Use Of Dentifrice Research Articles

Microstructural Changes of Human Enamel Surfaces by Brushing with and without Dentifrice Containing Abrasive

Toothbrushing with and without dentifrice containing abrasive was performed on human enamel pieces attached to resin plates exposed to the oral cavities of 3 human subjects for 8 weeks. The effects on the ground enamel surfaces with engraved scratches were examined by scanning electron and scanning laser microscopy. Brushing with such a dentifrice caused smaller scratches to disappear, large scratches to expand and new microwear to appear; in some samples, prism structures were exposed. Under brushing without dentifrice, these scratches were protected by an organic pellicle with mineral deposits, and also the experimental surface was entirely covered with these membranous deposits. The results indicate that toothbrushing with no dentifrice but saliva induces an organic-mineral protective membrane on the enamel surface. The membrane may increase the enamel resistance to caries. On the other hand, the use of abrasive-containing dentifrice causes slight abrasion with microwear. This roughness may contribute to the formation of dental plaque.

An intra-oral single-section demineralization/remineralization model.

This paper reviews the use of our intra-oral crown single-section model for the evaluation of in situ demineralization and remineralization. The model uses normal, healthy adults who are in need of a gold crown. A slot is placed in the working crown which can hold 3-4 single sections. A typical experiment would use an enamel lesion, root lesion, and sound root section which are characterized with polarized light microscopy and/or microradiography prior to insertion in the crown. After the experimental regimen, the sections are removed and re-characterized for any changes. The model has been used to evaluate mineral changes from the use of fluoride dentifrices and rinses, chewing gum, and food sequencing. The advantages of the model system are the before-and-after measurements on the same section, a natural plaque formation, interaction with saliva, episodic demineralization and remineralization, no bulky appliances, and the use of reasonable time frames. This model, therefore, reduces the artificiality of the in situ study to a great extent and appears to be a useful predictor of demineralization/remineralization interactions.

Ingestion of Flouride from Dentrifices by Children Aged 12 to 24 Months

The increase of dental fluorosis is largely imputable to the ingestion of dietary fluoride supplements and fluoride toothpastes. However, the toothbrushing habits of very young children is poorly documented. The purpose of this pilot study was to determine the toothbrushing habits of 12- to 24-month-old children and to estimate the quantity of fluoride ingested during toothbrushing. Fifty-nine parents completed a questionnaire regarding the toothcleaning habits of their children. When a dentifrice was used, a dental hygienist scheduled a meeting with the parents in order to observe and measure the amount of toothpaste used. Of the 36 parents who cleaned the teeth of their children, 69% used a toothpaste. Furthermore 20% of the children ingested more than 0.25 mg of fluoride per day by toothbrushing alone. Therefore the practice of toothbrushing and the use of fluoridated dentifrices are widespread among 12- to 24-month old children, and the amount of fluoride ingested from toothpaste could constitute a substantial proportion of the total daily intake of fluoride. Several measures are suggested to enhance the safe use of fluoride dentifrices.

Remineralization and Demineralization in situ from a Triclosan/Co-polymer/Fluoride Dentifrice

An in situ study was conducted to evaluate the effect of a dentifrice containing 1100 ppm F (NaF) and triclosan, an anti-plaque agent, on remineralization of artificially-formed caries lesions in thin sections of human enamel. The thin sections were placed in mandibular partial dentures of 15 subjects and covered with a steel mesh to provide an area for plaque accumulation. The subjects brushed their teeth and dentures three times daily for two-week periods in a cross-over design, after which the specimens were removed and analyzed by quantitative microradiography for changes in mineral content. Results showed that lesions treated with the triclosan-fluoride product were remineralized 18.0 +/- 23.4% compared with 19.0 +/- 32.3% from a 1100-ppm F (NaF) positive control. Use of a placebo dentifrice resulted in 71.9% demineralization. The findings showed that triclosan neither enhanced nor interfered with the promotion of remineralization by fluoride.

