Dental health in schoolchildren 5 years after water fluoridation ceased in south-west Scotland

A follow-up study of the dental health of children resident in two towns in south-west Scotland, one of which had fluoridated water until 1983, was carried out at the end of 1988. Comparison with an identical 1980 study allowed trends in the prevalence of caries to be examined. In 1988, the mean, decayed, missing and filled deciduous teeth (dmft) score for 5-year-old children in Stranraer, the formerly fluoridated town, was 3.08, 24 per cent worse than the score of 2.48 reported in 1980. In Annan, mean dmft for 5-year-old children was 3.18 in 1988, 27 per cent lower than the 1980 dmft score of 4.38. The difference in caries prevalence between the two towns in 1988 was a non-significant 3.1 per cent compared with the 44 per cent difference found in 1980. Similar trends in caries prevalence were also found in 10-year-old children with mean DMFT scores of 2.28 in Stranraer and 2.56 in Annan in 1988, a 10.9 per cent difference compared with the 50 per cent difference reported in 1980. The Stranraer DMFT score was 37.4 per cent higher than the DMFT of 1.66 recorded in 1980, while in Annan, the mean DMFT of 2.56 was 23.6 per cent lower than the 1980 score of 3.35. The comparison confirms a trend to lower caries levels in Annan children in line with the general trend in caries prevalence in much of western Europe. However, despite the almost universal use of fluoride toothpaste, caries prevalence in Stranraer children has increased since fluoridation ceased to almost parity with children in the non-fluoridated area. This study shows that there is still a benefit to be gained in terms of lower caries rates by implementing water fluoridation despite the general decline in dental caries.     

Caries experience and distribution in relation to treatment needs among teenagers in Espoo, Finland

An annual check-up was made in groups of 12- and 16-yr-old children by dentists of the Public Health Center of Espoo. The D index was used instead of DMFT index, because it expresses the need for conservative treatment. This information, again, is essential for planning public dental care. The children were divided into four groups according to the number of decayed teeth developed during a period of approximately 1 yr. Children with D = 0 were classified as healthy, D = 1 as low, D = 2 as moderate, and D = 3 or more as high caries incidence. In 1980 the percentage of the group D = 0 was about 52% in the 12-yr-olds. In 1988 the percentage had increased up to about 73%. The corresponding figures of the 16-yr-olds were 33% and 62%. Simultaneously, the high caries incidence groups had decreased in 12-yr-olds from 13% in 1980 to 5% in 1988 and in 16-yr-olds from 31% to 10%. These observations emphasize the need for retargeting prevention of caries in order to provide additional preventive treatment to the high incidence groups while the routine prophylaxis given to the other groups may be decreased.     

Needs and implementation of preventive dentistry in China

Based on a literature review and recent surveys, the needs and implementation of preventive dentistry in China have been estimated. The average DMFT of 12- and 15-yr-old schoolchildren in Beijing were 1.61 and 2.11 respectively. The caries prevalence was higher in the coastal cities in the south. The caries rate was also higher in urban areas than in rural areas. There were some controversies in the results of fluoridation studies with one study reporting as high as 47.2% of the children to be afflicted with enamel fluorosis. The community periodontal disease status and treatment needs index (CPTNI) showed that 93% of the 12-yr-olds had bleeding, 98% had calculus and 15% had shallow pockets, with 100% of the children needing prophylaxis. There was a high prevalence of dental malocclusion with 54% of schoolchildren with dental anomalies, of whom 36% needed treatment. Much emphasis had been placed on oral pathology, oral medicine and maxillofacial surgery in the curriculum of Stomatology in Chinese dental schools.     

