Fluoride Tablets Research Articles

Caries prevalence, Streptococcus mutans and sugar intake among 4-year-old urban children in Iceland.

Concern at the high prevalence of dental caries in Iceland prompted this survey of 158 preschool children in Reykjavik. On initial examination in 1987 45.8% of the children were caries-free and the prevalence of caries was a mean dmft 2.4 and a mean dmfs 3.3. A dietary questionnaire aimed at discovering the frequency of sugar consumption per week revealed a threshold value of 30 instances of sugar intake per week above which caries prevalence increased markedly. Some of this sugar is consumed in paediatric medicines, particularly antibiotics and anti-asthmatics, which are widely used in Iceland. Caries prevalence (dmft) for children taking such medicines regularly was 3.0 compared with 2.1 for remaining children (P less than 0.05). Those children who took fluoride tablets regularly had less caries (mean dmft 1.1) than those who used fluoride tablets irregularly or not at all (mean dmft 2.8; P less than 0.001). Samples of saliva from the dorsum of the tongue were taken for determination of numbers of Streptococcus mutans and lactobacilli. High bacterial counts were strongly associated with caries. Only 5% of children with more than 5 x 10(5 S. mutans cfu per ml were caries free but 27% of subjects had 67% of the total amount of caries for the group and all of these would have been detected by the bacterial test.

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.

Dental fluorosis among participants in a non-supervised fluoride tablet program.

The aim of the present study was to describe the intraoral pattern of dental fluorosis among fluoride tablet consumers. One hundred and forty-two children, of whom 56 had participated in a fluoride tablet program of 0.5/1.0 mg NaF per day were examined blindly for possible fluoride-induced enamel changes. A low prevalence of dental fluorosis was found among non-participants. The later in life the tooth was formed, the higher was the prevalence. The subjects who had participated in the fluoride tablet program showed a significantly higher prevalence of fluorosis. They could be divided into three groups: Group 1 exhibited a tooth prevalence pattern not statistically different from that of the non-participants, group 2 showed dental fluorosis in almost all teeth except in those formed before the start of the tablet program. In group 3 the early and the late formed teeth showed very little fluorosis while those formed in the few years just after the initiation of the fluoride tablet intake were affected by fluorosis.

Influence of food and antacid administration on fluoride bioavailability from enteric-coated sodium fluoride tablets

The relative bioavailability of enteric-coated sodium fluoride (NaF) tablets (10 mg F −) has been assessed following administration with a standard calcium-rich breakfast or calcium-poor lunch, and 2 h before or simultaneously with antacid administration (2.4 g aluminum-magnesium hydroxide), versus intake on an empty stomach. Twelve volunteers were studied 3 times according to an open, three-way crossover design over a 24 h period at weekly intervals. Meals were found to decrease the peak serum concentration of NaF from 122 μg/L during fasting (after baseline subtraction) to 71 and 88 μg/L with breakfast and lunch respectively, and to slow its absorption rate with Tmax increasing from 3.3 to 7.3 and 11.2 hours, without altering its bioavailability. Antacid impaired the bioavailability of NaF by 80% when administered simultaneously, with AUC decreasing from 987 to 155 μg.h/ L, but had no significant effect when taken 2 h before NaF. In conclusion, the enteric-coated NaF tablets used in this study can be administered with food or after a 2-hour delay following antacid administration, but should not be taken simultaneously with antacid.

Dissolution of calcium fluoride tablets in vitro and bioavailability in man.

The dissolution rate of CaF2 tablets in vitro and the degree of F absorption in vivo after tablet intake in man were investigated. 50% of total F was released in 0.1 N HCl after 45 min whereas virtually no release was seen in H2O or in 0.2 M PO4-buffer pH 6.8. In spite of the modest release of F in simulated gastric juice in vitro no F absorption as judged from the plasma fluoride concentration curve was seen within 6 h after intake of 4 mg F as CaF2 tablets.

Role of social class in caries occurrence in primary teeth.

The independent effect of social class on (A) the risk of having any caries (deft greater than or equal to 1) and on (B) the risk of having a few caries defects (deft greater than or equal to 3) in primary teeth was studied. The data, which were representative for all Finnish children of this age group, were collected by questionnaires from health centres and homes for 1637 children aged 2.5 to 7.5 years. The response rate was 83%. According to logistic regression analyses, children in the upper social class were clearly at lower risk of having caries than were children in the middle social class, independent of the child's age or sex, reported frequency of toothbrushing, consumption of sugar or use of fluoride tablets. In contrast, children in the lower social class had a higher risk of caries, which was independent of the reported dental health behaviour of the children. The results indicate that the differences among social classes in caries occurrence could not be eliminated by changes in dental health habits. Basic and applied research is needed to identify the relevant factors in socioeconomic status related to caries occurrence so that the differences in dental health between preschool children in different social classes can be reduced.