Antibacterial dentifrices

The present review concerns the effect on plaque and gingivitis of some antibacterial dentifrices. The difficulties of including cationic agents in conventional dentifrice formulations are briefly discussed. The focus is on 2 recently introduced dentifrices with triclosan as the active ingredient. One aims at providing a slow release reservoir of triclosan in the oral cavity by delivering the substance dissolved in a lipophilic copolymer. 3-month results indicate a modestly improved effect on plaque and gingivitis compared to that of triclosan alone. Long-term studies are needed before conclusions on the clinical relevance can be drawn. The other dentifrice on the market utilises the principle of additive effects by combining triclosan and zinc citrate in the formulation. The combination appears to be more effective against plaque and gingivitis than either compound alone. Studies of up to 1 year duration indicate that the level of oral hygiene and gingival health obtained through an initial period of motivation and oral hygiene instruction can be maintained by regular use of the test dentifrice, while most subjects in the control group returned to pre-experimental levels. Microbiological monitoring indicates no major shifts in plaque ecology nor any development of resistant bacteria, and adverse side-effects have not been observed. It is concluded that the new approaches to chemical plaque control may be beneficial to the population at large, and thus of great clinical relevance.

On the prevention of caries and periodontal disease

In 1971-72, a total of 375 adult subjects were recruited for a clinical trial aimed at assessing the effect of a preventive program, based on plaque control and topical application of fluoride, on the incidence of caries and periodontal disease. After a baseline examination, the volunteers were subjected to scaling, root planning and conventional caries therapy. During the course of the subsequent 6 years, they were recalled for preventive measures once every 2-3 months. After the 6-year follow-up examination, however, it was decided to extend the interval between the preventive sessions. Thus, during the next 9-year period, about 95% of the participants returned for preventive measures only 1 to 2 times per year. A small subgroup of about 15 subjects, who, during the initial 6 years had developed new caries lesions or had exhibited additional periodontal attachment loss, however, were also during the following 9 years recalled 3-6 times per year for oral hygiene control and preventive therapy. The re-examination performed in 1987 disclosed that the 317 subjects, who participated during the entire 15-year period, had a low incidence of caries and almost no further loss of periodontal tissue support. It was suggested that improved self performed oral hygiene, daily use of fluoridated dentifrice and regularly repeated professional tooth cleaning effectively prevented recurrence of dental disease.

A Critique of Topical Fluoride Methods (Dentifrices, Mouthrinses, Operator‐, and Self‐applied Gels) in an Era of Decreased Caries and Increased Fluorosis Prevalence

Within the last 20 years there has been a decrease in the caries prevalence of US schoolchildren, a change in the intraoral caries pattern, and a slowing of the progress of lesions. Simultaneously, the prevalence of enamel milder, cosmetically acceptable forms and is more noticeable in fluoride-deficient communities than those with optimal or above-optimal water fluoride concentrations. Circumstantial evidence indicates that a principal contributor to the caries decline is the extensive use of fluoride dentifrices. Conversely, although use of a fluoride dentifrice can add to the total daily amount of ingested fluoride in preschool children, there is little evidence to suggest that dentifrice ingestion is a principal factor causing the fluorosis increase. The value of fluoride methods may be assessed in relative or absolute terms. The relative, or percentage, caries reduction attributed to fluoride mouthrinses and gels appears to be a property intrinsic to the methods themselves and generally is little affected by the caries activity of the population being treated. Conversely, the absolute, or numerical, caries reduction is dependent upon the level of disease in the population. Thus, the reported caries decline reduces the number of surfaces prevented from developing caries, even though the percentage reduction remains substantially unchanged. Although inadvertent ingestion of fluoride can result from the use of mouthrinses and gels, there is little evidence to suggest that they have contributed to the fluorosis increase. When using topical methods, prudence should prevail to avoid ingestion of fluoride. Fluoride dentifrices should continue to be used routinely, and although lower potency dentifrices may be considered, the literature does not provide strong support for their need. Use of fluoride mouthrinses and gels for individual patients should be predicted upon their caries activity or risk. Use of these methods in public health programs is a matter of cost-effectiveness, which will be influenced by the caries prevalence of the target population.

