Prevalence and extent of dental caries, dental fluorosis, and developmental enamel defects in Lithuanian teenage populations with different fluoride exposures

The aim of this study was to describe the pattern of dental caries, dental fluorosis, and developmental defects of non-fluoride origin in Lithuanian children born and raised in regions with 1.1 ppm (1.1 mg/l F) and 0.3 ppm (0.3 mg/l F) water fluoride levels, respectively. All permanent surfaces/teeth of 300 teenagers were examined for dental caries, dental fluorosis, and non-fluoride developmental defects. The caries prevalence of the study population was 100%. The mean number of decayed surfaces (DS) differed only slightly and statistically insignificantly between the '1.1 ppm fluoride' and '0.3 ppm fluoride' groups (19.6 and 18.1, respectively). However, a greater number of inactive lesions and fewer fillings were found in the '1.1 ppm fluoride' group than in the '0.3 ppm fluoride' group (mean difference 1.18 and −2.80, respectively). The prevalence of dental fluorosis was 45% and 21%, respectively; the prevalence of non-fluoride opacities was 8% and 19%, respectively; and the prevalence of hypoplasia was 12% and 16%, respectively, in the '1.1 ppm fluoride' and '0.3 ppm fluoride' groups. Higher caries levels were noted in children with no fluorosis compared to those with fluorosis recorded (mean DS difference, 3.43). The results lend support to the hypothesis that the presence of fluoride in the oral environment promotes lesion arrest rather than inhibiting the initiation of new lesions.     

Spatial distribution of groundwater fluoride levels and population at risk for dental caries and dental fluorosis in Sri Lanka

Objectives: To investigate the distribution of groundwater fluoride levels in Sri Lanka in relation to its population distribution to determine the population at risk for dental caries or dental fluorosis. Methods: The study used the most upgraded spatial distribution map of groundwater fluoride levels in Sri Lanka, and it was overlaid with a census of population data of the country. Results: The results indicated that 12% of children aged <12 years were at risk for dental fluorosis, while 81.4% of those who lived in low-fluoride zones were vulnerable for development of dental decay. Overall, 82.4% of the country’s population lived in low-fluoride zones and 11.2% were at risk of potential health hazards posed by ingestion of excessive fluoride. Conclusion: The spatial approach provides a useful decision-support tool for developing an oral health strategy of safe fluoride use based on predicted oral health risks in communities.Key words: Groundwater, dental fluorosis, dental caries, spatial distribution     

Use of fluoride tablets and effect on prevalence of dental caries and dental fluorosis

A study was executed to investigate the relation between the use of fluoride tablets by children in the age period 1.5-6 yr on the one hand and the caries experience at the age of 6 and 15 yr and the prevalence of fluorosis at the age of 15 yr on the other hand. The year of birth of the child, the motivation of the mother to engage in preventive dental behavior, the level of her school education and her place of birth were taken into account as possible confounding factors. A significant relation was found between the use of fluoride tablets and the prevalence of fluorosis. The most important predicting factor for the caries experience of the child was the mother's motivation to engage in preventive dental behavior. An effect of fluoride tablets on the caries experience could not be demonstrated.     

Dental caries and fluorosis in Arussi province, Ethiopia

A dental health survey was carried out in the Arussi province in Ethiopia. The survey comprised 1,700 persons between 6 and 54 years of age in five age groups from four areas of the province. The present paper deals with findings on dental fluorosis and dental caries. Dental fluorosis was found in 18% of the subjects, mainly in a very mild form. The fluoride content of the water (0.2-0.3 part/10(6) F-) in combination with a high tea consumption was assumed to give a fluoride intake optimal for caries prevention. The prevalence of dental caries was low. Thirty-eight percent of the 6-7-year-old group had decayed primary teeth and 51% of the total sample had decayed permanent teeth. Comparisons with a study from 1958 revealed that the prevalence of dental caries had increased in the last few decades, probably due to the recently adopted habit of using sugar in the diet.     

昆明市儿童龋病和氟牙症流行状况调查

目的 通过对昆明市儿童龋病和氟牙症的流行病学调查,为该区开展饮水加氟预防龋齿提供可行性依据,并为昆明市龋病和氟牙症长期流行病学研究提供基础数据.方法 采用分层、整群随机抽样方法,调查5、12岁2个年龄组儿童各212、1 149人,调查内容包括5、12岁儿童龋病患病现状以及12岁儿童氟牙症流行现状.结果 昆明市5岁儿童...     