Combined effect of systemic and topical fluoride treatments on human deciduous teeth--case studies.

Forty-six deciduous teeth from caries-free children who had been exposed to systemic fluoride tablet treatment (0.5–1 mg F––/day) from 3 months prenatally to 7 years of age were examined hi

Effective delivery systems for prolonged fluoride release: review of literature

Controlled-release delivery systems have been investigated for use in fluoride therapy as a result of their ability to control the rate and site of fluoride release. Both sustained-release fluoride delivery systems and controlled-release fluoride preparations have been developed, including sustained-release fluoride tablets, fluoride-releasing polymers, microencapsulated fluoride in aerosols, and membrane-controlled fluoride reservoirs. Laboratory and clinical studies have confirmed the ability of these preparations to produce high levels of fluoride in saliva and plaque without toxic or adverse side effects. From these studies, it appears that controlled-release fluoride delivery systems have great potential as effective anticaries agents in cariesprone populations.

Distribution and retention of salivary fluoride from a sodium fluoride tablet following various intra-oral dissolution methods.

The distribution and retention of salivary fluoride were investigated according to the following intra-oral dissolution methods of a sodium fluoride tablet: active chewing/swishing, active sucking/swishing, and passive dissolution in the maxillary and mandibular labial vestibule. The results suggested that the oral cavity was somewhat compartmentalized, in that homogeneous distribution of a dissolved fluoride tablet did not occur throughout the mouth, but rather each site sampled was influenced by various rates of clearance and retention. Tablet chewing may have an advantage over tablet sucking in terms of salivary fluoride retention, and there was a tendency for fluoride to be preferentially retained in the maxillary labial vestibule following swishing. The passive tablet dissolution methods resulted in a less homogeneous distribution of fluoride. Although the fluoride retention values for passive dissolution were impressively superior to either active dissolution method, the alarmingly high salivary fluoride concentrations (4000 ppm F) recorded at the passive dissolution sites should discourage its use until the potential cytotoxicity of this approach is thoroughly investigated.

Combined fluoride, school-based program in a fluoride-deficient area: results of an 11-year study

In 1972, a school-based fluoride program was initiated in elementary schools in Nelson County, VA, a fluoride-deficient area. For 11 years, participating children ingested daily in school a 1-mgm fluoride tablet and rinsed weekly with a .2% sodium fluoride solution. They also received fluoride dentifrice and toothbrushes for home use. The program was extended into junior high school in 1978 and into high school in 1980. In 1983, dental examinations of children aged 6 to 17 years, who had continuously participated in the program for 1 to 11 years depending on school grade, showed a mean prevalence of 3.12 DMFS, which was 65% lower than the corresponding score of 9.02 DMFS for children of the same ages at the baseline examinations. The preventive program inhibited decay in all types of surfaces: 54% in occlusal surfaces; 59% in buccolingual surfaces; and 90% in mesiodistal surfaces.

Relationships between exposure to additional fluoride, social background and dental health in 7-year-old children.

The relationship between social background, water fluoridation, use of fluoride tablets and dmf scores was studied in a birth cohort of 7-yr-old New Zealand children. This analysis showed that the level of exposure to additional fluoride was a complex variable influenced by at least three factors: the use of fluoride toothpaste; the child's length of residence in a fluoridated area; the length of time for which the child had been provided fluoride tablets. Log linear modelling of the data suggested the presence of a relatively complex relationship between exposure to additional fluoride, social background and dental health. First, both duration of residence in a fluoridated area and the provision of fluoride tablets made significant net contributions to the variability in the dmf score. However, exposure to additional fluoride from these sources was differentially influenced by social background: while there were relatively strong associations between social background and the use of fluoride tablets, there was no significant association between duration of residence in a fluoridated area and social background. Finally, independently of an association with exposure to additional fluoride, family social background made a significant net contribution to the variability in dmf scores.

Preeruptive effect of NaF tablets on caries in children from 12 to 17 years of age.