Anticalculus effect of a dentifrice containing 0.5% zinc citrate trihydrate

A doubleblind 3-month anticalculus clinical study was conducted to determine the magnitude of the antitartar effect to be derived from use of a 0.5% zinc citrate dentifrice. From a population of 1600 subjects exhibiting calculus, 1210 subjects (age 18 and over) were selected and received a dental prophylaxis. The subjects were initially stratified on the basis of calculus score, age, and sex, then allocated randomly to a 3-month usage period of one of two treatment groups. These were a dentifrice containing 0.5% zinc citrate or a control dentifrice without zinc citrate. Calculus was assessed using the Volpe-Manhold Index. Oral soft tissue status was assessed throughout the course of the study. At the conclusion of the study 964 subjects had completed the trial: 486 using the zinc citrate dentifrice and 478 using the control. The results showed that the mean calculus scores in the group using the dentifrice containing zinc citrate were 13.7% lower than those of the group using the control dentifrice. This finding was statistically significant (P less than 0.05). No adverse effects related to the use of either dentifrice were observed.

ハイドロキシアパタイトによる人工う蝕の再石灰化

The purpose of this study was to examine the effect of apatite for dentifrice use on remineralozation of initial caries lesion. Artificial caries lesions were formed on specimens of intact human enamel with demineralizing solution (50% synthetic hydroxyapatite saturated lactate buffer, pH 4.5 according to Moreno et al (1974)). A simply demineralized group was used as control. Enamel blocks were immersed and stirred in a water solution of sludgy apatite at 37 � for 55 hrs, followed by 24 hrs, washing with synthetic saliva prepared according to Brikeland (1973) (HA group), and another group was washed only with synthetic saliva (Saliva group). SEM observation, polarized light microscopy (PLM), contact micro-radiography (CMR), microbeam X-ray diffractometry and analytical electron microscope (AEM) were performed. SEM image of artificial caries lesion surfaces showed a large quantity of minute on enamel surface of artificial caries lesions in the HA group. The surface was smooth as compared with the control group. This indicated clear remineralization of lesions rather than the deposit of apatite. CMR showed a thin radiopaque surface layer and radiolucent body of the lesion in the control group. In the HA group, the surface radiopaque layer was thick and the radiolucent body was unclear. PLM showed that the mineralized layer occupied a major portion of the surface and a thinner decalcified layer was found in HA group. Mircobeam X-ray diffraction pattern revealed hydroxyapatite. In the HA group, crystallinity of the lesion body was high as compared with the control group and the saliva group by microbeam X-ray diffractometry. It was also higher than sound enamel. SEM images of cross section showed notable remineralization in the HA group. Ca/P mole ratio of lesions determined by AEM was as high as that of sound enamel in the HA group, but was low in the saliva group. Artificial caries lesions were remineralized slightly by immersion in artificial saliva solution. But in the HA group, significant acceleration of remineralization was observed. We confirmed that remineralization of surface remineralized layer and demineralized lesion body of artificial caries lesions was advanced by exposure to a water solution of sludgy apatite for dentifrice use. These findings suggested that the initial artificial caries lesion could be remineralized by exposure to a water solution of sludgy apatite for dentifrice use.

