Enamel defects in 8-year-old children in fluoridated and non-fluoridated parts of Cheshire

The aim of this study was to compare the prevalence of developmental defects of enamel in fluoridated (1 ppm F) and non-fluoridated (less than 0.2 ppm F) communities in Cheshire, England. Eight-year-old children were examined under blind conditions. Only lifetime residents were included and only children with no history of dietary fluoride supplements. Significantly more children living in the fluoridated community (60%) had enamel defects compared to those in the non-fluoridated community (44%). In the fluoridated community, significantly more children whose parents claimed to begin brushing at an early age exhibited enamel defects.     

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.     

Caries prevalence and length of residency in fluoridated and non-fluoridated communities

The caries experience of grade 6 Canadian schoolchildren was examined related to length of residence in non-fluoridated Camrose (0.23 ppm) and adjacent fluoridated Wetaskiwin (1.08 ppm). The mean age was 11.94 +/- 0.65 years, 115 being examined in Camrose and 89 in Wetaskiwin. The mean DMFT and DMFS values were similar in both the non-fluoridated and fluoridated communities with DMFT of 2.39 and 2.65 and DMFS of 3.40 and 3.54, respectively. When a minimum 5-year residency requirement was imposed, the data changed, showing for those children with 5-year residency DMFT values of 2.43 and 2.26 and DMFS values of 3.35 and 2.79, respectively, for non-fluoridated Camrose and fluoridated Wetaskiwin. Although the fluoridated community had 17% less surfaces with caries, differences between the fluoridated and non-fluoridated communities were not statistically significant. Within the fluoridated community, differences in DMFT and DMFS between children resident less than 5 and greater than 5 years were statistically significant (DMFT p less than 0.05; DMFS p less than 0.01). When comparing regions where adjacent communities exist, with and without water fluoridation, and in making decisions on fluoride supplementation levels for children who have changed residency to such communities, it is important that this type of information is taken into account.     

Prevalence of enamel defects/fluorosis in fluoridated and non-fluoridated areas in Ireland

Water fluoridation was introduced in Ireland in 1964 and in recent years the availability of fluoride from other sources had increased. As part of a National Survey of Children's Health in Ireland Dean's and the DDE indices were used to determine the prevalence of enamel fluorosis/defects in 8- and 15-yr-old children in fluoridated and non-fluoridated areas. Over 94% of the children examined in all areas were regarded as having normal enamel, as defined by Dean's index, the remainder showing evidence of either questionable, very mild or mild fluorosis. Between 52% and 63% of the children had one or more teeth affected by enamel defects when measured by the DDE index. The prevalence of enamel fluorosis/defects was similar in children living in fluoridated and non-fluoridated areas but the prevalence of diffuse opacities (DDE) was higher in the fluoridated areas.     

Incisor caries in Western Australian children

In a comparison of caries of the incisor teeth of ten year old children living in a fluoridated area and those living in a non-fluoridated area, the prevalence of proximal lesions was found to be low (three teeth per 100 children) in the fluoridated area.     

Dental benefits of limited exposure to fluoridated water in childhood

The effect of limited exposure to fluoridated water in childhood is of potential importance in highly-mobile modern society, but the subject has not been well-studied. This longitudinal study assessed caries experience and S. mutans proportions from fissure plaque in school-children who lived for at least the three years of the study in a non-fluoridated community (0.2 mg/L). Residence histories permitted division of the cohort into those who had lived all their lives in non-fluoridated communities, and those who had lived for some time previously in a fluoridated community. The children were aged 6-7 years at the beginning of the three-year study. Children with previous residence in the fluoridated communities developed 26.8% less caries in their permanent teeth during the study than did the children who had lived in non-fluoridated communities all their lives (p = 0.04), and had 29.8% less caries after three years (p = 0.02). Differences between the groups in S. mutans proportions from fissure plaque, sampled at six-monthly intervals throughout the study, could not be demonstrated. The dental benefits observed could not be attributed to socio-economic differences between the groups. Despite evidence that the benefits of limited ingestion of fluoridated water are topical in nature, the fact that many of the affected teeth in this study were unerupted at the time of the fluoride exposure means that pre-eruptive benefits cannot be ruled out.     

