Longitudinal Evaluation of Sealing Molars with and without Incipient Dental Caries in a Public Health Program

Objectives: This study undertook a retrospective evaluation of the effect of sealants on the caries experience of initially sound and incipient permanent first molar pit and fissure surfaces. Methods : Records of children with complete five-year records were obtained from a school-based dental sealant program in a fluoridated community. Sealants were placed on 677 tooth surfaces in 96 children; 120 tooth surfaces in 17 children who received baseline examinations were not sealed because of lack of caregiver consent. Tooth surfaces were initially diagnosed as being sound or having incipient lesions, and evaluated for caries status after five years. Results : For initially incipient surfaces the five-year decay rate was 10.8 percent (41 of 380 surfaces) for sealed surfaces and 51.8 percent (29 of 56 surfaces) for nonsealed surfaces with an odds ratio of 8.88 (95% Cl=4.56, 17.35). Initially sound surfaces had a decay rate of 8.1 percent (24 of 297 surfaces) for sealed surfaces and 12.5 percent (8 of 64 surfaces) for nonsealed surfaces with an odds ratio of 1.63 (95% Cl=0.63, 4.08). The two odds ratios were significantly different. Conclusions : Initially sound tooth surfaces were unlikely to become decayed in five years, and did not benefit greatly from the application of sealants. Within the limitations of this study, there were clear efficiencies in sealing incipient, but not sound, surfaces. The targeting of teeth with incipient caries for sealants is therefore recommended.     

Effectiveness of School Water Fluoridation and Dietary Fluoride Supplements in School-aged Children

School water fluoridation and school-based fluoride tablet programs both have been shown in many studies to be effective in preventing dental caries. These studies indicate that school water fluoridation reduces dental decay by approximately 40 percent and school-based fluoride tablet programs by about 30 percent. However, nearly all the studies were done when the prevalence of caries among US schoolchildren was greater than it is today, which makes it difficult to assess their current effectiveness. Data from dental surveys of school-aged children conducted during the past 30 years indicate that overall caries prevalence has declined by more than 75 percent and that of approximal tooth surfaces by more than 90 percent. Recent national data indicate the difference in caries prevalence between children with lifetime residence in either fluoridated or nonfluoridated areas has also diminished, which raises questions about the cost effectiveness of initiating school-based fluoride programs for all areas. There are still groups of children, however, seriously affected by dental caries. It is safe to assume that implementation of school water fluoridation or fluoride tablet programs will result in traditionally reported benefits among these children. Ongoing school-based fluoride programs should not be discontinued until it is known what impact their cessation will have on dental disease.     

Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand

Abstract – Objectives: This epidemiological study aims to investigate the developmental enamel defects and dental caries among 9‐year‐old children resident in fluoridated and nonfluoridated regions in Auckland, New Zealand. Methods: A stratified, two‐stage random selection design where strata were defined by fluoridation status, school size, and school decile. After informed consent was obtained, parents completed oral health questionnaires and children underwent dental examinations at school clinics. Results: 612 children from 38 schools participated in the study. Overall, 175 (29%) children had lived continuously in fluoridated areas, 149 (24%) had lived continuously in nonfluoridated areas, and 288 (47%) had resided intermittently in fluoridated areas. Diffuse opacities were present in 117 (19%) children and deciduous teeth dental caries was seen in 370 (60%) children. After adjustment for covariates, a strong dose–response relationship between diffuse opacity and fluoridation status was found, with children who lived continuously in fluoridated areas being 4.17 times as likely to have diffuse opacities as children who lived continuously in nonfluoridated areas (P < 0.001). Conversely, a strong protective dose–response relationship between caries experience and fluoridation status was seen, with children who lived continuously in fluoridated areas being 0.42 times as likely to have dental caries as children who lived continuously in nonfluoridated areas (P < 0.001). Conclusions: Reticulated water fluoridation in Auckland reduces the risk of dental caries but increases the risk of diffuse opacities in 9‐year‐old children. Guidelines and health‐promotion strategies that enable children to minimize their risk to diffuse opacities yet reduce their risk of dental caries should be reviewed.     

Caries Prevalence in Head Start Children, 1986–87

Since the early 1970s, caries prevalence among school-aged children in the United States has declined. It appears that a small percentage of the children experience most of the caries increment. In addition, a large proportion of children in the US who need dental care receive it. An important factor in the amount of treatment received by children is the socioeconomic status of the family. Data on caries prevalence among preschool populations are limited. The Head Start program serves low-income families in the US and offers a unique opportunity to look at individuals who may be at greater risk of health problems and may experience less access to health services. A survey of 1,796 three- to five-year old Head Start children from low-income families was conducted in 1986-87. Caries prevalence, baby bottle tooth decay prevalence and relative need for dental care are reported for fluoridated and non fluoridated communities in California, Hawaii, and Micronesia. The data reveal scores that are higher in the sample population than in five-year-olds in national surveys and among Head Start children in previous surveys.     

