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Tobias G, Khaimov A, Zini A, Sgan-Cohen HD, Mann J, Chotiner Bar-Yehuda Y, Aflalo E, Vered Y. Caries prevalence and water fluoridation in Israel: a cross-sectional study. Quintessence Int 2024; 55:166-172. [PMID: 38414368 DOI: 10.3290/j.qi.b5003045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES 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. METHOD AND MATERIALS 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. RESULTS 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%). CONCLUSIONS 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. CLINICAL SIGNIFICANCE 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.
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Kumar S, Chhabra V, Mehra M, K S, Kumar B H, Shenoy S, Swamy RS, Murti K, Pai KSR, Kumar N. The fluorosis conundrum: bridging the gap between science and public health. Toxicol Mech Methods 2024; 34:214-235. [PMID: 37921264 DOI: 10.1080/15376516.2023.2268722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
Fluorosis, a chronic condition brought on by excessive fluoride ingestion which, has drawn much scientific attention and public health concern. It is a complex and multifaceted issue that affects millions of people worldwide. Despite decades of scientific research elucidating the causes, mechanisms, and prevention strategies for fluorosis, there remains a significant gap between scientific understanding and public health implementation. While the scientific community has made significant strides in understanding the etiology and prevention of fluorosis, effectively translating this knowledge into public health policies and practices remains challenging. This review explores the gap between scientific research on fluorosis and its practical implementation in public health initiatives. It suggests developing evidence-based guidelines for fluoride exposure and recommends comprehensive educational campaigns targeting the public and healthcare providers. Furthermore, it emphasizes the need for further research to fill the existing knowledge gaps and promote evidence-based decision-making. By fostering collaboration, communication, and evidence-based practices, policymakers, healthcare professionals, and the public can work together to implement preventive measures and mitigate the burden of fluorosis on affected communities. This review highlighted several vital strategies to bridge the gap between science and public health in the context of fluorosis. It emphasizes the importance of translating scientific evidence into actionable guidelines, raising public awareness about fluoride consumption, and promoting preventive measures at individual and community levels.
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Affiliation(s)
- Sachindra Kumar
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Vishal Chhabra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - Manmeet Mehra
- Department of Pharmacology, Guru Nanak Dev University, Amritsar, India
| | - Saranya K
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - Harish Kumar B
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Smita Shenoy
- Department of Pharmacology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ravindra Shantakumar Swamy
- Division of Anatomy, Department of Basic Medical Sciences (DBMS), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, India
| | - K Sreedhara Ranganath Pai
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Nitesh Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, India
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Moore D, Nyakutsikwa B, Allen T, Lam E, Birch S, Tickle M, Pretty IA, Walsh T. How effective and cost-effective is water fluoridation for adults and adolescents? The LOTUS 10-year retrospective cohort study. Community Dent Oral Epidemiol 2024. [PMID: 38191778 DOI: 10.1111/cdoe.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To pragmatically assess the clinical and cost-effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults and adolescents, using a natural experiment design. METHODS A 10-year retrospective cohort study (2010-2020) using routinely collected NHS dental treatment claims data. Participants were patients aged 12 years and over, attending NHS primary dental care services in England (17.8 million patients). Using recorded residential locations, individuals exposed to drinking water with an optimal fluoride concentration (≥0.7 mg F/L) were matched to non-exposed individuals using propensity scores. Number of NHS invasive dental treatments, DMFT and missing teeth were compared between groups using negative binomial regression. Total NHS dental treatment costs and cost per invasive dental treatment avoided were calculated. RESULTS Matching resulted in an analytical sample of 6.4 million patients. Predicted mean number of invasive NHS dental treatments (restorations 'fillings'/extractions) was 3% lower in the optimally fluoridated group (5.4) than the non-optimally fluoridated group (5.6) (IRR 0.969, 95% CI 0.967, 0.971). Predicted mean DMFT was 2% lower in the optimally fluoridated group (IRR 0.984, 95% CI 0.983, 0.985). There was no difference in the predicted mean number of missing teeth per person (IRR 1.001, 95% CI 0.999, 1.003) and no compelling evidence that water fluoridation reduced social inequalities in dental health. Optimal water fluoridation in England 2010-2020 was estimated to cost £10.30 per person (excludes initial set-up costs). NHS dental treatment costs for optimally fluoridated patients 2010-2020 were 5.5% lower, by £22.26 per person (95% CI -£21.43, -£23.09). CONCLUSIONS Receipt of optimal water fluoridation 2010-2020 resulted in very small positive health effects which may not be meaningful for individuals. Existing fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower NHS dental care utilization. This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.
