????the filled rate??the site of caries and the pit and fissure sealing were calculated. The difference was compared. Results??The prevalance of crown caries in the groups aged 12??13??14 and 15 were 53.2%??49.7%??53.7% and 56.6%??respectively. There was no significant difference between the 12-year-old group and the 14-year-old group??and the differences among the other age groups were statistically significant??P??0.05??.The mean DMFT was 1.45??1.56??1.67 and 1.85??respectively??and it increased with age??P??0.05??. There were significant differences in the prevalence and the mean DMFT between urban and rural areas??P??0.05??and between male and female??P??0.05??. The prevalence and the mean DMFT of 12-year old group were higher than that in 2005. Conclusion??The prevalence of permanent teeth caries in12-15-year-old population in Liaoning Province is higher than the national average level??and it is higher than in rural areas than in urban areas??higher in females than in males. It is necessary to further strengthen oral prevention and health care measures for the relevant population.     

Caries prevalence, oral health behavior, and attitudes in children residing in radiation-contaminated and -noncontaminated towns in Ukraine

INTRODUCTION: Several studies investigating the oral health status of children living in Ukraine after the Chernobyl catastrophe revealed an increase of caries in children residing in radionucleotide-contaminated areas. PURPOSE: (1) To compare prevalence of dental caries in contaminated and noncontaminated towns; and (2) to determine if there is a difference between dental behaviors and attitudes of children residing in contaminated and noncontaminated areas that may have contributed to differences in caries prevalence. METHODS: Children aged 13-14 were randomly selected in two towns of approximately the same population size (33 000): Ovruch (n = 119) from a contaminated area and Mirgorod (n = 100) from a noncontaminated area. Data on behaviors and attitudes were collected via a self-administered questionnaire having six domains: (i) family background; (ii) dental anxiety; (iii) dental utilization; (iv) oral hygiene; (v) use of fluoride toothpaste; and (vi) sugar consumption. Oral examinations included information on carious lesions, restorations, missing teeth, and soft tissue abnormalities. Caries prevalence was compared using a t-test. Regression analysis was conducted to determine the independent contribution of oral hygiene behaviors and dental utilization. RESULTS: There was a significant difference in caries prevalence in the contaminated town (mean DMFT = 9.1 +/- 3.5) versus the noncontaminated town (mean DMFT = 5.7 +/- 1.4; P < 0.000). Oral hygiene practices, age, and utilization of dental services were not found to be associated with differences in DMFT score between the two communities. CONCLUSION: There was a significantly higher caries prevalence in a radiation-contaminated town compared to a noncontaminated town of Ukraine. The difference was not explained by differences in oral health knowledge, attitudes or behaviors.     

Dental injury among Brazilian schoolchildren in the state of São Paulo

Abstract  – To describe the distribution of dental trauma in Brazilian schoolchildren and its association with demographic, environmental and clinical factors. A random sample of 73 243 schoolchildren's oral examination records from private and public units, selected from 131 cities within the state of São Paulo, Brazil, was analysed. Trauma was assessed based on international methodological standards prescribed by the World Health Organization for Oral Health Surveys (1997). Proportions obtained were compared between urban and rural schools, as well as between private and public units. Oral health status indices were estimated based on the decayed, missing and filled teeth (DMFT) index – the average number of decayed, missing and filled teeth; the proportion of caries-free 5-year-old schoolchildren and anterior maxillary overjet among 12-year-old schoolchildren. The prevalence of dental trauma in anterior dentition was of 2.4, enrolling average 1.2 teeth per child. A rate of 2.4 impaired anterior teeth per thousand was obtained, upper central incisors being those that were most affected – 7.7 in every 10. Among 8- to 11-year-old children, the rates grew regularly. The proportion of dental trauma was significantly higher in boys than in girls ( P  < 0.01), and gender prevalence ratio was of 1.58 for boys. The results showed positive associations between dental trauma and caries-free 5-year-old schoolchildren ( P  = 0.003), anterior maxillary overjet ≥3 mm ( P  < 0.001), and private school as a socio-economic proxy indicator ( P  = 0.048).     