A 12-year cross-sectional and longitudinal radiographic study of dental restorations in women in Gothenburg, Sweden

A dental examination was included in a mainly medically oriented population study of women in Gothenburg, Sweden. From panoramic radiographs the numbers of remaining teeth, restored teeth (fillings and crowns), pontics, and endodontically treated teeth were assessed in 1968-69 and in a 12-yr follow-up study in 1980-81. Women aged 38, 46, 50, 54 and 60 yr were initially studied. In the follow-up study, a group of 38-yr-old women was added. A comparison between cross-sectional data in 1968-69 and in 1980-81 in women aged 38 and 50 yr showed some marked differences. Dentulous women of the same age had in 1980-81 a larger mean number of teeth and a larger number of restored teeth (including crowns). The number of restored teeth in relation to remaining teeth was the same in the 38-yr-old women in 1980-81 but had increased in the 50-yr-olds. The absolute and relative numbers (in relation to remaining teeth) of crowns (also studied separately), pontics, and endodontically treated teeth were about the same in 1968-69 and 1980-81 both for the 38-yr-olds and the 50-yr-olds. There was a slight but statistically significant increase only in the absolute number of crowns for the 50-yr-olds. The follow-up study showed a moderate decrease of remaining teeth in all age groups. Related to remaining teeth, the number of restored teeth (including crowns), crowns, pontics, and endodontically treated teeth showed a statistically significant increase for all age groups except for the oldest, in which group a significant increase was only observed for crowns.     

Caries experience of Native children of British Columbia, Canada, 1980-1988

Abstract – Surveys of the dental health of Native children in British Columbia, Canada, were conducted in 1980, 1984 and 1988 by Medical Services Branch, Health and Welfare Canada. Data were gathered on children turning 5, 7, 9, 11, 13, and 15 yr of age in each survey year. This paper analyzes the findings related to dental caries and the treatment of caries. Comparisons were made between the 1980 and 1988 surveys using Student's t -tests; data from the 1984 survey were included for comparison. Results of these surveys demonstrate a continuous improvement in the dental health of Native children between the years 1980 and 1988, but the improvement was limited to the permanent dentition. The deft for 5-yr-olds remained constant over the time interval. In contrast, the DMFT for each group significantly decreased from 1980 to 1988 ( P <0.05). The percentage of 5-yr-old children who were caries-free in the primary dentition remained constant, and primary tooth mortality (tooth abscessed or with crown destroyed) in 5-yr-olds did not change. However, the percentage of children surveyed with caries-free permanent teeth improved significantly at each survey year and permanent tooth mortality significantly declined ( P <0.05). The proportion of filled, compared with carious, primary and permanent teeth increased from 1980 to 1988. In contrast, the number of extracted primary teeth stayed relatively constant for 5-yr-olds, but the proportion of missing teeth declined significantly for all other age groups ( P <0.05). The caries experience of this population of Native children was high relative to that of children of comparable age residing in the same region and to that of children who live in other parts of the world.     

A reassessment of the dental health of urban Scottish schoolchildren following the cessation of water fluoridation

A comparison was made between the dental health of children in two Scottish towns, one of which was fluoridated until 1983. The mean decayed, missing and filled (dmft) score was found to be 69 per cent lower in 5-year-old children in the fluoridated town compared with the non-fluoridated one and there was a similar 65 per cent difference for DMFT scores in those aged 15 years. 10-year-old children in the fluoridated town had a 39 per cent lower DMFT score, less than the 50 per cent difference found in the 1980 study. Comparison with an identical 1980 study allowed secular trends in caries prevalence to be examined. This revealed a 13 per cent reduction in dmft scores for 5-year-old children and a 16 per cent reduction in DMFT in 10-year-old children in the non-fluoride town. There was a 52 per cent reduction in dmft in 5-year-old children in the previously fluoridated town; however those aged 10 years had a higher DMFT score in 1986 than in 1980. Although this study found that there is a residual benefit from fluoridation in all age groups, there are indications of an adverse trend in dental health in the 10-year-old children in the fluoridated town. The investigation confirmed that the trend is towards lower caries levels amongst Scottish schoolchildren.     

Effect of fluoridation on dental health in 5-and 11-year-old Irish schoolchildren

Sixty percent of the population of the Republic of Ireland live in communities served with fluoridated water supplies. A study was carried out to compare dental caries levels, treatment needs, and the cost of meeting these needs, in one town with fluoridated water supplies and two smaller towns without. In the fluoridated town 5-yr-old children had 36% less caries and would cost 29% less to treat than the corresponding age group in the non-fluoridated towns. Restorative treatment levels in both areas were minimal for this age group. In the 11-yr-old children there was a 42% difference in DMFT and a cost saving in treatment required because of caries of 50% in favour of the fluoridated community. Anterior permanent teeth benefited most, with a reduction of 81% in mean DMFT. In both areas most of the decay was seen in the permanent first molar teeth. Restorative treatment levels, while higher for the 11-yr-old age group, were still unsatisfactory.     

