Fluoridated City Research Articles

Caries prevalence and water fluoridation in Israel: a cross-sectional study.

To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5,000 individuals was fluoridated. In 2014, CWF in Israel stopped. Data on 12-year-old children from all areas in Israel from the national cross-sectional epidemiological survey conducted in 2011 to 2012 were stratified by city water fluoridation and by city and school socioeconomic status. Two dependent variables were defined: (1) DMFT index of caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov classification of fluorosis. Data from 2,181 12-year-olds were analyzed. The average DMFT was 1.17 ± 1.72, and 49% were caries-free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs 0.98 in fluoridated cities) and there were more caries-free children in fluoridated cities (56.4% vs 40.6% in nonfluoridated). DMFT was higher in cities with lower socioeconomic status than high socioeconomic status (1.29 vs 1.05, respectively, P < .001) and there were fewer caries-free children in low socioeconomic status cities (44.5% vs 53.0% in high socioeconomic status cities, P < .0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in the Thylstrup-Fejerskov index), had questionable to mild fluorosis (9.3%). CWF is a cheap, simple method of dental health protection that reaches all socioeconomic levels, and cessation of water fluoridation reduced the health of Israel's children. Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities.

Caries prevalence and water fluoridation in Israel: a cross-sectionalstudy.

To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5000 individuals was fluoridated. In 2014 CWF in Israel stopped. Data on 12-year-old children from all areas in Israel from the national crosssectional epidemiological survey conducted in 2011-2012 were stratified by city water fluoridation and by city and school socio-economic status (SES). Two dependent variables were defined: (1) DMFT index -caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov (TF) classification of fluorosis. Data from 2181, 12-year-olds was analyzed. the average DMFT was 1.17+1.72 and 49% were caries free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs. 0.98 in fluoridated cities) and there were more caries free children 56.4% in fluoridated cities vs. 40.6% in non-fluoridated. DMFT was higher in cities with lower SES than high SES (1.29 vs. 1.05 respectively, p<0.001) and there were less caries free children in low SES (44.5% vs. 53% in high SES cities, p<0.0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in TF index), had questionable to mild fluorosis (9.3%). CWF is a cheap, simple method of dental health protection that reaches all socio-economic levels and cessation of water fluoridation reduced the health of Israel's children. Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities.

Does water fluoridation influence ethnic inequalities in caries in Brazilian children and adolescents?

This study aimed to investigate the influence of community water fluoridation on ethnic inequalities in untreated dental caries among children and adolescents in Brazil while taking the human development context into account. Data from a nationwide Brazilian epidemiological population oral health survey were used (SB Brazil 2010). Outcomes were caries prevalence measured by the proportion of individuals with one or more untreated decayed teeth and caries severity defined by the mean number of untreated decayed teeth (DT). Three different contexts were considered: 1-cities with no water fluoridation; 2-cities with water fluoridation and low Human Development Index (HDI); and 3-cities with water fluoridation and high HDI. The exposure was ethnic/racial group (White, Pardo, Black) and covariates were age, sex and household income. Multilevel logistic and negative binomial regressions were performed with 6696 children (aged 5years) and 11585 adolescents (aged 12 and 15-19years). For both children and adolescents, ethnic differences in caries prevalence and mean DT were found in the nonfluoridated cities with low HDI and also in cities with high HDI, most of which were fluoridated. For example in nonfluoridated cities with low HDI, 5-year-old Pardo children were more likely to have untreated decay (OR=1.22; 95% CI: 1.02, 1.46) and had more decayed teeth (RR=1.18; 95% CI: 1.04, 1.34) than their White counterparts after adjusting for sex and household income. No statistically significant differences were observed in fluoridated cities with low HDI. Water fluoridation appears to be associated with reduced ethnic inequalities in dental caries prevalence and mean DT among children and adolescents in more disadvantaged settings.

Biomarkers of Fluoride in Children Exposed to Different Sources of Systemic Fluoride

There has been no comparison between fluoride concentrations in urine and nails of children exposed to different sources of systemic fluoride. The aim of this study was to compare the relationship between fluoride intake with urinary fluoride excretion and fluoride concentrations in fingernails and toenails of children receiving fluoride from artificially fluoridated water (0.6-0.8 mg F/L, n = 25), naturally fluoridated water (0.6-0.9 mg F/L, n = 21), fluoridated salt (180-200 mg F/Kg, n = 26), and fluoridated milk (0.25 mg F, n = 25). A control population was included (no systemic fluoride, n = 24). Fluoride intake from diet and dentifrice, urinary fluoride excretion, and fluoride concentrations in fingernails/toenails were evaluated. Fluoride was analyzed with an ion-selective electrode. Urinary fluoride excretion in the control community was significantly lower when compared with that in the fluoridated cities, except for the naturally fluoridated community. However, the same pattern was not as evident for nails. Both urinary fluoride output and fluoride concentrations in fingernails/toenails were significantly correlated to total fluoride intake. However, the correlation coefficients for fluoride intake and urinary fluoride output were lower (r = 0.28, p < 0.01) than those observed for fingernails/toenails (r = 0.36, p < 0.001), suggesting that nails might be slightly better indicators of fluoride intake at the individual level.