辽宁省12～15岁人群恒牙患龋情况抽样调查报告（2015—2016年）

目的　了解辽宁省12～15岁人群恒牙龋病状况,为辽宁省口腔健康保健工作及相关研究提供数据支持。方法　采用多阶段分层等容量随机抽样的方法,抽取辽宁省12、13、14、15岁城乡常住人口共3836人。按照第四次全国口腔健康流行病学调查方案的牙列检查方法和标准,使用社区牙周指数（CPI）探针检查全口恒牙冠龋患情况。计算患龋率、龋均、充填率、患龋牙位及窝沟封闭情况,并比较存在的差异。结果　辽宁省12、13、14和15岁人群患龋率分别为 53.2%、49.7%、53.7%和 56.6%,12岁年龄组与14岁年龄组差异无统计学意义,其余各年龄组间差异均有统计学意义（P＜0.05）; 龋均分别为1.45、1.56、1.67 和 1.85,随着年龄增加而增加,差异有统计学意义（P＜0.05）;患龋率和龋均两项指标城乡间比较,农村高于城市,差异有统计学意义（P＜0.05）;不同性别间比较,女性高于男性,差异有统计学意义（P＜0.05）。与2005年第三次全国口腔健康流行病学调查结果相比,12岁人群患龋率和龋均均升高。结论　辽宁省 12～15 岁人群患龋率和龋均高于全国平均水平,农村高于城市,女性高于男性,需进一步加强相关人群的口腔预防保健措施。     

Caries experience in subjects18–22 years of age after 13 years''discontinued water fluoridation in Okinawa

The purpose of this study is to compare the state of teeth in young adults who had consumed fluoridated water from birth to 5-8 yr of age with the subjects who had non-fluoridated water. The sample consisted of 117 18-22-yr-old female nursing school students. The data obtained in dental examinations were sorted according to their place of residence, and then divided into groups depending on whether their place of residence had been supplied with fluoridated water or not. The fluoride concentration in the water had been 0.7-1.0 ppm in the six water supply systems which were under the control of the US military base. In the subjects who had fluoridated water, the following differences were found when compared to the control subjects: missing teeth and highly progressed caries occurred less frequently; significantly lower caries prevalence was present on free smooth and approximal surfaces; the overall DMFT differences in favor of the fluoridated subjects were small and non-significant.     

DMFT, dmft and treatment requirements of schoolchildren in Asturias, Spain

An epidemiological survey was carried out in 1992 to study the dental health status of schoolchildren aged 6, 9 and 12 in Asturias, Spain. It focused on the caries prevalence, dmtf, DMFT, restoration indices and dental treatment needs of this population. A representative sample of 1839 subjects, randomly selected and proportionally assigned by age group (6, 9 and 12) with the classroom as the sample unit, was examined. Analysis of the data showed that in 6-year-old children the caries prevalence in primary teeth was 45.8%. The mean caries in-dices were 2.10 dmft and 0.25 DMFT. At 9 years old the prevalence of caries in primary teeth was 62.8% and in the permanent teeth 49.1%. The mean level of caries was 2.38 dmft and 1.50 DMFT. At 12 years old the caries prevalence in permanent teeth was 71% and in first molars 64.2%. The mean caries experienced was 3.30 DMFT. In all groups the D-component constituted the major part of the caries index. The results for girls were higher than for boys in almost all age groups. Surface fillings were the treatment most required in all age groups.     

The life course approach: explaining the association between height and dental caries in Brazilian adolescents

AIM: To investigate the relationship between height and dental caries in Brazilian adolescents. METHODS: A cross-sectional survey design was used to collect retrospective data. Of 764 eligible 13-year-old adolescents enrolled in urban private or public schools in a Brazilian town, 652 were clinically examined and interviewed. Data were collected on socioeconomic circumstances, family related variables, oral health behaviour and anthropometric measures (height and weight). Dental caries was measured by decayed, missing and filled teeth (DMFT) index. The DMFT was categorized according to two levels of severity (low DMFT 6) using the 75th percentile of the distribution as the cut-off point. Data analysis involved multiple logistic regression. RESULTS: Adolescents who were the second or later child were 1.90 times more likely to have a high DMFT, whilst being a taller adolescent had a protective effect on caries experience (OR = 0.04; 95% CI = 0.00-0.79). In addition, adolescents from rural areas (OR = 2.74; 95% CI = 1.56-4.82), those whose mothers had less than 8 years of education (OR = 2.10; 95% CI = 1.03-4.27) and those who reported high levels of paternal punishment (OR = 1.60; 95% CI = 1.02-2.52) had an increased risk of having a high DMFT. CONCLUSION: There is a relationship between height and dental caries experience in this sample of Brazilian adolescents.     