Dental caries status and treatment needs of the permanent dentition of 6–12-year-olds in Hong Kong

An oral health survey was conducted in 1986 on a representative sample of primary school children in Hong Kong. 1483 Chinese children of both sexes, aged 6-12 yr, attending 56 primary schools were surveyed. The DMFT index for the 6-yr-olds was 0.1, and for the 12-yr-olds it was 1.5. Forty percent of the 12-yr-olds were clinically caries-free. The permanent molars constituted 90% of the total caries experience of the 12-yr-olds. Over 90% of the caries lesions were found in pits and fissures. The dental caries treatment need in the permanent dentition was low and of the simple type. A great reduction in the dental caries experience of the permanent dentition of children has occurred since the introduction of water fluoridation 25 yr ago. In addition to treatment care, preventive measures should be provided by the School Dental Care Service for children with a high caries risk.     

Dental health in Icelandic urban children aged 11 and 12 years

Abstract A total of 1370 children were examined for caries, gingivitis, periodontal pocketing, calculus and loss of marginal alveolar bone. The mean DFT and DPS scores were 6.2 and 8.7 for 11-yr-old children and 8.2 and 12.1 for 12-yr-olds. The average number of initial caries lesions was 12.4 among 11-yr-olds and 15.7 among 12-yr-olds. The proximal and smooth surfaces accounted for 37% of the total DPS score in the 11-yr-old children and 43% in the 12-yr-olds. The median DPS score for the 11-yr-old boys and girls was 7, while for the 12-yr-old boys it was 9 and for the girls 11. Only 1.8% of the children were free from caries. The occurrence of gingivitis, expressed by GBI, was 20 in both age groups. 8% of the children showed no advanced gingival inflammation, while less than 1 % had bleeding gingivitis at all examined surfaces. Supragingival calculus was found in 10% of the children. Neither periodontal pocketing nor loss of marginal alveolar bone was observed.     

A model to determine the economic viability of water fluoridation

Objectives: In view of concerns expressed by South African local authorities the aim of this study was to develop a model to determine whether water fluoridation is economically viable to reduce dental caries in South Africa. Methods: Microsoft Excel software was used to develop a model to determine economic viability of water fluoridation for 17 water providers from all nine South African provinces. Input variables for this model relate to chemical cost, labor cost, maintenance cost of infrastructure, opportunity cost, and capital depreciation. The following output variables were calculated to evaluate the cost of water fluoridation: per capita cost per year, cost‐effectiveness and cost‐benefit. In this model it is assumed that the introduction of community water fluoridation can reduce caries prevalence by an additional 15 percent and that the savings in cost of treatment will be equal to the average fee for a two surface restoration. Results: Water providers included in the study serve 53.5 percent of the total population of South Africa. For all providers combined chemical cost contributes 64.5 percent to the total cost, per capita cost per year was $0.36, cost‐effectiveness was calculated as $11.41 and cost‐benefit of the implementation of water fluoridation was 0.34. Conclusions: This model confirmed that water fluoridation is an economically viable option to prevent dental caries in South African communities, as well as conclusions over the last 10 years that water fluoridation leads to significant cost savings and remains a cost‐effective measure for reducing dental caries, even when the caries‐preventive effectiveness is modest.     

Dental caries, fluoride levels and oral hygiene practices of school children in Matebeleland South, Zimbabwe

Abstract 1386, 5–6-yr-old and 1326, 12-yr-old schoolchildren in the mainly rural province of Matabeleland South, in Zimbabwe, were examined for dental caries and interviewed about their oral hygiene practices. Fluoride contents of the drinking water source of the schools were determined and were found to be in the range 0.05–2.5 ppm. Among 5–6-yr-old children, 25.2% were affected with caries and the mean dent score was 0.6 whereas 19.8% of the 12-yr-old children had caries, and the mean DMFT score was 0.3. In both age groups low fluoride levels in drinking water (<0.8 ppm) were associated with higher prevalence of caries (5–6-yr-olds: OR 2.47: 12-yr-olds: OR 2.09). Chewing sticks were the most commonly applied oral hygiene practice. Children who reported using chewing slicks had fewer carious lesions than children who reported the use of toothbrush and toothpaste.     