Attitudes to fluorosis and dental caries by a response latency method

BACKGROUND: Understanding socially relevant attitudes to fluorosis and dental caries is important. Previous studies have concentrated mainly on aesthetic implications. AIMS: To investigate social judgements beyond the aesthetic, made when viewing digitally manipulated extraoral images of dental fluorosis of varying degrees of severity and images of dental caries. METHODOLOGY: Using a response latency technique, which allowed both the direction and strength of attitudes to be measured, 40 volunteers made judgements on 144 image/characteristic combinations. RESULTS: Participants made social judgements which extended beyond the aesthetic to factors such as sociability, reliability and cleanliness. Judgements on mild fluorosis were not markedly different from those made about the same individual with normal enamel, but severe fluorosis had a significant negative impact on social judgements. Untreated dental caries was judged less favourably than normal enamel and mild fluorosis. CONCLUSIONS: Attribution of characteristics that go beyond the aesthetic are significantly influenced by altered tooth appearance.     

Association between infant formula feeding and dental fluorosis and caries in Australian children

Objective: The objective of this study was to evaluate associations between patterns of infant formula feeding and dental fluorosis and caries in a representative sample of Australian children. Methods: A population‐based study gathered information on fluoride exposure in early childhood. Information on infant formula feeding and fluoridation status was used to group children: three groups in nonfluoridated areas (formula nonuser, user for ≤6 months, and user for 6+ months) and four groups in fluoridated areas (nonuser, user with nonfluoridated water, user with fluoridated water for ≤6 months, and user with fluoridated water for 6+ months). Children aged 8‐13 years were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index. Primary tooth caries experience recorded at age 8‐9 years was extracted from clinical records. Fluorosis cases were defined as having TF 1+ on maxillary incisors. Fluorosis prevalence and primary caries experience were compared across formula user groups in multivariable regression models adjusting for other factors. Results: Total sample was 588 children. Children in fluoridated areas had higher prevalence of very mild to mild fluorosis, but lower caries experience than those in nonfluoridated areas. Among children in nonfluoridated areas, formula users for 6+ months had significantly higher prevalence of fluorosis compared with nonusers. There was no significant difference in fluorosis prevalence among the formula users in fluoridated areas. Among children in fluoridated areas, formula users with nontap water had higher caries experience. Conclusion: Infant formula use was associated with higher prevalence of fluorosis in nonfluoridated areas but not in fluoridated areas. Type of water used for reconstituting infant formula in fluoridated areas was associated with caries experience.     

铜山县高氟区少年龋病和氟斑牙患病情况的调查

目的调查徐州市铜山县高氟区12~15岁人群氟斑牙和龋病的流行情况,探究龋病患病患病率、龋均与氟斑牙之间的相关关系,为高氟区少年的氟斑牙和龋病的防治提供参考。方法参考第二次全国口腔健康流行病学抽样查的基本方法与诊断标准和Dean氟牙症分类标准,对高氟区12~15岁初中学生氟斑牙和龋病的患病情况进行检查记录。结果社区氟斑牙指数Fci为2.52,为氟斑牙重度流行区域;诊断为氟斑牙的人群中各年龄组氟斑牙患病率无差异;本次调查人群总患龋率为22.7%;氟斑牙人群的患龋率各年龄组间无显著性差异,龋均各年龄组间差异无显著性;诊断为氟斑牙的患龋病人群中患龋率比较不同记分组有显著性差异(P=0.042),重度组与轻度组比较及重度组与非氟斑牙组比较,龋均均有显著性差异。结论高氟区12~15岁少年的氟斑牙人群的患龋率与非氟斑牙人群比有显著性差异(P=0.000),其中记分为重度的组患龋率比轻度的组和非氟斑牙组高。     

The prevalence of dental caries and fluorosis in Japanese communities with up to 1.4 ppm of naturally occurring fluoride