Community fluoridation status and caries experience in children

OBJECTIVE: This study compares dental caries experience in fluoridated and nonfluoridated communities. METHODS: A dental health survey designed to collect data on caries experience and treatment needs for community-specific public health planning purposes was conducted in public elementary schools during the 1996-97 school year. Oral examinations of 17,256 children were completed, representing 93 percent of children residing in 62 East Tennessee communities. RESULTS: The analysis showed that water fluoridation was significantly related to caries experience in the primary (dfs) and permanent (DMFS) dentitions and to the proportion of caries-free children in the primary and permanent dentitions. When the data were adjusted for socioeconomic status, race, and age, caries levels were 21 percent lower in the primary dentition and 25 percent lower in the permanent dentition in fluoridated communities than in nonfluoridated communities. In addition, the proportion of children who were caries free was larger in fluoridated as compared with nonfluoridated communities by 19 percent in the primary dentition and 6 percent in the permanent dentition. CONCLUSION: Although the design of the study prevented the collection of individual fluoride and residency histories, findings suggest there was substantially lower caries experience in fluoridated communities than in nonfluoridated communities.     

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.     

Caries in permanent dentition and social class of children participating in public dental care in fluoridated and nonfluoridated areas

Abstract A random sample of 7-16-year-old children (n= 2778) who visited municipal dental clinics in fluoridated and nonfluoridated areas was studied. Structured questionnaires were used to collect data on social class and fluoride exposure; caries diagnoses were made by local dentists in municipal dental clinics. Children from the highest social class had the lowest caries frequency in both fluoridated and nonfluoridated areas. Differences between middle and lower class children were small. Water fluoridation had a similar effect in all social classes.     

Effect of Residence in a Fluoridated Community on the Incidence of Coronal and Root Caries in an Older Adult Population

Eighteen-month caries incidence among older adult residents of fluoridated and nonfluoridated communities was compared. Rates for both coronal and root caries were consistently lower among long-term residents of the fluoridated communities than among life-long residents of nonfluoridated communities. Coronal caries incidence was significantly lower for people who had resided in fluoridated communities for more than 30 years (1.95 vs 1.33 surfaces). Root caries incidence was significantly less among residents for more than 40 years (0.56 vs 1.11 surfaces). Fluoridation appeared to be beneficial for the older adults examined, even though the exposure to fluoridated water began in adulthood.     

Effectiveness of Water Fluoridation

The efficacy of communal water fluoridation in reducing dental caries has been reviewed based on surveys conducted in the last decade of caries prevalence in fluoridated and nonfluoridated communities in the United States as well as in Australia, Britain, Canada, Ireland, and New Zealand. The efficacy is greatest for the deciduous dentition, with a range of 30–60 percent less caries in fluoridated communities. In the mixed dentition (ages 8 to 12), the efficacy is more variable, about 20–40 percent less caries. In adolescents (ages 14–17), it is about 15–35 percent less caries. Current data on caries prevalence in adults and seniors are extremely limited and include several populations living in communities with higher than optimal fluoride levels. For these adults and seniors, a range of 15–35 percent less caries would also apply. Viewed in toto, the current data for children, adolescents, adults and seniors show a consistently and substantially lower caries prevalence in fluoridated communities. For an accurate measurement of the efficacy of water fluoridation in reducing dental caries, it is essential that only persons with a record of continuous or long-term residency in fluoridated versus nonfluoridated areas be included in such assessments. Because of the high geographic mobility in our society and the widespread use of fluoride dentifrices, supplements, and other topical fluoride agents, such comparisons are becoming more difficult to conduct. Accordingly, the effectiveness (rather than the efficacy) of water fluoridation has decreased as the benefits of other forms of fluoride have spread to communities lacking optimal water fluoridation.     

The geodemographic distribution of caries experience in neighboring fluoridated and nonfluoridated populations

OBJECTIVE: This study compares the geodemographic distribution of caries experience in neighboring fluoridated and nonfluoridated populations. METHODS: All 5-year-old children living in fluoridated (N=1,422) and nonfluoridated (N=4,779) areas of Cheshire, UK, were examined by trained and calibrated examiners. The Target Market level of the Super Profiles geodemographic classification was used to produce market penetration ranking reports for caries experience. The same area types were compared in fluoridated and nonfluoridated populations. Lorenz curves and Gini coefficients were generated from the outputs of the penetration rankings. RESULTS: There was a 12.4 percent difference in prevalence and a 29.4 percent difference in dmft between fluoridated (dmft>0=32.4%, dmft=1.01) and nonfluoridated (dmft>0=37.0%, dmft=1.43) areas. The area types at the top of both penetration rankings were deprived in nature and those at the bottom were affluent. The Gini coefficients in each area were 22.7 and 23.7 percent. CONCLUSIONS: The results demonstrate that water fluoridation is effective at preventing dental disease after controlling for confounding factors. In both populations the majority of disease was not confined to a small number of deprived area types. This undermines the contention that a targeted approach to caries prevention is a practical option.     

