Non-fluoridated Areas Research Articles

A photographic study of enamel defects among South Australian school children

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

Relationship of dental caries and fluorosis to fluoride supplement history in a non-fluoridated sample of schoolchildren.

A random sample of 206 Michigan children, aged from 9 to 13, were examined for fluorosis from a larger group of 2038 children participating in a dental project. Clinical examinations included caries data (DMFS) and assessment of fluorosis by use of the Tooth Surface Index of Fluorosis (TSIF). Separate examiners were used for each index. The response rate of a questionnaire mailed to parents to gather information on residence histories, use of fluoride supplements, and antibiotics was 78%. The prevalence of fluorosis was about 20% among the respondents. Of the 4868 tooth surfaces examined, 9.2% were affected by fluorosis. In all cases, dental fluorosis was judged as mild, with most occurrences on the posterior teeth. No instances of moderate or severe fluorosis were found. The caries experience of respondents was 1.69 +/- 2.73 DMFS. Caries experience does not appear to be significantly related to income, education, or fluoride supplement use. Approximately 52% of respondents were reported to have taken fluoride supplements with various degrees of consistency. Parents' education was positively related to both prevalence of fluorosis (odds ratio = 2.2) and use of fluoride supplements (odds ratio = 2.7). No significant relation was revealed with evidence of fluorosis and use of supplements. This study shows a relatively mild level of dental fluorosis in a sample of children from a non-fluoridated area. Dental fluorosis in this group does not appear to be related to use of fluoride supplements or differences in caries experience.

The Effects of Airborne Fluorides on Oral Conditions in Morocco

The purpose of this study was to determine the prevalence and severity of dental caries and dental fluorosis, as well as various other oral conditions, in 2378 subjects (ages seven to 60) living in the fluoridated area of Khouribga and the non-fluoridated area of Beni Mellal, Morocco. The community index of dental fluorosis (CFI) ranged from 1.99 to 2.80 in the high-fluoride area: Over 90% of the population was affected, and more than one-third of the subjects showed moderate dental fluorosis. However, in Beni Mellal, more than 96% of the dentate subjects examined were free of dental fluorosis, and the CFI of 0.02 was considered not significant. Significant differences were observed between the two areas with respect to caries prevalence. DMFT and DMFS indices were markedly lower in the fluorosis area of Khouribga. The oral conditions of subjects appeared to be better in Khouribga, where the gingival and calculus indices were significantly lower than in Beni Mellal. The analyses of covariance showed no significant differences in plaque accumulation (PI) between the Khouribga and Beni Mellal samples. However, a close statistical correlation was found between PI and GI in Beni Mellal and Khouribga.

The relationship between fluoridation, social class and caries experience in 5-year-old children in Newcastle and Northumberland in 1987.

The dental health of 457 5-year-old children who have lived continuously in fluoridated (at 1.0 mg F/litre) Newcastle and 370 children of the same age in non-fluoridated (less than 0.1 mg F/litre) South Northumberland has been reported. This paper examines in detail the caries prevalence in social class groups I + II, III, IV + V, and the social class/fluoridation relationship in 1987. The prevalence of dental caries in the three social class groupings I + II, III, and IV + V (and the mean dmft), respectively, was 35% (1.1), 46% (1.7) and 67% (2.4) in the fluoridated area, and 59% (2.2), 67% (3.7) and 77% (5.0) in the non-fluoridated area. Fluoridation was effective in all social class groupings and, because caries levels were higher in social classes IV + V, fluoridation brought about greater savings for these children than for those in social classes I + II. Fluoridation reduces but does not eliminate social inequalities, leaving social disadvantage/social background/social class as the major factors in caries prevalence for this age group. Further research into the fluoridation/social class relationship is required, particularly since the understanding of occupational class, now considered an imperfect representation of social class, is being superseded by other criteria which have stronger associations with measures of poor health.

New studies cast doubt on fluoridation benefits

An analysis of national survey data collected by the National Institute of Dental Research (NIDR) concludes that children who live in areas of the U.S. where the water supplies are fluoridated have tooth decay rates nearly identical with those who live in nonfluoridated areas. The analysis was done by John A. Yiamouyiannis, a biochemist and expert on the biological effects of fluoride, who has been an ardent opponent of fluoridation for 20 years. His results are not widely different from those recently found—but as yet unpublished—by NIDR in analyzing the same data. In the 1986-87 school year, NIDR examiners looked for dental caries in 39,207 schoolchildren aged five to 17 from 84 different geographical areas. Yiamouyiannis obtained the survey data from NIDR under the Freedom of Information Act. Yiamouyiannis compared decay rates in terms of decayed, missing, and filled permanent teeth. The average decay rates for all the children aged five to 17 were 2.0 ...

Relation of sources of systemic fluoride to prevalence of dental fluorosis.