Water fluoridation and dental caries in 5- and 12-year-old children from Canterbury and Wellington

OBJECTIVES: Claims have been made that the effectiveness of water fluoridation has reduced due to the widespread availability of other sources of fluoride. This study examines the differences in the oral health of children living in fluoridated and non-fluoridated areas of Canterbury and Wellington, New Zealand. DESIGN: The data used in this cross-sectional study had been routinely collected into a computerized data-collection system by the School Dental Services in the two study areas. SUBJECTS AND METHODS: Records of dental status (dmfs/DMFS), fluoridation status, ethnicity, and socio-economic status for 8030 5-year-olds, and 6916 12-year-olds in 1996 were analysed. RESULTS: Caries prevalence and severity was consistently lower for children in the fluoridated area for both age groups, and within all subgroups. Five-year-olds in the fluoridated area had 2.63 dmfs (sd, 5.88), and those in the non-fluoridated area 3.80 dmfs (sd, 6.79). For 12-year-olds the respective figures were 1.39 DMFS (sd, 2.30) and 2.37 DMFS (sd, 3.46). Multivariable analysis confirmed the independent association between water fluoridation and better dental health. CONCLUSIONS: This results of this study show children living in a fluoridated area to have significantly better oral health compared to those not in a fluoridated area. These differences are greater for Maori and Pacific children and children of low socio-economic status.     

The cost-effectiveness of adding fluorides to milk-products distributed by the National Food Supplement Programme (PNAC) in rural areas of Chile

OBJECTIVE: This paper assesses the cost-effectiveness of a community dental caries prevention programme, targeting pre-school children living in non-fluoridated rural areas of Chile. BASIC RESEARCH DESIGN: The results of a community trial to measure the effects of using fluoridated powdered milk and milk-cereal to prevent dental caries, together with the cost of running the programmeme, were used to determine its cost-effectiveness when compared to the status-quo alternative. In the experimental community, fluoridated milk products were given to approximately 1,000 children aged between six months and six years, using the standard National Complementary Feeding Programme available in Chile. The control group received the milk products only. Dental caries status was recorded at the beginning and end of the programme in both communities using WHO criteria. The costs that would be incurred by such a programme, using a societal perspective, were identified and measured. RESULTS: Children who received fluoridated products had significantly lower mean levels of dental caries than those who had not. This improvement was achieved with a yearly cost of RCH (1999) $1,839.75 per child (1 US$ = RCH (1999) $527.70). On average, this programme resulted in a net societal savings of RCH (1999) $2,695.61 per diseased tooth averted after four years when compared to the control group. CONCLUSIONS: While the analysis has inherent limitations as a result of its reliance on a range of assumptions, the findings suggest that there are important health and economic benefits to be gained from the use of fluoridated milk products in non-fluoridated rural communities in Chile.     

Sources of dietary fluoride intake in 6-7-year-old English children receiving optimally, sub-optimally, and non-fluoridated water

OBJECTIVES: Due to increased consumption of pre-packaged drinks, tap water may no longer be the principal source of water intake and consequently fluoride intake. Little is known about the importance of solid foods as fluoride sources and how the relative contribution of foods/drinks to fluoride intake is affected by residing in fluoridated or non-fluoridated areas. This study investigated the relative contributions of different dietary sources to dietary fluoride intake and compared this in children residing in optimally artificially fluoridated, sub-optimally artificially fluoridated, and non-fluoridated areas. METHODS: Thirty-three healthy children aged 6 years were recruited from fluoridated and non-fluoridated communities and categorised into three groups based on fluoride content of home tap water: optimally fluoridated (< or =0.7 mgF/L), sub-optimally fluoridated (> or =0.3 to < or =0.7 mgF/L) and non-fluoridated (50.3 mgF/L) drinking water. A 3-day dietary diary collected dietary information. Samples of foods/drinks consumed were collected and analyzed for fluoride content. RESULTS: Drinks provided 59%, 55% and 32% of dietary fluoride intake in optimally, sub-optimally and non-fluoridated areas respectively. Tap water, fruit squashes and cordials (extremely sweet non-alcoholic fruit flavoured drink concentrates) prepared with tap water, as well as cooked rice, pasta and vegetables were important sources of fluoride in optimally and sub-optimally fluoridated areas. Carbonated soft drinks and bread were the most important contributors to dietary fluoride intake in the non-fluoridated area. CONCLUSION: The main contributory sources to dietary fluoride differ between fluoridated and non-fluoridated areas. Estimating total fluoride intake from levels of fluoride in tap water alone is unlikely to provide a reliable quantitative measure of intake. Studies monitoring dietary fluoride exposure should consider intake from all foods and drinks.     