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Affiliation(s)
- Deborah Moore
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Blessing Nyakutsikwa
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | | | - Stephen Birch
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Faculty of Biology, Medicine and Health, Division of Dentistry, The University of Manchester, Manchester, UK
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Lowery G. Mini-publics in dental public health policymaking. Community Dent Health 2023; 40:248-251. [PMID: 37642353 DOI: 10.1922/cdh_00077lowery04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
What are mini-publics and under what circumstances could they be applied to public health dentistry? This question is explored with reference to water fluoridation in England, a policy intervention characterised by a visceral politics that has embedded a systemic preference for non-decision-making. Mini-publics can nevertheless inform decision-making by inviting a representative sample of the affected citizenry to consider the available evidence and come to a set of conclusions and/or recommendations that if all parties cannot agree, none can reasonably object. In doing so, mini-publics have the potential to break the policy deadlock by adding an additional layer of legitimacy to the decision-making process, albeit this is dependent upon decision-makers granting value to their findings.
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Affiliation(s)
- G Lowery
- Dental Sciences, Newcastle University, UK
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Zhao Y, Raymond K, Chondur R, Sharp W, Gadd E, Bailie R, Skinner J, Burgess P. Costs and benefits of community water fluoridation in remote Aboriginal communities of the Northern Territory. Aust J Rural Health 2023; 31:1017-1026. [PMID: 37706591 DOI: 10.1111/ajr.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). DESIGN Dental caries experiences were compared between CWF and non-CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. SETTING AND PARTICIPANTS Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. INTERVENTION CWF. MAIN OUTCOME MEASURES Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. RESULTS Given the total 20-year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300-499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long-term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). CONCLUSIONS The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more.
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Affiliation(s)
- Yuejen Zhao
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Kate Raymond
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Ramakrishna Chondur
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Wayne Sharp
- Power and Water Corporation, Northern Territory, Darwin, Northern Territory, Australia
| | - Elizabeth Gadd
- Power and Water Corporation, Northern Territory, Darwin, Northern Territory, Australia
| | - Ross Bailie
- The University of Sydney, Sydney, New South Wales, Australia
| | - John Skinner
- Macquarie University, Sydney, New South Wales, Australia
| | - Paul Burgess
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
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Hamilton EK, Griffin SO, Espinoza L. Effect of CDC adjustment of state-reported data on community water fluoridation statistics. J Public Health Dent 2023; 83:320-324. [PMID: 37401874 PMCID: PMC10530577 DOI: 10.1111/jphd.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Advancing community water fluoridation (CWF) coverage is a national health objective. The Centers for Disease Control and Prevention began adjusting state-reported data to calculate CWF coverage in 2012, and then modified methods in 2016. We evaluate improvements attributable to data adjustment and implications for interpreting trends. METHODS To assess adjustment, we compared the percentage deviation of state-reported data and data adjusted by both methods to the standard estimated by the U.S. Geological Survey. To assess effects on estimated CWF trends, we compared statistics calculated with data adjusted by each method. RESULTS The 2016 method outperformed on all points of evaluation. The CWF national objective measure (percentage of community water system population receiving fluoridated water) was negligibly affected by method. Percentage of US population receiving fluoridated water was lower with the 2016 method versus the 2012. CONCLUSIONS Adjustment of state-reported data improved overall quality of CWF coverage measures and had minimal impact on key measures.
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Affiliation(s)
| | - Susan O. Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lorena Espinoza
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Najihah L, Wan Husin WZ, Marhazlinda J. Multivariable Projections of Caries-Free Prevalence and the Associated Factors from 2019 to 2030 among Schoolchildren Aged 6, 12 and 16-Year-Old in Malaysia. Children (Basel) 2023; 10:1125. [PMID: 37508622 PMCID: PMC10378140 DOI: 10.3390/children10071125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 07/30/2023]
Abstract
This study identified caries-free associated factors and conducted multivariable projections of the caries-free prevalence until 2030 among six-, 12-, and 16-year-old schoolchildren in Malaysia. It was a secondary data analysis of caries-free prevalence and potential associated factors obtained from the Health Information Management System (HIMS), Department of Statistics Malaysia (DOSM), and Food Balance Sheets (FBS). Multiple linear regression and regression with ARMA errors were employed to determine the associated factors and predict the caries-free prevalence from 2019 or 2020 until 2030 for the six-, 12-, and 16-year-old groups, respectively. Gross Domestic Product (GDP) and household income, sugar consumption, and water fluoridation were significantly associated with caries-free status, with the most impactful in all age groups being water fluoridation. With the projected values of the associated factors, the caries-free prevalence in schoolchildren of all age groups in Malaysia is predicted to increase in the next decade. Similar to the past decade, the prevalence trend will remain the highest among the 12-year-olds and the lowest among six-year-olds. Caries-free prevalence was predicted to increase by 9.10%, 15.52%, and 15.10% in the six-, 12-, and 16-year-old groups, respectively. The prevalence multiplied the highest at four times greater than in the past ten years among 16-year-olds, compared with less than 2% in the six- and 12-year-old groups. In conclusion, by factoring in economic factors, sugar consumption, water fluoridation, and age groups, the caries-free prevalence of schoolchildren in Malaysia is projected to increase at different rates in the next decade until 2030. Thus, strategic oral health plans to recognise effective promotion programmes and strengthen others for each age group are crucial.