OBJECTIVES: The purpose of this study was to determine the relationship between the concentration of fluoride in drinking water and the prevalence of dental caries and fluorosis in seven Japanese communities with different concentrations of fluoride occurring naturally in the drinking water. METHODS: A total of 1,060 10- to 12-year-old lifetime residents were examined to determine the prevalence of dental caries and fluorosis in communities with trace amounts to 1.4 ppm fluoride in the drinking water in 1987. Systemic fluorides (drops or tablets) have never been available in Japan and the market share of fluoride-containing toothpaste was 12 percent at the time of the study. RESULTS: The prevalence of dental caries was inversely related and the prevalence of fluorosis was directly related to the concentration of fluoride in the drinking water. The mean DMFS in the communities with 0.8 to 1.4 ppm fluoride was 53.9 percent to 62.4 percent lower than that in communities with negligible amounts of fluoride. Multivariate analysis showed that water fluoride level was the strongest factor influencing DMFS scores. The prevalence of fluorosis ranged from 1.7 percent to 15.4 percent, and the increase in fluorosis with increasing fluoride exposure was limited entirely to the milder forms. CONCLUSIONS: The findings of this study conducted in 1987 in Japan parallel those reported by Dean et al. in the early 1940s.     

Dental fluorosis and dental caries among 12-yr-old children from high- and low-fluoride areas in Lithuania

We investigated the prevalence and severity of dental fluorosis, and the occurrence of dental caries, among 12-yr-old children from high- and low-fluoride areas in a country with high caries figures and a developing oral healthcare system. The sample included a total of 600 lifetime residents from high-fluoride (HF; 1.7-2.2 ppm) and low-fluoride (LF; 0.2 ppm) areas in Lithuania. The diagnoses of dental fluorosis followed the Thylstrup-Fejerskov Index (TF), and a diagnosis of dental caries followed the World Health Organization criteria. In the HF area, 66% of the 12-yr-old children had dental fluorosis (TF score > 0) compared with 4% in the LF area. The maximum TF severity scores were 7 and 3, respectively. The mean number of teeth with fluorosis was 4.5 [95% confidence interval (CI) = 4.0, 5.0] for the HF group and 0.2 (95% CI = 0.1, 0.2) for the LF group. In the HF group, 72% had a decayed, missing or filled teeth (DMFT) score of > 0, compared with 87% in the LF group. The mean DMFT was 2.0 (95% CI = 1.8, 2.3) in the HF group and 3.5 (95% CI = 3.2, 3.8) in the LF group. Current untreated caries (DT) occurred (DT >0) in half of both the HF and LF groups. Regardless of the concentration of fluoride in the drinking water, the prevalence of past (DMFT > 0) and present (DT > 0) caries was high, calling for more emphasis on the prevention of tooth decay in countries, such as Lithuania, with high caries figures and a developing oral healthcare system.     

The relationship between dental caries and dental fluorosis in areas with moderate- and high-fluoride drinking water in Ethiopia

OBJECTIVE: The aim of the study is to assess the relationship between caries and dental fluorosis in Ethiopian children living in Rift Valley areas known for endemic fluorosis. METHOD: A total of 306 children (12-15 years old), selected from areas with moderate (0.3-2.2 mg/l), or high (10-14 mg/l) fluoride concentration in the drinking water were interviewed and examined for caries and dental fluorosis. Scorings were recorded according to the DMF system, and the Thylstrup-Fejerskov (TF) Index. RESULTS: Prevalence of dental fluorosis (TF-score > or = 1) was 91.8% (moderate area) and 100% (high-fluoride area). The corresponding caries prevalence and mean DMFT in the areas were 45.3% versus 61.6%, and 1.2 versus 1.8, respectively. Age and severity of dental fluorosis were found to be independent predictors for DMFT > or = 1. When compared with 12-year olds with TF-scores 0-4, odds ratios were 3.0 (95% CI 1.6-5.7) and 2.0 (95% CI 1.2-3.2) if TF-scores were > or = 5 and age 13-15 years, respectively. A positive relationship between caries and fluorosis was observed across tooth types in both areas. The percentage of children with DMFT > or = 1 was highest in groups with TF-score > or = 5 in the second molar, followed by the first molar. CONCLUSION: The present findings indicate that the second molar is the tooth most severely affected by dental fluorosis and dental caries. Dental caries increased with increasing severity of dental fluorosis, both in moderate- and high-fluoride areas. Thus, a positive relationship between dental caries and dental fluorosis was observed across various tooth types, in both areas.     

Effect of different diagnostic thresholds on dental caries calibration

OBJECTIVES: (a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values. PARTICIPANTS: A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity. METHODS: Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used. MAIN OUTCOME MEASURES: WHO and WHO+IL diagnostic thresholds according to tooth and dental surface. RESULTS: Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL. CONCLUSION: It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.     