Oral Fluoride Retention after Use of Fluoride Dentifrices

Fluoride is the only extensively clinically proven means of reducing dental caries. Despite a large body of epidemiological data on the effectiveness of fluoride, delivered in the form of dentifrices, mouthrinses, drinking water, etc., the precise mode of action of fluoride is not completely understood. The purpose of this paper is to report an investigation of the link between oral fluoride levels and applied fluoride dose from dentifrices. Human salivary fluoride clearance studies and equilibrium baseline studies of fluoride in saliva and plaque have been carried out with dentifrices which contained 1,000, 1,500 and 2,500 micrograms fluoride per gram as sodium monofluorophosphate. After a single brushing with a fluoride dentifrice, salivary fluoride decreased in two distinct phases: an initial rapid phase which lasted for 40-80 min, depending on the individual, and a second slow phase lasting for several hours. The latter phase is believed to be due to fluoride released from an oral fluoride reservoir. During regular repeated use of the test dentifrices, the equilibrium baseline fluoride concentration, attained in both saliva and plaque between one application and the next, increased significantly compared with placebo values. Such elevated baseline fluoride concentrations also increased with increasing Na2FPO3 content of the dentifrices. The present work supports the concept that labile fluoride, stored in an oral fluoride reservoir at the time of treatment application, may maintain a prolonged protective effect against dental caries.

The Effect of Plaque Thickness on Progression of Artificial Caries Lesion Formation in situ

Eighty thin enamel sections with artificially-formed caries lesions were implanted in the buccal surfaces of molars (in the removable partial dentures of ten subjects) and covered with a steel mesh for plaque accumulation to occur. The mesh was placed in contact with the enamel surface in half the lesions and 0.5 mm above the lesions in the other half, thus facilitating formation of thin and thick plaque samples. Following two-week use of a non-fluoride dentifrice, the lesions were analyzed for mineral change by quantitative microradiography. Significant mineral was lost from lesions in both groups, but the loss was twice as large in the thick-plaque group. These findings are important to in vivo remineralization models, since they show that plaque thickness should be controlled for minimization of variation.

Relationship of Total Fluoride Intake to Beneficial Effects and Enamel Fluorosis

Recent studies indicate that the prevalence of very mild to moderate dental fluorosis, as classified by Dean, has increased relative to that found in earlier investigations. To date, fluoridated water, fluoride supplements, the diet, fluoride dentifrices, and other topical fluoride applications have been identified as sources of systemic fluoride. Recent evidence suggests that there is a strong association between mild to moderate enamel fluorosis and the use of fluoride supplements during early childhood, and that the presently recommended supplementation schedule for U.S. children above the age of 2 years may be too high. Evidence also suggests that there is a strong association between fluoride dentifrice use during early childhood and enamel fluorosis in fluoridated populations. These findings support the need for a careful review of existing supplementation schedules and early oral hygiene practices. There is a pressing need for additional analytical epidemiological studies to confirm existing findings and to determine whether other fluoride sources may be associated with enamel fluorosis. Further, since exposure to combinations of individual risk factors has been shown to carry more than merely an additive increase in the risk of fluorosis, these studies must be multifactorial in design. There is also a need for more fluorosis prevalence and severity data to be gathered, so that the development of enamel fluorosis as a public health problem can be assessed, and so that the success of measures implemented to maximize efficacy while minimizing unwanted side-effects can be monitored.

Clinical Evidence of the Role of Pre-eruptive Fluoride in Caries Prevention

Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth.

Fluoride Exposure in Michigan Schoolchildren

Recent trends in the prevalence of dental caries in children, as well as a possible increase in the prevalence of dental fluorosis, have prompted some researchers to suggest the reassessment of water fluoride concentration standards. Instead of reducing water fluoride concentrations, an alternative approach would be to limit the use of, or reduce the fluoride concentration of, dentifrices, mouthrinses, and supplements. Information about the use of these other sources of fluoride, however, is scarce. Using data from a 1987 survey of Michigan schoolchildren, exposure to selected fluoride sources as well as toothbrushing habits are described. Responses from questionnaires revealed that, overall, 98.5 percent of the children have used fluoride dentifrices, 27 percent have used topical fluoride rinses, 72.5 percent have had at least one exposure to professionally applied topical fluoride, and 27 percent have used dietary fluoride supplements. Although the use of fluoride dietary supplements was appropriate for most children residing in fluoride-deficient Cadillac, the percentages of children in the other communities who have ingested these supplements suggest that these products are being prescribed improperly. Given the almost universal use of fluoride dentifrices at an early age, it may be time to investigate the use of reduced fluoride dentifrices for children. In addition, continuing efforts to decrease inappropriate dietary fluoride supplementation are required.