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Affiliation(s)
- Lokman Najihah
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Wan Zakiyatussariroh Wan Husin
- Mathematical Science Studies, College of Computing, Informatics and Media, Universiti Teknologi MARA Cawangan Kelantan, Machang 18500, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Sanmukapriya MV, Shanmugam N. Estimation of Fluoride Content in Various Drinking Water Sources Available in Coimbatore District, Tamil Nadu, South India. Indian J Occup Environ Med 2023; 27:89-93. [PMID: 37304001 PMCID: PMC10257244 DOI: 10.4103/ijoem.ijoem_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 06/13/2023] Open
Abstract
Fluoride acts as a key element in dental caries prevention strategy. The consumption of drinking water with adequate fluoride concentration protects the tooth from dental caries.To assess the fluoride level in various drinking water sources available in Coimbatore city. 100 water samples from corporation water, bore-well water and packaged water were randomly collected from five zones of Coimbatore. Fluoride estimation was done by colour comparator technique. The fluoride concentration in bore well water (0.9 ppm) was found to be high when compare to corporation water (0.48 ppm) and bottled water (0.2 ppm). The result obtained from this study stated that the fluoride level was suboptimal in community water and bottled water. Various alternative measures to be taken to artificially fluoridate the drinking water in Coimbatore to have better dental health.
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Affiliation(s)
| | - Nathiya Shanmugam
- Department of Pharmacology, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India
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9
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Do LG, Spencer AJ, Sawyer A, Jones A, Leary S, Roberts R, Ha DH. Early Childhood Exposures to Fluorides and Child Behavioral Development and Executive Function: A Population-Based Longitudinal Study. J Dent Res 2023; 102:28-36. [PMID: 36214232 DOI: 10.1177/00220345221119431] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is important to both protect the healthy development and maintain the oral health of the child population. The study examined the effect of early childhood exposures to water fluoridation on measures of school-age executive functioning and emotional and behavioral development in a population-based sample. This longitudinal follow-up study used information from Australia's National Child Oral Health Study 2012-14. Children aged 5 to 10 y at baseline were contacted again after 7 to 8 y, before they had turned 18 y of age. Percent lifetime exposed to fluoridated water (%LEFW) from birth to the age 5 y was estimated from residential history and postcode-level fluoride levels in public tap water. Measures of children's emotional and behavioral development were assessed by the Strength and Difficulties Questionnaire (SDQ), and executive functioning was measured by the Behavior Rating Inventory of Executive Function (BRIEF). Multivariable regression models were generated to compare the associations between the exposure and the primary outcomes and controlled for covariates. An equivalence test was also conducted to compare the primary outcomes of those who had 100% LEFW against those with 0% LEFW. Sensitivity analysis was also conducted. A total of 2,682 children completed the SDQ and BRIEF, with mean scores of 7.0 (95% confidence interval, 6.6-7.4) and 45.3 (44.7-45.8), respectively. Those with lower %LEFW tended to have poorer scores of the SDQ and BRIEF. Multivariable regression models reported no association between exposure to fluoridated water and the SDQ and BRIEF scores. Low household income, identifying as Indigenous, and having a neurodevelopmental diagnosis were associated with poorer SDQ/BRIEF scores. An equivalence test confirmed that the SDQ/BRIEF scores among those with 100% LEFW were equivalent to that of those who had 0% LEFW. Exposure to fluoridated water during the first 5 y of life was not associated with altered measures of child emotional and behavioral development and executive functioning.