The purpose of this study was to evaluate the preeruptive effect of NaF tablets on caries in proximal surfaces of permanent molars and premolars. The material consisted of 47 subjects who had consumed fluoride tablets for a minimum of 5 yr between 1/2 and 6 yr of age in accordance with recommendations from the National Swedish Board of Health and Welfare (F+-group) and 69 comparable children who had never consumed such tablets (F(-)-group). All had resided since birth in an area with a water fluoride concentration of 0.2 ppm and had been exposed to fluorides in toothpaste, mouthrinse solution and varnish since at least the age of 6. The children were examined by means of bitewing radiographs at the ages of 12, 13, 14 and 17. Two confounding factors, i.e. salivary counts of Streptococcus mutans and lactobacilli, were estimated and used for correction of crude caries differences. The mean values of these factors were higher in the F(-)-group than in the F+-group. The results showed a statistically significantly higher caries prevalence in the F(-)-group compared to the F+-group when the children were 14-yr-old, 4.4 vs. 2.9 DFS, corresponding to a caries reduction of about 34%. After correction for confounding, this was reduced to 24%, representing a non-significant difference of 1.1 DFS but still indicating a preeruptive effect. At the age of 17, the difference in caries prevalence was statistically not significant, 7.1 vs. 5.6 DFS, corresponding to a reduction of 21%. Based on corrected data, this was reduced to 15%.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental caries and gingivitis in second grade schoolchildren in The Hague over the period 1969-1981.

In 1969, 1972, 1975 and 1978 dental examinations were carried out in the City of The Hague on cohorts of about 800 children from kindergartens and elementary schools in order to test a (dental) health education program. Since 1980/1981 weekly fluoride mouthrinses have been done in kindergartens and elementary schools in areas with lower SES. In 1981, a baseline dental examination for a follow-up study was carried out on about 500 second grade schoolchildren from areas of low and medium SES. In this baseline examination in 1981 a considerable improvement in dental health was found compared with the earlier cohort examinations, especially in medium SES groups. The average D3MFS value in 1981 was 1.53 and 0.92 for second grade children of the low and medium social level respectively; the average d3fs values were 5.83 and 3.42. Over the 12-yr period (1969-1981) a respective D3MFS reduction of 57.6 and 76.2% was found for low and medium SES. The percentage d3fs reduction for the primary dentition was 55.3 and 72.9%, respectively. In 1978 and 1981 the percentage of children without gingivitis was 26.8 and 31.9%. The difference in the number of gingivitis-free children between 1978 and 1981 seemed to be due to an increase in the number of children without gingivitis in the medium SES groups. A greater use of fluoride tablets was found in low and medium socioeconomic levels between 1972 and 1975, followed by a decrease in the period between 1975 and 1978 and another increase by 1981 compared with 1978.

Diagnosis of mild enamel fluorosis in permanent maxillary incisors using two scoring systems

The main purpose of this study was to compare the diagnosis of mild enamel fluorosis as established by two scoring systems, that of Dean based primarily on quantitative aspects and that of Thylstrup & Fejerskov with a preferentially qualitative approach. A further aim was to study the prevalence of fluorosis in permanent maxillary incisors after intake of fluoride tablets for a minimum of 5 yr between 1/2 and 6 yr of age in accordance with recommendations from the National Swedish Board of Health and Welfare. Maxillary incisors were examined in 118 13-yr-old children; 49 constituted a tablet group and the remaining 69 a control group who had never consumed tablets. Scored according to Dean, the difference in enamel fluorosis between the two groups was statistically not significant at the 5% level, whereas the system of Thylstrup & Fejerskov did give a significant difference. The frequency of fluorosis was substantially lower than that resulting from consumption of drinking water in Uppsala, Sweden, containing 1-1.2 ppm F. A probable relationship was found between the scoring systems, particularly if the Dean score 0.5 ("questionable") was converted to score 1. To ensure correct diagnosis, the tooth surface should be exposed to prolonged drying and apply relevant criteria for the differential diagnosis of disturbances of other origin. The higher sensitivity of Thylstrup & Fejerskov's system relates to score 1, narrow white lines located corresponding to perikymata. Here there seems to be a risk of over- or underdiagnosing. Recommendations are given for epidemiologic surveys and for experimental trials of limited size.

The opposition to fluoride programs: report of a survey.

State dental directors were surveyed in spring 1984 regarding fluoridation and fluoride programs. Forty-four states reported existing fluoride mouth-rinse programs in schools; 22, fluoride tablets in schools. About 90 percent of directors felt that support for fluoride programs by state departments of health and constituent dental societies either had remained the same or increased over the previous five years. Approximately half felt the antifluoridation movement to be as strong as five years earlier. About one-third indicated a shift in focus by water fluoridation opponents to include other fluoride systems. Most felt this shift occurred during 1981-82. Information was reported on 255 individual challenges to fluoride programs. Results of this survey indicate that expenditure of considerable resources and effort continues to be necessary to ensure the longevity of public fluoride systems.

Prevalence of developmental defects of enamel and dental caries in New Zealand children receiving differing fluoride supplementation.