Effects of Long-term Fluoride in Drinking Water on Risks of Hip Fracture of the Elderly: An Ecologic Study Based on Database of Hospitalization Episodes

Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the nonfluoridated cities. We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.

Study links fluoridated water and hip fractures

Drinking fluoridated water may increase the risk of hip fractures among the elderly, says a study published last week in the Journal of the American Medical Association [ 268 , 746 (1992)]. Christa Danielson and colleagues at the University of Utah, Salt Lake City, found increased risk of hip fracture in men and women over 65 who were exposed to fluoride in drinking water for about 20 years. Danielson compared the incidence of hip fractures in Brigham City, Utah, where water is fluoridated at 1 ppm, with the incidence of hip fractures in two other Utah cities, where the water is not fluoridated and fluoride levels are less than 0.3 ppm. She found women in the fluoridated city were 1.27 times as likely to suffer hip fractures as women from unfluoridated cities. Men were 1.41 times as likely to suffer hip fractures as those from unfluoridated cities. This is not ...

Relationship Between Dental Caries Experience and Surface Enamel Fluoride Concentration in Young Men from Three Optimally Fluoridated Cities

An in vivo enamel biopsy technique was used to determine relationships between dental caries experience and surface enamel fluoride levels in a group of young men from three fluoridated cities on the east coat of the U.S. A significant inverse relationship between enamel thickness and fluoride concentration was observed, and a weak but statistically significant inverse relationship between caries scores and enamel fluoride concentration was noted. The effect was most pronounced in biopsies which did not exceed 5.9 micron in depth.

Fluoride intake of young male adults in the United States

The total daily fluoride intake for young male adults living in four geographical areas of the United States has been estimated by the analysis of "market basket collections" obtained in 1975 and 1977. The fluoride intake in 1975 vaired from 0.912 mg/day in an unfluoridated city (Kansas City, Mo.) to 1.720 mg/day in a fluoridated city (Atlanta, Ga.). The 1977 collection from San Francisco, Calif. contained more fluoride (1.636 mg/day) than the 1975 collection (1.213 mg/day). The level of intake found in this study is less than that reported by San Filippo and Battistone (Clin. Chem. Acta 31: 453, 1971) who analyzed similar collections from Baltimore, Md. in 1967 to 1968 (2.09 to 2.34 mg/day). This study, as well as the earlier one, indicates that relatively low levels of fluoride are being consumed in the United States by the young adult male 16 to 19 years of age.

Fluoridation of Water Supplies and Cancer-A Possible Association?

1. In the recent book Fluoride, Teeth and Health published by the Royal College of Physicians, it was asserted inter alia that there was no evidence that fluoride increases cancer mortality. 2. This statement was challenged by the presentation of data showing crude cancer mortality rates in two groups of large American cities. The rise in the crude mortality rate between 1950 and 1970 in 10 cities which had fluoride added to their water supplies early in that period was undoubtedly larger than the rise in ten unfluoridated cities. 3. The US National Cancer Institute asserted that this rise could be explained by the different age-sex-race structures of the populations in the two groups of cities. 4. The Royal College of Physicians invited the Council of the Royal Statistical Society to comment. 5. Our analysis shows that the two groups of 10 cities differed in their age-sex-race structure in 1950. The cities which were to be fluoridated started with many fewer elderly white females, somewhat fewer elderly white males and more non-whites at all ages below 50. 6. When these differences are taken into consideration, the two groups both had higher-than-expected cancer mortality in standardized comparison with national rates; this conforms with world-wide experience that cancer is generally more common in towns than in rural areas. But the two groups were not similar in 1950, despite similar crude death rates: the cities which were to be fluoridated had at that time an excess of cancer deaths which was 10-3 per 100,000 population greater than that of the control cities. 7. By 1970, the two sets of cities differed much more in their demographic structure than they had in 1950. The fluoridated cities now had many more non-whites of all ages in their populations, and many fewer whites under the age of 55. These demographic changes made the fluoridated cities much more likely to have deaths from cancer. 8. When these demographic changes are taken into account we find, in proportional terms, that the excess cancer rate increased by 1 per cent over the 20 years in the fluoridated cities, but it also increased by 4 per cent in the unfluoridated control cities, giving a difference of 3 per cent to the advantage of the fluoridated cities. 9. Alternatively, but not in keeping with normal epidemiological practice, these results could be expressed in absolute rather than relative terms. The excess cancer rate increased by 8-8 per 100,000 population over the 20 years in the

The prevalence of malocclusion, related to dental caries and lost first permanent molars, in a fluoridated city and a fluoride-deficient city

The data from this study, as well as from previous studies reported, suggest that children who have the benefit of ingested water fluorides continuously from birth have significant protection against dental caries. They also have a significantly lower rate of loss of permanent teeth, specifically first permanent molars, than children who do not get water-borne fluorides at the optimum concentration. The study adds further substantiation to Salzmann's previous large-scale study regarding the potential hazard of developing malocclusion as a result of early first permanent molar loss. Other factors, such as untreated caries and filled teeth with poor contact points, should be studied. Thus, the benefits which accrue from public water fluoridation programs may be measured not only in terms of significant protection against detal caries but also with respect to a reduced hazard of malocclusion, especially severe malocclusion which may be regarded as physically handicapping.