Urinary fluoride levels in South Australian pre-school children in summer and winter

A bstract — Summer and winter samples of first-morning urine from 168 pre-school children attending kindergartens in fluoridated and non-fluoridated communities in South Australia were analysed for fluoride and creatinine concentration. The urinary fluoride: creatinine ratio, as an index of fluoride ingestion, was greater in winter for both the fluoridated and non-fluoridated area samples, the difference being interpreted as a result of increased losses of fluoride through the sweat in summer. The results do not indicate a need to vary the concentration of fluoride in the reticulated water supply with the seasons.     

A photographic study of enamel defects among South Australian school children

Colour photographs were taken of the anterior teeth of 1757 consenting 8–9 year old primary school children in fluoridated and non-fluoridated areas of South Australia. Children with a lifelong exposure to fluoridated water were significantly more likely to have blemished permanent incisor teeth than the children who had never resided in a fluoridated area. Children who resided in a non-fluoridated area but had taken fluoride supplements at some stage in their first five years had a prevalence of enamel blemishes equivalent to those of children in fluoridated areas of the State.     

Aesthetic concerns of children and parents in relation to different classifications of the Tooth Surface Index of Fluorosis

Abstract –Increasing prevalence of dental fluorosis for children both from fluoridated and non-fluoridated communities are now well documented. Along with recent studies purporting possible adverse health effects from fluorides, this proven public health intervention is again being challenged. This study was undertaken to determine the prevalence of dental fluorosis for children from fluoridated and non-fluoridated areas in British Columbia. In addition, children and parents were provided with an opportunity to express concerns about the aesthetics of the child's anterior teeth. Children from representative schools in two communities were surveyed using the Tooth Surface Index of Fluorosis (TSIF). Questionnaires were sent home to parents to detail their child's use of various fluoride preventive practices and residence histories. Completed questionnaires were returned and exams were performed on 1131 children. Of those examined, 60% had dental fluorosis on at least two tooth surfaces, only 8% had scores ranging from "2" to "6", and 52% were classified with a score of "1". Parental and child ratings on the aesthetics or color of the child's teeth suggests that there are few children with aesthetic problems in the TSIF category of "1". While concerns of parents were more common, the actual source of those concerns was not assessed in the questionnaire. Not unexpectedly, children with fluorosis on anterior teeth ranging between TSIF scores of "2" to "6" appear to have increased concerns about tooth color. Data from children with confirmed residence histories from fluoridated communities suggest that the occurrence of aesthetic problems in these children is rare.     

Effectiveness of acidified fluoride solutions in prevention of dental caries in school children

The purpose of the study was assessment of the influence of locally applied acidified fluoride solutions on the condition of teeth of school children living in a town district with fluoridated drinking water and in another district without fluoridation of drinking water. Acidified fluoride solutions were applied locally by brushing--5 procedures at two-week intervals in the first and second year of the experiment. The condition of teeth was assessed calculating the indices CMF and CMFp. In the light of the obtained results it may be said that the externally applied acidified solutions of fluorides had an approximately evident effectiveness in prevention of caries both in children drinking fluoridated or non-fluoridated water.     

Caries levels and patterns in head start children in fluoridated and non-fluoridated, urban and non-urban sites in Ohio, USA

The purpose of the study was to determine caries levels and prevalences of previously identified caries patterns in low income children in the primary dentition in Ohio, USA. Children were examined from urban fluoridated (n = 505), urban non-fluoridated (n = 395), non-urban optimal fluoride (n = 183), and non-urban suboptimal fluoride (n = 227) sites. Caries scores were similar for the two sites having optimal fluoride; scores from fluoridated sites were lower than scores from the two suboptimal fluoride sites. Children from all four sites were caries-free ranging from 36% in the urban non-fluoridated site to 50% in the non-urban optimally fluoride site. More children in the suboptimal fluoridated sites had smooth surface lesions than in the optimally fluoridated sites. More children with defect associated lesions had fewer than six (chi 2 = 222; P less than 0.01) carious surfaces than did children with smooth surface lesions.     

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 and fluorosis among children in a rural Georgia area

PURPOSE: This IRB-approved study compared the caries experience, fluorosis prevalence, and plaque and salivary fluoride concentrations ([F]) in middle school (MS; N = 51) and elementary school (ES; N = 144) children residing in nonfluoridated and fluoridated communities in rural Georgia. All participants were exposed to fluoridated water at school (0.5-1.2 ppm), some received that level at home, and others received home water with < 0.1 ppm F. METHODS: Subjects' parents completed a questionnaire regarding fluoride exposure. Children were examined at school by two calibrated dentists. RESULTS: No significant differences were seen in DMFS+dfs between children with or without fluoridated home water, nor for those with or without fluorosis. MS children with non-fluoridated home water had lower mean salivary [F] values than MS children with fluoridated home water. No differences were found among MS and ES children in mean plaque [F] for those with or without fluorosis. CONCLUSIONS: Home water fluoridation had little effect on the variables measured. These findings appear to be due to fluoride exposure from fluoridated dentifrices, fluoridated drinking water at school, and the fluoride "halo" effect.     