Modification of occurrence of caries in children by toothbrushing and sugar exposure in fluoridated and nonfluoridated areas

Abstract A representative sample (2024 children, 7–16 years old) from fluoridated and nonfluoridated areas was studied. Structured questionnaires were used to collect data on oral health habits; caries diagnoses were made by local dentists in municipal dental clinics. In the fluoridated area a positive correlation existed between toothbrushing frequency and occurrence of dental caries. In the nonfluoridated area the correlation was negative. This difference in the effect of toothbrushing on caries was statistically significant. Sugar exposure increased the difference.     

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.     

The Results of Water Fluoridation in Ireland

The visit of Dr. Trendley Dean to Dublin in the mid-1950s helped accelerate the decision to introduce water fluoridation as a public health measure in the prevention of caries in the Republic of Ireland. A challenge to the constitutional validity of the Health (Fluoridation of Water Supplies) Act 1960 failed and in 1964 the water supplies of Dublin city were fluoridated. Over the next seven to eight years all the major urban communities in the Republic of Ireland were fluoridated. Currently, 67 percent of the 3.5 million people in the country reside in fluoridated communities. Studies conducted over the last 20 years show that residents of fluoridated communities have better dental health than those in nonfluoridated communities—the mean dmft is lower in children and the number of natural teeth present in adults is higher.     

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 Dental Fluorosis Among Schoolchildren Who Were Lifelong Residents of Communities Having Either Low or Optimal Levels of Fluoride in Drinking Water

Objective : This paper reports findings for dental caries and dental fluorosis in 8–10- and 13–16-year-old schoolchildren who were lifelong residents of communities having either naturally occurring low (Broken Bow and Holdrege, NE; <0.3 ppm) or optimal (Kewanee, IL; 1 ppm) levels of fluoride in drinking water. Methods : Findings are reported for participants who received both dental caries and dental fluorosis examinations (n=495). The DMFS and TSIF indices, respectively, were used to assess dental caries and dental fluorosis. Results : The mean DMFS score adjusted for age, sealant presence, and fluoride use was significantly lower in Kewanee (1.8) than was the adjusted mean caries score in either Holdrege (2.9) or Broken Bow (3.6). Adjusted mean DMFS scores in Broken Bow and Holdrege were not statistically different. The mean percent of fluorosed tooth surfaces per person, adjusted for age and use of dietary fluoride supplements, was similar in the three communities (approximately 15%); more than 80 percent of tooth surfaces in all participants were fluorosis-free. Conclusion : Findings from the present study suggest that water fluoridation still is beneficial and that dental sealants can play a significant role in preventing dental caries. In addition, findings from this survey appear to support the premise that the difference in dental fluorosis prevalence between fluoridated and nonfluoridated communities has narrowed considerably in recent years.     

The Association Between Enamel Fluorosis and Dental Caries in U.S. Schoolchildren

BackgroundThe authors assessed the association between enamel fluorosis and dental caries to determine if there is any beneficial effect of enamel fluorosis in U.S. schoolchildren.

MethodsThe authors used data from a National Institute of Dental Research survey of the oral health of U.S. children conducted in 1986 and 1987 to determine the prevalence of caries and mean decayed, missing or filled surfaces on permanent maxillary right first molars in children 7 to 17 years of age who had a history of a single residence. (To date, this is the only national oral health data set in the United States with detailed information on fluoride exposures.) They examined the association between enamel fluorosis and caries using logistic regression analysis, controlling for potential confounders in communities with water at or above optimal fluoridation levels and in communities with nonfluoridated or suboptimally fluoridated water.ResultsPermanent maxillary right first molars with fluorosis consistently had lower levels of caries experience than did normal molars. Adjusted odds ratios for caries prevalence in molars with fluorosis were 0.71 (95 percent confidence interval [CI], 0.56–0.89) in communities with nonfluoridated or suboptimally fluoridated water and 0.89 (95 percent CI, 0.74–1.06) in communities with water at or above optimal fluoridation levels.ConclusionThis study's findings suggest that molars with fluorosis are more resistant to caries than are molars without fluorosis.Clinical ImplicationsThe results highlight the need for those considering policies regarding reduction in fluoride exposure to take into consideration the caries-preventive benefits associated with milder forms of enamel fluorosis.     