A survey of the prevalence of dental caries and developmental enamel defects in 666 New Zealand children aged 9 years and with differing histories of fluoride supplementation was carried out in 1982. In the LF (low fluoride) group 22.8% of children had diffuse white opacities compared with the WF (water fluoridation) group, 36.7%, and the CT (continuous use of fluoride tablets) group 49.4% (P = 0.0018). When the tooth prevalence was determined, the differences were more marked with 4.9% of teeth affected in the LF group and 24.7% in the CT group. Dental caries prevalence in the fluoride history groups displayed an inverse relationship with fluoride supplementation, the LF group had a DMFT of 2.4, the WF group, 1.7 and the CT group, 1.2. The prevalence of both diffuse opacities and of dental caries in the PT group where tablets had been used to 5-6 yr of age was anomalous. The survey confirmed that diffuse opacities occur in children with a low fluoride intake but the prevalence increases in groups of children given fluoride supplements.

The use of fluoride preparations in dental practice.

Abstract— A survey of a 10 per cent sample of general practitioners in Queensland showed that topical fluoride therapy was still widely practised and accepted in Queensland and believed by most dentists to be economically worthwhile. In a State where less than five per cent of the population has access to a fluoridated water supply, all of the dentists in the sample advocated the use of fluoride tablets by young children. Since there was an apparent lack of preparedness by most of the dentists to manage acute fluoride poisoning resulting from excessive ingestion of fluoride through these sources, a schedule of treatment has been recorded.

The cost and effectiveness of school-based preventive dental care.

The National Preventive Dentistry Demonstration Program assessed the cost and effectiveness of various types and combinations of school-based preventive dental care procedures. The program involved 20,052 first, second, and fifth graders from five fluoridated and five nonfluoridated communities. These children were examined at baseline and assigned to one of six treatment regimens. Four years later, 9,566 members of this group were examined again. Analyses of their dental examination data showed that dental health lessons, brushing and flossing, fluoride tablets and mouthrinsing, and professionally applied topical fluorides were not effective in reducing a substantial amount of dental decay, even when all of these procedures were used together. Occlusal sealants prevented one to two carious surfaces in four years. Children who were especially susceptible to decay did not benefit appreciably more from any of the preventive measures than did children in general. Annual direct per capita costs were $23 for sealant or fluoride prophy/gel applications and $3.29 for fluoride mouthrinsing. Communal water fluoridation was reaffirmed as the most cost-effective means of reducing tooth decay in children.

Use of fluorides by Finnish adolescents.

According to the recommendations of the National Board of Health in Finland fluoride tablets should be used daily from the age of 6 months to 15 yr in fluoride deficient areas. Topical fluorides are recommended in addition to systemic fluorides. The aim of this study was to analyze the use of fluoride tablets and topical fluorides by Finnish adolescents. Teenagers (n = 4705) representing Finnish youth aged 12, 14, 16 and 18 yr were sent mail questionnaires in February 1981. The response rate was 88%. The proportion of daily fluoride tablet users was 12% among 12-yr-old girls, 3% among 14-yr-old girls and among boys 10% and 4%, respectively. Fluoride rinses at home were used daily by only 1%. During the most recent school term, 34% had several times, and 8% once, participated in classroom fluoride rinsing. In the same period 14% had used fluoride gel several times, and 10% once. Thus despite dental health education, fluoride tablets and rinses are used very rarely at home by Finnish teenagers. The recommendations of the National Board of Health are far removed from the behavior of adolescents. Use of fluoride tablets and topical fluorides do not seem to be a practical alternative to drinking-water fluoridation, because of the low level of compliance.

Eight-year evaluation of a combined fluoride program in a nonfluoride area

The purpose of this study is to measure the long-term effects of a combination of self-applied fluoride methods among schoolchildren living in a rural area with low concentrations of fluoride in drinking water. Participating children rinse weekly with a 0.2% sodium fluoride solution and ingest daily a 1-mg fluoride tablet in school under supervision of their teachers, and received fluoride toothpaste and toothbrushes for use at home. In 1980, dental examinations of children ages 6-14, who had continuously participated in the program for 1 to 8 years, depending on their school grade, had an overall mean caries prevalence of 3.22 DMFS, 49% lower than the corresponding mean score of 6.31 DMFS for children of the same ages at the baseline examination. The preventive program inhibited decay in all types of tooth surfaces: 37% in occlusal, 41% in buccolingual, and a striking 86% in mesiodistal. At each succeeding follow-up survey, benefits have continued to improve; the reductions in caries prevalence were 18% after 2 years, 35% after 4 years, 45% after 6 years, and 49% after 8 years. Findings in approximal tooth surfaces have also continued to improve as the length of the program has increased; reductions in caries in mesiodistal surfaces were 32%, 69%, 85%, and 86% after 2,4,6, and 8 years, respectively. Internal analyses of data indicate that the decline in dental caries prevalence resulted from the fluoride program and not from an unexplained natural decline in caries prevalence. The self-applied combined fluoride regimen used in this program has been shown to produce a pronounced anticaries effect.