The prevalence of dental fluorosis in a nonfluoridated area was determined and related to the reported fluoride ingestion histories of the children examined. A convenience sample of 543 schoolchildren in rural areas of Michigan was examined for fluorosis using the Tooth Surface Index of Fluorosis. Questionnaires that asked about previous use of fluorides were sent to parents of all children examined. The response rate was 76 percent (412 usable questionnaires). A criterion for inclusion in the data analysis stipulated that only fluorosed surfaces that occurred bilaterally would be included. Fluorosis was found on 7 percent of all tooth surfaces and only in the mild form. Twenty-two percent of the subjects were classified as having fluorosis. Dietary supplement was the only fluoride that was found to be significantly related to the occurrence of fluorosis. A greater proportion of the subjects with fluorosis listed physicians, rather than dentists, as the source of fluoride prescriptions. The results demonstrate similarities to the fluorosis reported in other studies in nonfluoridated areas, but also suggest the need to minimize the occurrence of fluorosis through proper assessment of a child's fluoride exposure and the judicious use of additional fluoride.

A Modified DDE Index for Use in Epidemiological Studies of Enamel Defects

The aim of this study was to investigate possible modifications to the DDE Index to make it simpler to use and to make the data collected more meaningful and amenable to analyses and interpretation. After the use of the DDE Index in a National Study in Ireland, initial alterations to the Index were tested on a group of children with enamel defects, in Ireland and New Zealand. The DDE Index was then modified to allow for the measurement of demarcated, diffuse, and hypoplastic defects and their severity. With the Modified Index, the prevalence of defects both on index teeth and all permanent tooth surfaces of 8- and 15-year-old children in fluoridated Cork City and non-fluoridated areas of Cork County and Manchester, U.K., was measured. The prevalence of enamel defects on one or more index teeth of children in the three areas ranged from 30 to 42% in 8-year-olds and from 31 to 38% in 15-year-olds. The percentage of children affected as seen by full-mouth examination was somewhat higher, ranging from 38 to 51% for 8-year-olds and 58 to 63% for 15-year-olds. The percentage of index teeth affected (7 to 14%) was generally higher than for all teeth (5 to 9%). Demarcated opacities were the most common defect seen. Diffuse opacities were found to be the discriminating factor between the fluoridated and non-fluoridated areas. In all areas, the vast majority of diffuse opacities extended over less than 1/3 of the surface area of the teeth affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of a 32-month fluoride varnish study in Sherbrooke and Lac-Megantic, Canada

The effectiveness, safety, and practicality of fluoride varnishes are evaluated in the contexts of a literature review and a clinical study of two agents in two nonfluoridated Canadian communities. Caries-inhibiting effects of two fluoride varnishes are compared in a randomized, controlled clinical trial in a nonfluoridated area.

Epidemiologic oral health survey of Argentine children.

An epidemiologic oral health survey of 2279 children aged 7-8 and 12-13 was carried out in eight different regions of Argentina using methods and criteria recommended by the WHO. The children examined lived in rural or urban areas and were of Caucasian or Amerindian extraction. Periodontal status showed that 75% of this population had soft deposits, while calculus and gingivitis increased with age. Calculus: 0.4 at 7 yr to 16.1 at 13; gingivitis: 2.7% at 7 yr to 27.2% at 13. At age 8, the mean number of dmf per child was 3.9. The percentage of caries-free children with permanent dentition dropped from 60% at age 7 to 32% at age 13. In Amerindian children, all these parameters were higher. Both the mean dmf and DMF per child were substantially lower in natural fluoride areas than in non-fluoride areas. Data from this first nationwide epidemiologic study in this country provide baseline data for further investigations. According to the data obtained in this study, Argentine regions may be classified as high, medium or low risk areas, although a lack of adequate dental care was found in all regions. With these risk priorities as a guideline, we propose an initial strategy consisting of a carefully planned and selective program of primary dental health care.

Dental disease in selected 5 and 10-year-old children attending social priority and ordinary schools in non-fluoridated areas of county Durham

Several previous studies have shown a relationship between dental disease and the socialclass of the individual. This study investigated the caries experience and gingival health of 5- and 10-year-olds in a non-fluoridated area. It was found that 5-year-old children attending social priority schools had experienced significantly more caries than children in ordinary schools. A significant difference was likewise found in the gingival health, the social priority children having more sites affected by gingival inflammation. At 10 years, no significant differences were found between the two groups in either caries experience or gingival health. Use of the Community Dental Service was investigated, and it was found that 44% of the 10-year-old social priority schoolchildren received dental care from the Community Dental Service, an increase over the proportion of 12% in the corresponding 5-year-old group.

Report on caries reduction in French schoolchildren 3 years after the introduction of a preventive program.

A combination of preventive methods have been used to reduce dental caries in children aged 7-8 at baseline, living in a non-fluoridated area in the West of France. The preventive program involved a daily supervised toothbrushing at school with 180 mg of fluoridated toothpaste, professional prophylaxis every 2 months with topical application of fluoride gel and reinforced motivation. The oral hygiene level was measured using the Silness-Löe plaque index and caries were recorded using the def and DMF surface indices, including incipient lesions. The 3-yr results showed a significant 52% plaque reduction in the test group compared with the control group. Caries reduction was significant at the 0.01% level: 44% for primary teeth and 60% for permanent teeth.