The Surface-Specific Caries Pattern of Participants in a School-Based Fluoride Mouthrinsing Program with Implications for the Use of Sealants

This paper describes the surface-specific changes in the DMFS after seven years of a school-based mouthrinsing program occurring in the elementary schools of the fluoride-deficient Three Village Central School District, Long Island, New York. The effectiveness of mouthrinsing was evaluated annually by comparing the caries prevalence of a random sample of participants to that of Three Village elementary schoolchildren examined in 1975, prior to the beginning of the program. Because sixth-grade children rinsed the longest and had the longest exposure to the caries challenge, only sixth-grade children who participated in the program are included in the analysis. Overall, they experienced a 50 percent reduction in dental caries; the reduction was not uniformly experienced by all surfaces. Proximal surface caries showed the greatest rate of change but the least absolute change, because the amount of proximal carious lesions was low initially. Occlusal surfaces showed the greatest absolute reduction in dental caries, whereas buccolingual surfaces had the lowest percentage reduction. The majority of the decayed or filled surfaces, 94 percent, involved pits or fissures. Therefore, it was concluded that the combined use of sealants and weekly fluoride rinsing could produce a virtual elimination of dental decay in elementary schoolchildren.     

Patterns of dental caries following the cessation of water fluoridation

OBJECTIVES: To compare prevalence and incidence of caries between fluoridation-ended and still-fluoridated communities in British Columbia, Canada, from a baseline survey and after three years. METHODS: At the baseline (1993/4 academic year) and follow-up (1996/7) surveys, children were examined at their schools. Data were collected on snacking, oral hygiene, exposure to fluoride technologies, and socio-economic level. These variables were used together with D1D2MFS indices in multiple regression models. RESULTS: The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community. While numbers of filled surfaces did not vary between surveys, sealed surfaces increased at both study sites. Caries incidence (assessed in 2,994 life-long residents, grades 5, 6, 11, 12) expressed in terms of D1D2MFS was not different between the still-fluoridating and fluoridation-ended communities. There were, however, differences in caries experienced when D1D2MFS components and surfaces at risk were investigated in detail. Regression models did not identify specific variables markedly affecting changes in the incidence of dental decay. CONCLUSIONS: Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.     

Prevalence of Dental Fluorosis in Fluoridated and Nonfluoridated Communities—a Preliminary Investigation

As a result of undocumented observations that the prevalence of dental fluorosis in both fluoridated and nonfluoridated communities may be higher than would be predicted on the basis of Dean's data from the 1940s, dental fluorosis assessments using a modification of Dean's Index were made in 1981 as part of routine examinations in a series of clinical trials. A total of 1,663 children in fluoridated or nonfluoridated communities, ranging in age from seven to 17 years, were examined during 1981-82. The prevalence of dental fluorosis in nonfluoridated communities ranged from 1.7 percent in 16-year-olds to 13.9 percent in 10-year-olds and, in fluoridated communities, ranged from 17.1 percent in 13-year-olds to 33.0 percent in 14-year-olds. At all age levels common to the two types of communities, the difference in prevalence of dental fluorosis was statistically significant. Compared with findings in Dean's studies in 1942, for children of comparable age in communities with essentially the same water-fluoride levels, the prevalence of dental fluorosis in the present study was 3 1/2 times higher in nonfluoridated communities and two times higher in fluoridated communities. Mean fluorosis scores, however, were similar. If additional studies substantiate that the prevalence and intensity of dental fluorosis are increasing, the accepted norms for fluoride dosage need to be reassessed--especially in supplements, dentifrices, and water.     

Effects of lifelong consumption of fluoridated water or use of fluoride supplements on dental caries prevalence

Abstract This study was undertaken to determine the prevalence of dental caries in children ages 6–14, from fluoridated and non-fluoridated areas in British Columbia, Canada, and the effects of receiving certain fluoride preventive procedures during childhood. Children from two communities were surveyed using a modified Decayed, Missing and Filled Tooth Surface Index (D₁ D₂ MFS). Questionnaires on the use of various fluoride preventive practices and residence histories during childhood were collected. Completed questionnaires were returned and exams were performed on 1131 children. Crude caries prevalence scores for the different fluoride exposure groups were tested for differences in dental age and the level of educational attainment of parents and/or guardians. No significant group differences were found. The 110 children with lifelong exposure only to fluoridated water had 35%, or 0.88 (S.D. = 2.91), fewer decayed or filled tooth surfaces per child (P(0.07) than children with no reported exposure to systemic fluorides. For the 122 children who had taken fluoride supplements for 4 yr or more, 0.67 fewer decayed and filled tooth surfaces (26% reduction) were observed per child when compared to children with no exposure to fluoridated water or supplements. For children who used fluoride supplements for less than 4 yr, no significant benefits were observed. Approximately 75% of the caries prevalence for control and fluoride-exposed groups was on pit and fissured surfaces. Reductions by surface type showed savings on both smooth and pit and fissured surfaces.