Assessment of different methods for diagnosing dental caries in epidemiological surveys

AIMS: The aims of the study were: (i) to assess different clinical diagnostic methods of dental caries during epidemiological surveys; (ii) to determine which combinations of methods and diagnostic adjuncts show the best performances in epidemiological surveys when compared with examinations performed in a traditional dental setting (standard); (iii) to evaluate the influence of including noncavitated (NC) lesions in dental caries estimation. METHODS: Forty 12-year-old children were divided into low and moderate caries prevalence groups. The individuals were submitted to 12 epidemiological examinations (in an outdoor setting), which combined three methods (blade, mirror and mirror + CPI (Community Periodontal Index) dental probe) with or without diagnostic adjuncts (previous dental brushing and dental drying). The last examination was performed in a traditional dental setting (standard examination). The unit of measure was the DMFS (decayed, missing and filled surfaces) index according to WHO criteria. The variance analysis, Dunnet's and Tukey's tests were applied. RESULTS: For the DMFS analysis, the visual/tactile method, with or without diagnostic adjuncts, was the best method for both groups, presenting a performance higher than 90% when compared with the standard examination, except for the examinations without previous dental brushing for the low caries prevalence group. Previous dental brushing was more relevant than dental drying (P = 0.0054). All of the epidemiological examinations underestimated the NC diagnosis even with the association of diagnostic adjuncts when compared with the standard examination. CONCLUSION: The visual-tactile (for both groups) and the visual (mirror) methods plus dental brushing (for the moderate group) are appropriate for diagnosing cavitated lesions, but not NC lesions.     

Streptococcus mutans and dental caries in urban and rural schoolchildren in Thailand

Two groups of Thai schoolchildren aged 11-13 yr were examined for dental caries, dental fluorosis and Streptococcus mutans. One hundred children lived in an urban district, Bangkok, and 71 children in a rural district, Petchaboon. Saliva samples were analyzed for S. mutans by the spatula method. The fluoride content of the drinking waters was also determined. The prevalence of caries, diagnosed according to WHO, was 89% in Bangkok and 18% in the rural district. Mean DMFT was 3.46 and 0.38 respectively. S. mutans was found in 98% of the urban children and in 82% of the rural. The differences in distribution between S. mutans and DMFT classes were statistically significant for the total sample. Mild fluorosis was present in some of the rural children.     

Dose-response relationship between water fluoride levels and the category of questionable dental fluorosis

There is a dose-response relationship between the prevalence of the questionable category of dental fluorosis as reported by various authors and the drinking water fluoride level. While the possibility that chance could have produced this trend cannot be conclusively ruled out, a distinct pattern of increasing prevalence with increasing water fluoride level can be discerned. Such a pattern is not compatible with the concept of a threshold level for the action of fluoride ion on the enamel organ.     

Comparison of dental fluorosis and caries in primary teeth of preschool-children living in arid high and low fluoride villages

Abstract The aim of this study was to determine the degree of fluorosis in the primary dentition and the accompanying caries patterns in groups of preschool-children in high and low fluoride areas. Among 331 coloured children, aged 1 -5 years, living in an area with water F concentrations ranging from 2.2 to 4.1 parts/10⁶, 82% were caries free and the dmft values ranged from 0 to 15 with a mean dmft of 0.8 ± 2.1. Varying degrees of fluorosis in the primary teeth were present in 50.6% of the children. In 177 coloured children of similar ages from an adjacent area with 0.2 parts/10⁶ F in the drinking water the dmft values ranged from 0 to 20 with a mean dmft of 5.4 ± 5.8. Only 28% of the children were caries free. None of the children in this area had fluorosis. The caries prevalence was significantly higher in the low fluoride area than in the high fluoride area. The degree of fluorosis found in the primary dentition in the children from the high fluoride area was higher than had been anticipated and was accompanied by a very low caries prevalence.     