Effect of fluoridation on the cost of dental treatment among urban Scottish schoolchildren

Abstract Dental treatment needs of 230 children aged 4and 5 years and 288aged 9 and 10 years who were lifetime residents of two towns, one fluoridated and the other non-fluoridated, were costed on the Resource Related Index. This index is based on the British National Health Service scale of fees for general dental practitioners. The overall cost of dental treatment required by 4-and 5-year-olds in the fluoridated community was 45% less than in the non-fluoridated community. The corresponding difference for 9- and 10-year-olds was 47%. The differences in the cost of treatment for dental caries only (fillings, extractions and general anesthetics) were 56% in 4-and 5-year-olds and 76% in 9-and 10-year-olds in favour of the fluoridated community. In the latter community, no child examined required denial extractions under general anaesthesia. Certain assumptions made in the study and the implications of the findings in terms of cost savings brought about by fluoridation are discussed.     

Dental caries and dental treatment in the primary dentition in an industrialized South African community

This paper reports an examination of dental caries in the primary dentition of 2-5-yr-old white children in an industrialized South African city, in 1981 and 1983. There was a decrease in dental caries prevalence over the 2-yr period accompanied by an increase in dental treatment in 3-5-yr-olds. Treatment, however, remains low. Socioeconomic status had a varying effect on the trends, but in general there was a greater reduction in dental caries in the lower socioeconomic areas.     

A dental survey of Tibetan children in Dharamsala

Since their exodus in 1959 about 100,000 Tibetans have settled in disparate communities in northern India and Nepal. This study describes the dental health of 243 Tibetan children in Dharamsala, in the State of Himachal Pradesh, India. Only 20% of 6-yr-olds were caries-free in the primary dentition while 96.9, 53.3, and 22.4% of 6, 12, and 15-yr-olds were caries-free in the permanent dentition respectively. The DMFT of 12-yr-old children was 1.1, while 15-yr-old children had a DMFT of 3.1. While plaque and calculus were present in many sextants, there was little intense gingivitis and signs of advanced periodontal diseases were rarely present. Almost no dental care had been received. Appropriate dental health promotion activities are discussed.     

Use of dental services by the middle-aged and the elderly in Hong Kong

Abstract The objectives of this analysis were to describe the dental service use pattern of the 35–44- and 65–74-yr-old age groups and to determine to what extent this pattern could be explained by selected sociodemographic and attitudinal variables. The study populations comprised 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese. Use of dental services was determined on the basis of the respondents' own perception of the regularity of their dental visits and by the time since the last denial visit. The younger groups was categorized into regular users, irregular users, and nonusers, and the older group was categorized into three groups according to last dental visit (within 2 yr, 2–5-yr, 5 yr or more). A modification of the Andersen and Newman model for individual determinants of health care use was used as the framework for a logistic regression analysis. Predisposing variables were sex, education, occupation, altitudes, knowledge, preventive orientation, and dental anxiety; enabling variables were Family Possession Index, income, family support and access to a dental programme; need variables were perceived conditions of teeth, denial problems, denial pain, need for treatment, normative need for treatment, and denture wearing. In general, use of denial services was low. For the 35–44-yr-olds, the best regression model (sensitivity: 62%, specificity: 95%, overall correct classification: 88%) indicated that there was an increased probability of having a regular dental care pattern if respondents were prevention oriented, had access to a dental benefit programme, had not experienced pain, had a higher income, perceived their teeth as fair or poor, and perceived a need of treatment. For the 65–74-yr-olds, three variables remained in the final model (sensitivity: 51%, specificity: 68%, overall correct classification: 61%). Respondents who had not seen a dentist within the last 2 yr were more likely to have had pain and to know less about dental caries. As the number of teeth in need of treatment increased by 1, respondents were 1.09 times more likely not to have seen a dentist within 2 yr.     