RISK OF ENAMEL FLUOROSIS ASSOCIATED WITH FLUORIDE SUPPLEMENTATION, INFANT FORMULA, AND FLUORIDE DENTIFRICE USE

Eight hundred fifty 11- to 14-year-old residents of nonfluoridated communities in Massachusetts and Connecticut, who were born between 1972 and 1975, were investigated in a case-control study of the possible association between enamel fluorosis and exposure to fluoride supplements, infant formula, and/or fluoride dentifrice. The effect of median household income, an indicator of socioeconomic status, was also examined. Clinical examination, using the Fluorosis Risk Index, a fluorosis index developed for this project, allowed cases and controls to be identified based upon the specific time period of exposure to the various sources of ingested fluoride. Risk factor exposure was assessed via a mailed questionnaire with a response rate of 80%. Mild-to-moderate enamel fluorosis was strongly associated with fluoride supplementation during the first six years of life (odds ratio = 4.0) and with median household income (odds ratio = 6.6). Subjects in the middle median household income group who had used fluoride supplements through the first six years of life had a 28-fold increase in the risk of fluorosis compared with unexposed subjects in the lower median household income group. An odds ratio of 1.7 associated with infant formula use was suggestive of an increased risk of enamel fluorosis as was an odds ratio of 2.9 associated with fluoride dentifrice use.

Influence of increased toothbrushing frequency on dental health in low, optimal, and high fluoride areas in Finland.

In our previous report we found that the dental health of Finnish 13-15-yr-old children had significantly improved from 1973 to 1982. The aim of this study was to assess whether the improved dental health was associated with frequency of toothbrushing and associated use of fluoride dentifrice. In both 1973 and 1982 some 360 children were scored for the DFS index. In each of three towns with 0.2 ppm, 1.0 ppm, and 2.5 ppm fluoride in the drinking water, samples of about 40 children were randomly picked from each age cohort of 13, 14, and 15 yr. The children were grouped into "infrequent", "daily", or "frequent" brushers. Overall, from 1973 to 1982 the proportion of "daily" and "frequent" brushers had increased from 56% to 75% (P less than 0.001). The overall DFST (T = total) and DFSA (A = approximal) scores had declined significantly in all brushing frequency groups. Looking at separate fluoride areas, the actual decline was found to have occurred in the low fluoride area where in 1982 the DFS scores were 50% or less of the 1973 scores (P less than 0.05). In the low fluoride area in 1973, no association was found between brushing frequency and DFS scores whereas in 1982, high brushing frequency was found to be associated with low DFS scores (P less than 0.05). The decrease in DFS scores was suggested at least partly to be associated with the increased frequency of brushing the teeth with fluoride dentifrice.

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.

Fluoride in plaque following use of dentifrices containing sodium monofluorophosphate.

Previous work showed that plaque fluoride increased with increasing NaF content of mouthwashes following daily use. The main aim of this study was to test whether a similar relationship was detectable after regular use of dentifrices containing amounts of sodium monofluorophosphate equivalent to 1000, 1500, and 2500 micrograms F/g. Plaque was collected from three groups, each consisting of approximately 80 children, who had each used one of the dentrifrices for one year. Plaque fluoride increased significantly with increasing Na2FPO3 content of the dentifrices. For the 1000-micrograms-F/g group, plaque fluoride also increased significantly with increasing frequency of dentifrice use, but did not correlate with amount of dentifrice applied per brushing. The inverse correlation observed between mean plaque fluoride concentrations and mean three-year caries increments suggests that oral fluoride measurements may prove valuable in estimating the likely anti-caries efficacy of fluoride-containing dental products.

A 1-year study on the maintenance of gingival health by a dentifrice containing a zinc salt and non-anionic antimicrobial agent.