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Affiliation(s)
- L G Do
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - A J Spencer
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - A Sawyer
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - A Jones
- School of Population and Global Health, Population and Public Health, The University of Western Australia, WA, Australia
| | - S Leary
- Bristol Dental School, University of Bristol, Bristol, UK
| | - R Roberts
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - D H Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
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Motohashi J, Taguchi C, Song W, Kawamura K, Arakawa H, Kawagoe M, Tsurumoto A. Development of small-scale water fluoridation equipment. J Oral Sci 2022; 64:283-285. [PMID: 36089373 DOI: 10.2334/josnusd.21-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE A water fluoridation program launched in the United States in 1945 has become a worldwide application for caries prevention. Although such a program is important in Japan, water fluoridation in large communities has not been established. This study aimed to develop safe small-scale water fluoride equipment that can be easily used to carry out water fluoridation programs in areas with children in long-term care facilities, and in developing countries without water supply facilities. METHODS Batch-type NaF addition adjustment equipment was manufactured as small-scale water fluoride equipment. The fluoride concentration of the adjusted water with this equipment was measured using an ion meter and a fluoride composite electrode. All 51 water quality standards set by the Ministry of Health, Labour, and Welfare of Japan were tested. RESULTS The fluoride ion concentration of the adjusted water was 0.7 mg/L and it was constant and stable. The adjusted water conformed to the water quality standard values of the Japanese Water Supply Law. CONCLUSION Water produced with small-scale water fluoridation equipment had a fluoride concentration of 0.7 mg/L, which is the recommended concentration for caries prevention. The fluoride concentration was stable.
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Affiliation(s)
- Jun Motohashi
- Department of Oral Health Science, Tsurumi University School of Dental Medicine
| | - Chieko Taguchi
- Department of Community Oral Health, Nihon University School of Dentistry at Matsudo
| | - Wenqun Song
- Department of Oral Health, Kanagawa Dental University
| | | | | | | | - Akihisa Tsurumoto
- Department of Oral Health Science, Tsurumi University School of Dental Medicine
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11
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Bomfim RA, Watt RG, Frazão P. Intersectoral collaboration and coordination mechanisms for implementing water fluoridation: Challenges from a case study in Brazil. J Public Health Dent 2021; 82:468-477. [PMID: 34888880 DOI: 10.1111/jphd.12492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/03/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Community water fluoridation has been associated with better oral health conditions globally and reduced dental caries. While oral health policies are governed by the health sector agenda, water fluoridation is undertaken by public, private, and mixed public/private companies of the sanitation sector. The first aim of this study was to investigate the degree of intersectoral collaboration, and the second was to investigate how the coordination mechanisms are perceived by the sanitation agents of the sectors involved in water quality management, for the potential establishment of water fluoridation in a central-west state in Brazil. METHODS Semi-structured interviews were conducted with chief sanitation agents from nonprofit, profit, and mixed public/private companies responsible for water quality and fluoridation in a purposive sample. Theoretical frameworks of intersectoral collaboration and coordination mechanisms were used for analysis. RESULTS Twelve interviews were conducted. Informal collaboration was identified in the sanitation sector within companies involved in water provision. The main coordination mechanisms were network-type mechanisms, which involve consultations and knowledge sharing, and market-type mechanisms, which explore new job opportunities and cost-effectiveness, especially in water quality measures. Enabling themes (enablers) were identified, such as positive attitude toward including water quality and fluoridation in a collaborative health and sanitation common agenda. Moreover, fluoridation did not meet the regulatory and surveillance agenda at the state level, and until that moment, there was no proposal of the health sector for water fluoridation. CONCLUSIONS Partnership creation, consolidation, and shared mission, especially between health and sanitation sectors, were identified as main challenges for implementing water fluoridation policy.