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目的了解西藏那曲地区藏族学生砖茶型氟牙症及龋病流行情况,并对两者关系进行探讨。方法2004年7月采用单纯随机抽样的方法,对12～17周岁的471名藏族学生,按WHO推荐的Dean分类法和龋病调查方法对氟牙症及龋病患病情况进行检查;采用SPSS11.5进行统计分析,氟牙症与龋病的相关性分析用Mantel-Haenszelχ2检验和线性相关性检验;将不同程度的氟牙症按Dean标准分级,并与龋病患龋率进行分层趋势χ2检验。结果氟牙症患病率为53.5%,氟牙症指数为1.09,属中度流行地区;恒牙患龋率较高(56.7%),程度较重(龋均为4.09±2.106);龋病的发生与氟牙症呈高度正相关(χM2H=12.060,P<0.01;OR=1.954,P<0.01),为显著线性关系(χ2=12.715,P<0.01);随着氟牙症程度的加重,患龋率呈上升趋势(χ2=14.846,P<0.01)。结论砖茶型氟牙症已成为当地龋病高发的易感因素;减少氟牙症的发生,应成为当地藏族学生预防龋病的重要措施之一。     

Effect of fluoridated salt intake in infancy: a blind caries and fluorosis study in 8th grade Hungarian pupils

Salt fluoridation is effective at inhibiting caries, but fluorosis prevalence data are deficient. OBJECTIVES: The purpose was to undertake a blind study of caries and tooth mottling in 8th grade school pupils from south-east Hungary who had resided (test) or not resided (control), until November 1985, in a 350 ppm F-/kg domestic salt-fluoridated area during their early years of life. METHODS: In Szeged, blind clinical caries and anterior tooth mottling scoring (+10% repeats) of 49 previously salt-fluoridated (mean age 14.14 years) and 59 non-salt-fluoridated subjects (mean age 14.08 years) were undertaken by one examiner, in June 1997. In addition, radiographic and photographic recordings were taken. In Glasgow, four dental and two lay staff scored the projected 35 mm colour transparencies (+10% repeats) of each pupil's six upper anterior teeth, for tooth mottling. All clinical, radiographic and photographic data were then analysed. RESULTS: Mean DMFS scores were 9.18 (SD=10.72) for test users and 4.51 (SD=6.24) for control users (P<0.01) and, based on repeat observations, clinical reliability=0.99; X-ray reliability=0.95. Clinically, three test children had fluorosis of 10 teeth, with eight teeth in two controls. Photographic scoring by the clinical examiner gave a 97.2% clinical match, while photographic agreements for all four dentist pairs were 92.5%-97.2%, with lay observers' agreements at 89.8%. For both groups, 10% repeats produced 98.5% agreements. In a sole test case "fluorosis" photographic unanimity was obtained, and non-unanimous "possible fluorosis" was recorded by two to four panel members for only three other test and two control subjects. CONCLUSIONS: No evidence was found that significant anterior tooth fluorosis resulted in subjects exposed previously to 350 ppm F-/kg domestic salt from birth to 2.3-4.8 years of age. However, no caries benefit was demonstrated after the 11.5-year salt fluoridation gap. Caries differences seemed social class-related, city-based controls having less disease than rural test subjects, in spite of an identical F- tablet regimen in all schools from 1987, until subjects were 10 years old. These data emphasise (a) the superiority of sustained community-delivered fluoridation and (b) the need to maintain constant fluoride delivery to tooth surfaces, certainly well beyond 10 years of age.     

Fluoride exposure and dental fluorosis in Newburgh and Kingston, New York: policy implications

OBJECTIVES: This analysis was conducted to determine the changes in the effect of exposure to fluoridation and other sources of fluoride on dental fluorosis in children attending Newburgh and Kingston school districts in New York State. METHODS: Data for this analysis were obtained from two surveys conducted in the 1986 and 1995 school years. Analyses were limited to 3500, 7-14-year-old lifelong residents of a fluoridated or a nonfluoridated community. Dean's classification and DMFS index were used for recording dental fluorosis and caries, respectively. A questionnaire was used to collect fluoride exposure data. Regression procedures were used to estimate the effect of fluoridation, fluoride supplements, and brushing before the age of 2 years on dental fluorosis. RESULTS: Children examined in 1996 were at higher risk for both questionable and very mild to severe dental fluorosis if they received fluoride from water or daily tablet use, or started brushing before the age of 2 years. The increase in risk from 1986 to 1995 was greater for African-American children. CONCLUSION: This analysis showed that the risk of developing dental fluorosis did not decline over time in these communities. Continuous exposure to water fluoridation had an observable effect on dental fluorosis. However, implementation of fluoridation in Newburgh Town did not result in an increase in dental fluorosis prevalence.