Dental caries in 12-year-old urban and rural children in Zimbabwe

608 12-yr-old children in Harare, and 556 in rural areas of Mashonaland and Central Province, Zimbabwe, were examined for dental caries in 1985. 27.6% of children in the urban area, and 20.9% in the rural, had caries (P less than 0.01). The mean DMFT in urban and rural areas was 0.57 (+/- 1.13) and 0.49 (+/- 1.42), respectively (P = 0.29). Girls had higher levels of caries than boys. Most of the caries occurred on occlusal surfaces, and first molars were the most affected of all teeth. Caries experience was similar to that reported 10 yr previously in Zimbabwe, and similar to that found recently in 12-yr-olds in Kenya and Tanzania. The authors question whether in fact developing countries having high or increasing levels of caries in 12-yr-olds constitute the exception or the rule with regard to trends in dental caries prevalence.     

Practices and opinions of pediatric and general dentists in Connecticut regarding the age 1 dental visit and dental care for children younger than 3 years old

PURPOSE: This study aimed to determine the percentage of general and pediatric dentists in Connecticut that were aware of, and practice, the current AAPD guidelines for the age one dental visit and to determine the services they provide to 0-2-yr-old patients. METHODS: A survey was mailed to Connecticut general and pediatric dentists seeking information on practice type, years in practice, training, ages of children seen, procedures performed and opinions regarding the age one dental visit. RESULTS: The response rate was 42% for general dentists and 84% for pediatric dentists, giving a sample of 113 and 60 dentists, respectively. All responding pediatric dentists reported seeing 0-2-yr-olds as compared to 42% of general dentists. Although not statistically significant, general dentists who were female or in practice less than 10 years were more likely to see 0-2-yr-olds. The majority of pediatric dentists reported performing all procedures surveyed, however, only just over half of general dentists provided topical fluoride or restorative care. Among pediatric dentists, 98% were aware of the AAPD guidelines and 92% agreed with them compared to 41% and 45% of general dentists respectively. CONCLUSIONS: Nearly all Connecticut pediatric dentists are caring for 0-2-yr-olds compared to 42% of Connecticut general dentists.     

Periodontal disease prevalence in different age groups in Japan as assessed according to the CPITN

A CPITN survey was conducted involving 12,832 Japanese subjects from 7 to 64 years of age. Subjects under 18 were schoolchildren, and 18-year-old and older subjects represented various social backgrounds, having been randomly selected from both urban and rural Japan. Fifty percent of the 7-yr-old children had signs of periodontal disease, and this percentage increased with increasing age. In those under 14, this increase in periodontal disease was mainly due to an increase in the proportion of children developing dental calculus. Subjects with 6 mm or deeper pockets were observed starting from the 20-29-yr-old age group. In subjects over this age, the prevalence of periodontal disease was higher in men than in women. The percentages of subjects having pathologic pockets had increased remarkably in the 30-44-yr-olds. In the 45-64-yr-old group, almost all subjects had some sign of periodontal disease, and the percentage of those with 4 or 5 mm pockets and 6 mm or deeper pockets were 37% and 21%, respectively.     

Relationship of caries with socioeconomic status in 14-year-old children from communities with different fluoride histories

Abstract The aim of this study was to describe the caries prevalence of 14-yr-old children living in two fluoridated communities, a non-fluoridated community, and a community that discontinued fluoridation 5 yr before the children were examined and to relate the caries prevalence to socio-economic status. Clinical examinations were completed on 413 children of whom 227 had been continuously resident in their towns. Children living in the fluoridated communities had significantly lower mean CMFT and DMFS scores than those in the non-fluoridated town. The children from the town that had discontinued fluoridation 5 yr earlier had mean DMFT and DMFS score that occupied an intermediate position. The differences were greater when only the continuous residents were examined. There were significant differences in the mean DMFT and DMFS when comparing socioeconomic status and fluoridation of the water supply. No interaction effect was demonstrated between these two factors.     

The impact of changing dental needs on cost savings from fluoridation

Background:  Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia.
Methods:  Net costs were estimated as Costs_(programme) minus Costs_{(averted caries).} Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6–20, 21–45, 46–65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized.
Results:  With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal.
Conclusions:  Community water fluoridation remains a cost-effective preventive measure in Australia.