Dental caries experience in schoolchildren in fluoridated and non-fluoridated communities in Western Australia

A cross-sectional survey was undertaken in 1987 to measure the difference in caries experience in schoolchildren between a fluoridated (0.8 mg/L F-) and a non-fluoridated region (0.1-0.4 mg/L F-). 3436 children aged 5-15 yr were examined. Children in the non-fluoridated region had a higher caries experience than those in the fluoridated region. Mean differences were 1.06 dfs (95% CI = 0.66 to 1.47, P less than 0.001) and 0.48 DFS (95% CI = 0.23 to 0.72, P less than 0.001). After adjusting for potential confounding factors (fluoride tablet consumption, socioeconomic status, number of fissure-sealed surfaces, and mobility between regions) the relative risk of not being caries-free in the non-fluoridated region compared with the fluoridated region was 1.43 (95% CI = 1.21-1.70, P less than 0.0001) for the primary dentition and 1.39 (95% CI = 1.18-1.63, P less than 0.0001) for the permanent dentition.     

Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation

OBJECTIVE: The effect of water fluoridation upon dental erosion/tooth wear in the UK has not been investigated. This study aimed to compare the prevalence of tooth wear in 14-year-old schoolchildren in non-fluoridated and fluoridated districts of North West (NW) England. The influence of deprivation and tooth brushing was also investigated. DESIGN: A random sample of 10% of the 14-year-old population in NW England was selected and stratified according to fluoridation status as determined from water authority postcode listings. METHODS: Tooth wear was scored on the labial, incisal and palatal/lingual surfaces of the 12 anterior teeth and the occlusal surfaces of the first molars. Enamel wear was scored 0, dentine was scored 1 or 2, dependent on whether less than or more than a third of the surface had exposed dentine. Secondary dentine or pulpal exposure scored 3. Townsend deprivation scores were gained from residential post codes. RESULTS: A total of 2,351 children were examined, of which 637 (27%) lived in the one fluoridated district of South Cheshire and 1,714 (73%) lived in 11 non-fluoridated districts. Fifty-three per cent of the children had exposed dentine with significantly more males affected than females (p<0.001). In the fluoridated district, significantly fewer children had exposed dentine on labial and palatal smooth surfaces (p<0.001) but no differences were found for incisal and occlusal surfaces. The interaction of fluoridation and tooth brushing twice per day resulted in a significant (30%) reduction in erosion. Smooth surface wear was more prevalent in children resident in affluent areas. CONCLUSION: Children in non-fluoridated districts are 1.5 times more likely to have smooth surface wear compared with children in fluoridated districts. Fluoridation and use of fluoridated toothpaste twice a day provide added protection from dental erosion. The risk of tooth wear is greater with increasing affluence.     

Fluorosis risk in grade 2 students residing in a rural area with widely varying natural fluoride

OBJECTIVES: This pilot study was performed to determine the prevalence of dental fluorosis and the association between fluorosis and a number of risk factors in a group of second grade students in a rural, non-fluoridated area of Ontario, Canada. METHODS: Of 1739 students screened during routine health surveillance, 1367 had erupted maxillary central incisors. Fluorosis was scored on these children using the Tooth Surface Index of Fluorosis (TSIF). A fluoride exposure questionnaire and water sample vial was sent home from school with each child. RESULTS: Valid responses were obtained for 752 children (55%). The prevalence of fluorosis in respondents was 23.3%, with 4.9% scoring TSIF of 2 or more. In bivariate analysis, several variables were significantly associated with the prevalence and/or severity of fluorosis. These included: water fluoride concentration, breast-feeding duration, professionally applied topical fluoride, fluoride supplement use, bottle-feeding, fluoridated mouthwash use, and early parental toothbrushing with toothpaste. In logistic regression analysis limited to children living at the current residence for 4 years or more, only four variables had significant independent effects. These were water fluoride concentration, breast-feeding duration, fluoride supplement use, and fluoridated mouthwash use. CONCLUSIONS: These findings indicate that fluorosis is an important concern in non-fluoridated areas. Fluoride supplements should not be recommended unless an independent home water test is performed. Breast-feeding for 6 months or more may protect children from developing dental fluorosis in the permanent incisors.