An experimental dentifrice containing zinc citrate and Triclosan was used by student nurses for 12 months without supervision, while a corresponding group used a control dentifrice. Dental flossing was not permitted during the first 6 months. Gingival health achieved in a pre-experimental period, during which oral hygiene instruction was given, was maintained by users of the experimental dentifrice for 12 months but not by users of the control dentifrice. About 1/3 of the control group used floss daily during the 2nd 6 months and significantly improved their gingival health to a level comparable to that of the experimental group. Flossing brought no extra benefit for the latter group. In the control group, approximal regions were less healthy than buccal or lingual sites. The gingival health of these sites improved significantly with daily flossing. The experimental dentifrice maintained gingival health in all sites irrespective of the use of floss. The study has confirmed that oral health can be maintained by the use of the experimental dentifrice for at least 12 months in a habitual toothbrushing regime, and that the dentifrice would be as effective and simpler than relying on the combination of brushing and regular flossing.

２０００年における新潟県の１２歳児う蝕り患状況の予測

In Niigata Prefecture as of 1986, 536 educational institutions composed of kindergardens, primary schools, and junior high schools in 71 municipalities had adopted the school-based fluoride mouth rinsing (FMR) program and good results in the improvement of the dental caries situation have been obtained. The percentage of primary schoolchildren in the FMR program is 22%.However, it will be impossible to attain the goal of the WHO in the year 2000 (DMFT 3.0 at 12 years of age), if only 22% of chldren participate in the FMR program.The purpose of this study was to develop a prediction model to estimate the caries prevalence at 12 years of age in the year 2000 and to analyze conditions in order to attain the goal of the WHO.Five parameters were designed to predict the caries prevalence for the future.The parameters were as follows:a. Percentage of children participating in the FMR program in 1992. (a) 22%: no increase from 1986, b) 41%: all towns and villages perform FMR in addition to the present cities' prevalence in 1992, c) 50%: reach 50% in 1992, d) 100%: reach 100% in 1992)b. Effectiveness of dental caries reduction by FMR.a) Clinical effectiveness; Effectiveness of dental caries reduction by FMR in ideal conditions.b) Community effectiveness; Effectiveness of dental caries reduction in all schoolchildren participating in the FMR program in Niigata Prefecture.c. Natural reduction of dental caries without FMR.d. Annual increment of dental caries between 11 (6th grade of primary school) and 12 (1st grade of junior high school) years of age.e. Annual change in children's population in municipalities in Niigata prefectureTwenty-eight cases were assumed from these parameters.Estimated values were calculated in these 28 cases.The maximum DMFTindex in the year 2000 will be 4.05 if the percentage of children performing FMR by community effectiveness is 22% and there is no natural reduction of dental caries without FMR. The minimum will be 1.73 if the percentage of children in the FMR program because of clinical effectiveness is 100% continually from preschools and there is natural reduction of dental caries without FMR. Although there are 9 cases which attain the goal of the WHO, 6 of these suppose 100% participation in 1992. However, it seems impractical to expect 100% participation. The remaining 3 cases suppose participation of 41% or 50%, and the effectiveness of dental caries reduction by FMR is clinical effectiveness. And there are 2 cases which approach the goal of the WHO under the condition of 41%. One case is 3.26 (No. 8) based on the condition that there is natural reduction of dental caries without FMR, and another is 3.12 (No. 11) based on the condition that primary school-chidren perform FMR continually from preschools. Therefore, we suggest that in order to attain the 12-year-old children's goal of the WHO in Niigata Prefecture, the percentage of children performing FMR should be more than 41% (all towns and villages performing FMR in addition to the present cities' prevalence) in the year 1992, the schoolchildren should perform FMR continually from preschools, FMR program should be performed properly under the supervision of the people who are concerned with health and education to get more effective caries prevention, and the use of fluoride-containing dentifrices should be encouraged to get natural reduction of dental caries without FMR.