The relationship between dental caries and tooth enamel fluoride.

Four thin layers of enamel totaling approximately 8 μm were removed from each of two bicuspids in 215 subjects, age 14–24 years, and analyzed for fluoride. The concentration of fluoride in the outer layers decreased significantly with subjects’ age. A small but statistically significant correlation between enamel fluoride and DMFS of individual subjects was found. Correlations were somewhat stronger in the outer enamel layers and in subjects from nonfluoridated areas.

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.

Detailed examination of caries progression in 4-year-old children in a non-fluoridated area in Ireland.

314 4-year-old children were examined in Mallow, Ireland (a non-fluoridated area). 30.6% were found to be caries free. Investigation of the pattern of decay in the dentitions of these children showed the primary secondary molar as the tooth most commonly affected by caries irrespective of def score. The distribution of the disease is examined on a surface by surface basis. Decay occurring on the occlusal surface is predominant and no homogeneous pattern is found among the other surfaces. A statistical method for examining possible patterns of surface involvement is introduced.

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

A random sample of 7-16-year-old children (n = 2778) who visited municipal dental clinics in fluoridated and non fluoridated areas were 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.

Caries-Preventive Effects of Fluoride Tablets in Schoolchildren Four Years after Discontinuation of Treatments

The Wayne County data indicate that administration of fluoride tablets in school should be recommended in nonfluoridated areas as an effective public health measure to prevent dental caries. In addition to reducing dental caries effectively, administering fluoride tablets in school has a number of other desirable features; it is safe and relatively inexpensive; it requires no paper products and thus eliminates waste disposal; it takes little time to administer (less than three minutes per day for a classroom of average size); it is easy for young children to learn and to do; and it can be supervised by teachers, aides, or volunteers after minimal training. Findings that benefits still persist, although perhaps to a slightly lesser degree, four years after treatment is discontinued further accentuate the public health appeal of the procedure. The data give no indication that two fluoride tablets a day are more protective than one tablet a day. Therefore, a single one-mg fluoride tablet daily is recommended for school programs because of lower cost and greater feasibility.

Apatitic fluoride increase in enamel from a topical treatment involving intermediate CaHPO4 . 2H2O formation, an in vivo study.

Previous laboratory and animal studies have reported high levels of apatitic fluoride uptake from a topical fluoride procedure in which teeth were pretreated with an acidic solution saturated with respect to CaHPO4 • 2H2O (DCPD) prior to the fluoride treatment. A study was initiated to determine the fluoride uptake from this procedure under clinical conditions. A microbiopsy technique was used to measure enamel fluoride contents before, 1 month after, and 3 months after an application of an acidulated phosphate fluoride (APF) solution alone or in combination with a DCPD pretreatment on the maxillary incisors of 50 fourth-grade children in a nonfluoride area. 1 month after treatment, there was no significant difference in enamel fluoride concentration between APF and control groups. The DCPD/APF treatment produced mean fluoride uptakes of 1,011 ± 134 ppm (n = 50) and 2,042 ± 221 ppm (n = 47) in the outer 3.5 μm of enamel when measured 1 and 3 months, respectively, after treatment. The results indicate that the DCPD pretreatment can substantially increase permanently bound fluoride uptake under clinical conditions.

Dental caries prevalence and treatment status of 12-year-old children in a non-fluoridated area.

424 12-year-old children were examined in Mallow, a non-fluoridated town in North Cork, to ascertain the dental status of children finishing first level education. Both the caries prevalence and the treatment pattern were examined. The DMF was found to be 6.58 and the RI was 52.5%. A new index of restored and sound teeth (RSI) was applied and a value of 38.6% was obtained.

Infant Formulas Contain Variable Amounts of Fluoride

Attention should be drawn to an article by Tinanoff and Muller (J Dent Child 45:53, 1978) dealing with the fluoride content in milk and formula for infants. There is little doubt that the use of a fluoride supplement in nonfluoridated areas consistently lowers the mean caries scores for both primary and permanent teeth. Many pediatricians are in the habit of prescribing supplemental fluoride for all children regardless of the type of diet in such areas.

The effect of drinking water fluoridation on the fluoride content, strength and mineral density of human bone.

The effect of drinking water fluoridation on the fluoride content of human bone, on cancellous bone strength and on the mineral density of bone was studied by analysing 158 autopsy samples of the anterior iliac crest from persons from two different areas. In the samples from the town of Kuopio, where drinking water has been fluoridated since 1959, the fluoride concentrations were considerably higher than in samples from the surrounding area where low-fluoride drinking water is used. The fluoride content of bones from Kuopio increased significantly with age, while considerably less change with age was found in samples from outside Kuopio. The highest fluoride content in bone ash was observed in women with severe osteoporosis. Cancellous bone strength measured by a strain transducer was statistically significantly higher in women with chronic immobilizing disease from Kuopio, compared with the corresponding group from outside Kuopio. No statistically significant differences in bone strength were found in men. There were no statistically significant differences in bone mineral density, as measured by gamma ray attenuation, between the samples from the fluoridated and non-fluoridated areas.