Dental caries and sugar intake of children from rural areas with different water fluoride levels in Paraíba, Brazil

Few reports have investigated caries prevalence in rural areas of Brazil. OBJECTIVE: The aim of this study was to observe the caries prevalence (DMFT, DMFS) in 12-year-old children living in rural villages of Paraíba, Brazil with low and moderate fluoride levels in the drinking water and to relate it to sugar intake and oral hygiene. METHODS: One hundred and ninety four children from 13 villages were grouped according to the water fluoride levels: low fluoride (LF, <0.2 ppm F, 96 children) and moderate fluoride (MF, 0.7-1.0 ppm F, 98 children). Caries and oral hygiene (OHI-S) were scored according to WHO criteria. Sugar intake was assessed through interviews. A sub-set of subjects (n=23) from the LF group was re-examined 2 years later. RESULTS: For the LF and MF groups the DMFT (mean, SD) observed was 3.9 (3.7) and 2.5 (2.1) respectively, the DMFS was 9.2 (10.6) and 5.4 (5.7). Both indexes (DMFT, DMFS) showed significant differences (P<0.01, Mann-Whitney U-test) according to the fluoride levels in the drinking water. The mean increment of caries in the sub-set group of subjects was approximately 1.5 surfaces per subject/year. The reported sugar intake was low for both water fluoride groups (P>0.05). In a regression analysis the water fluoride levels, the use of fluoridated toothpaste and oral hygiene index were related to DMFS (R2=0.08, P< or =0.05). CONCLUSIONS: Caries prevalence was lower in MF than in LF rural areas of Paraíba. Caries and sugar intake seems to be lower in rural areas than in urban areas of Paraíba with similar fluoride levels in the drinking water.     

Distribution and prevalence of dental caries in Bauru, Brazil, 1976-2006

AIMS: To compare caries prevalence and severity, as well as the disease distribution in the permanent dentition of 12-year-old schoolchildren in Bauru, Brazil, from 1976 to 2006. METHODS: Probabilistic samples were obtained in six surveys, from 1976 to 2006, which were conducted by calibrated examiners, following the same protocol. For data analysis, the DMFT (decayed, missing and filled teeth), Significant Caries Index (SiC Index), percentage of caries-free children, Gini Coefficient and Care Index were determined. RESULTS: The means (SD) for DMFT were 9.89 (3.96), 6.98 (3.80), 4.30 (3.11), 4.29(3.44), 1.53(2.07), and 0.90(1.53) in 1976, 1984, 1990, 1995, 2001 and 2006, respectively. Except for years 1990 and 1995 and also for 2001 and 2006, there were statistically significant differences in mean DMFT among the surveys (p < 0.05). The number of caries-free children (DMFT=0), which has significantly increased over the years (p < 0.001), ranged from 0.4% in 1976 to 63.8% in 2006. The SiC Indexes were 14.34, 11.42, 7.74, 8.06, 3.89, and 2.63; the Care Index were 31.9%, 57.4%, 68.7%, 50.5%, 66.4%, and 56.3%; and the Gini Coefficients were 0.23, 0.30, 0.39, 0.43, 0.66, and 0.76 in the surveys. CONCLUSION: Dental caries experience and prevalence in 12-year-old schoolchildren have declined significantly during the last 30 years in Bauru.     

Dental Fluorosis and Caries Prevalence in Children Residing in Communities with Different Levels of Fluoride in the Water

Objectives: This study investigated the prevalence of dental fluorosis and caries in 7–14-year-old children residing in communities with negligible (NF: 0.2 ppm), optimal (OPF: 1.0 ppm), and four-times optimal (4X OPF: 4.0 ppm) naturally occurring fluoride in their water systems. Methods : Examinations were performed on 344 children who were lifetime residents of their communities. Results : Whether using the tooth surface index of fluorosis or Dean's index, children examined in the 4X OPF community had the highest prevalence of dental fluorosis. While the severity of fluorosis seen in the OPF and NF communities was mild in appearance, the results indicate that fluorosis does occur in optimally and negligibly fluoridated communities. Compared to the NF community, DMFT and DMFS scores in the OPF community were 9.2 percent and 21.2 percent lower, respectively. Conclusions : The ingestion of water containing 1 ppm or less fluoride during the time of tooth development may result in dental fluorosis, albeit in its milder forms. However, in these times of numerous products containing fluoride being available, children ingesting water containing 1 ppm fluoride continue to derive caries protection compared to children ingesting water with negligible amounts of fluoride. Thus, the potential for developing a relatively minor unesthetic condition must be weighed against the potential for reducing dental disease.     

Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations

OBJECTIVES: To determine the experience, prevalence, and severity of dental caries in adolescents naturally exposed to various fluoride concentrations. METHODS: A cross-sectional census was conducted on 1,538 adolescents aged 12 and 15 years living at high altitude above sea level (> 2,000 m or > 6,560 ft) in above-optimal fluoridated communities (levels ranging from 1.38 to 3.07 ppm) of Hidalgo, Mexico. Sociodemographic and socioeconomic data were collected using questionnaires. Two previously trained and standardized examiners performed the dental exams. RESULTS: Caries prevalence was 48.6 percent and mean of decay, missing, and filling teeth (DMFT) for the whole population was 1.15 +/- 1.17. In terms of severity, 9.6 percent of the adolescents had DMFT > or = 4, and 1.7 percent had > or = 7. The significant caries index (SiC) was 2.41 in the group of 12-year-olds, and 3.46 in the 15-year-olds. Higher experience and prevalence were observed in girls, in children with dental visit in the past year, those in the wealthiest socioeconomic status (SES) (quartiles 2, 3, and 4), those whose locale of residence is in San Marcos and Tula Centro, and in fluorosis-free children and those with moderate/severe fluorosis. In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. CONCLUSIONS: The results indicated that caries experience, prevalence, and severity as well as SiC index among 12- and 15-year-old adolescents were relatively low. Sociodemographic and socioeconomic variables commonly associated with dental caries were also observed in Mexican adolescents. Unlike other studies, we found that caries increased with higher SES. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities.     

Fluorosis in relation to fluoride levels in water in central Nigeria

Abstract– Objectives : This study was conducted to examine the prevalence of dental fluorosis in relation to fluoride levels in water among children aged 12–15 years in the states of Plateau and Bauchi, Nigeria. Methods : Children ( N =203) were examined using WHO criteria. The children were from two schools and permanent residents of the communities in which the schools are located (Tilden Fulani and Kanadap). Intra-examiner reliability for determining fluorosis scores was 80%. Results : Fluoride levels in the water ranged from 0.0–0.4 mg/L. Prevalence of dental fluorosis in the sample was 51%. Forty-one percent had very mild fluorosis, 7% had mild fluorosis and 3% had moderate to severe fluorosis. The lowest DMFT was observed in the school where the fluoride level of the water ranged between 0.0 and 0.4 mg/L, and in the group with very mild fluorosis. Conclusion : Fluoride levels in water for central Nigeria were appropriate for oral health. In the areas where the children were permanent residents, factors other than the fluoride levels of the water contributed to the severity of dental fluorosis.     

Gains in oral health and improved quality of life of 12-13-year-old Nepali schoolchildren: outcomes of an advocacy project to fluoridate toothpaste

OBJECTIVES: To report on gains in oral health and improved quality of life of 12-13-year-old Nepali schoolchildren five and six years after the introduction of fluoride toothpaste in 1999. DESIGN: Cross sectional baseline surveys in 1999 and 2001, and follow up surveys in 2004 and 2005 were multi-stage cluster sampling in design. SETTING: Urban and rural schools in Central, Far Western, Mid Western and Western Developmental Regions of Nepal. PARTICIPANTS: 2,770, 12-13-year-olds in 1999 and 1,001, 12-13-year-olds in 2004 were examined regionally. 637 12-13-year-olds from Kathmandu valley and 448 12-13-year-olds from Tansen municipality were examined in 1999. The same schools in Kathmandu valley and Tansen were visited in 2005 and 761 and 482 12-13-years from Kathmandu valley and Tansen were examined. 6,064 8-15-year-olds in 2001 and 1,001 12-13-year-olds in 2004 participated in the collection of information on oral hygiene practice and quality of life. METHOD: Examinations were carried out by trained and calibrated examiners using the WHO diagnostic criteria for caries and questionnaires were interview administered by trained interviewers. Intervention: Advocacy for fluoride toothpaste between 1997 and 2002. RESULTS: There was a 26.6% decline in caries prevalence and 38.0% decrease in 12-13-year old DMFT from 1999 to 2004 throughout four of five regions of Nepal. Approximately 65-75% of the 12-13-year-olds used fluoride toothpaste from 1999 to 2004. School specific data reveals a reduction in DMFT of 43.8% in Tansen and 53.6% in the Kathmandu valley from 1999 to 2005. From 2001 to 2004, report of oral pain decreased by 10%. CONCLUSIONS: The most likely reason for the decline in dental caries and reduction in oral pain is the widespread consumption of fluoride toothpaste by the 12-13-year-old schoolchildren.