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Affiliation(s)
- Rafael Aiello Bomfim
- Department Community Health, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Public Health School, University of São Paulo, São Paulo, Brazil
| | - Richard G Watt
- Dental Public Health, Head of Dental Public Health, University College of London, London, UK
| | - Paulo Frazão
- Public Health School, University of São Paulo, São Paulo, Brazil
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12
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Bomfim RA, Watt RG, Tsakos G, Heilmann A, Frazão P. Does water fluoridation influence ethnic inequalities in caries in Brazilian children and adolescents? Community Dent Oral Epidemiol 2021; 50:321-332. [PMID: 34342029 DOI: 10.1111/cdoe.12676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES 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. METHODS 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 5 years) and 11 585 adolescents (aged 12 and 15-19 years). RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Rafael Aiello Bomfim
- Department of Community Health, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Brazil.,Public Health School, University of São Paulo, São Paulo, Brazil
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Paulo Frazão
- Public Health School, University of São Paulo, São Paulo, Brazil
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Mohd Nor NA, Chadwick BL, Farnell DJJ, Chestnutt IG. Factors associated with dental fluorosis among Malaysian children exposed to different fluoride concentrations in the public water supply. J Public Health Dent 2021; 81:270-279. [PMID: 33634490 DOI: 10.1111/jphd.12448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/17/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the prevalence of dental fluorosis, and factors associated with its occurrence in two cohorts of children exposed to different fluoride concentrations in the Malaysian water supply. METHODS A cross-sectional study was conducted among lifelong residents (n = 1,155) aged 9 and 12 years old living in fluoridated and nonfluoridated areas. Malaysian children aged 12 years were born when the level of fluoride in the public water supply was 0.7 ppm while those aged 9 years were born after the level was reduced to 0.5 ppm. Fluorosis was blind scored using standardized photographs of maxillary central incisors using Dean's criteria. Fluoride exposures and other factors were assessed by parental questionnaire. Data were analyzed using descriptive statistics, Chi-squared analyses, and logistic regression. RESULTS Fluorosis prevalence was lower (31.9 percent) among the younger children born after the reduction of fluoride concentration in the water, compared to a prevalence of 38.4 percent in the older cohort. Early tooth brushing practices and fluoridated toothpaste were not statistically associated with fluorosis status. However, the prevalence of fluorosis was significantly associated with parents' education level, parents' income, fluoridated water, type of infant feeding method, age breast feeding ceased, use of formula milk, duration of formula milk intake, and type of water used to reconstitute formula milk via simple logistic regression. Fluoridated water remained a significant risk factor for fluorosis in multiple logistic regression. CONCLUSIONS Fluorosis was lower among children born after the adjustment of fluoride concentration in the water. Fluoridated water remained as a strong risk factor for fluorosis after downward adjustment of its fluoride concentration.
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Affiliation(s)
- Nor Azlida Mohd Nor
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Barbara L Chadwick
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - Damian J J Farnell
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - Ivor G Chestnutt
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
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14
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James P, Harding M, Beecher T, Browne D, Cronin M, Guiney H, O'Mullane D, Whelton H. Impact of Reducing Water Fluoride on Dental Caries and Fluorosis. J Dent Res 2020; 100:507-514. [PMID: 33345672 DOI: 10.1177/0022034520978777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Guidance intended to reduce fluoride toothpaste ingestion in early childhood was introduced in Ireland in 2002. In 2007, water fluoride concentration was adjusted from 0.8-1.0 to 0.6-0.8 ppm. The objective of this study was to determine the difference in caries and fluorosis levels following introduction of these 2 policy measures. A before-and-after study compared caries and fluorosis in random samples of 8-y-olds in Dublin (n = 707) and Cork-Kerry (n = 1148) in 2017 with 8-y-olds in Dublin (n = 679) and Cork-Kerry (n = 565) in 2002. Dentinal caries experience (primary teeth, d3vcmft(cde)) and fluorosis (permanent teeth, Dean's index of very mild or higher) were clinically measured. Lifetime exposure to community water fluoridation (CWF) was classified as "full CWF"/"no CWF." Effect of examination year on caries prevalence and severity and fluorosis prevalence was assessed using multivariate regression adjusting for other explanatory variables. There was little change in commencement of fluoride toothpaste use at ≤24 mo following introduction of toothbrushing guidance. Among children with full CWF, there was no statistically significant difference in caries prevalence or severity between 2017 and 2002. In 2017, caries prevalence was 55% in Dublin (full CWF) and 56% in Cork-Kerry (full CWF), and mean d3vcmft(cde) among children with caries was 3.4 and 3.7, respectively. Caries severity was less in 2017 (mean 4.2) than 2002 (mean 4.9) among children with no CWF (P = 0.039). The difference in caries severity between children with full CWF and no CWF was less in 2017 than in 2002 (interaction P = 0.013), suggesting a reduced benefit for CWF in 2017. In 2017, fluorosis prevalence was 18% in Dublin (full CWF) and 12% in Cork-Kerry (full CWF). Fluorosis was predominantly "very mild" with no statistically significant difference between 2017 and 2002. CWF at 0.6 to 0.8 ppm is an effective caries-preventive measure. Results suggested low uptake of toothbrushing guidance, a reduced caries-preventive effect for CWF in primary teeth, and no reduction in fluorosis following introduction of the policy measures.
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Affiliation(s)
- P James
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - M Harding
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.,Cork Kerry Community Healthcare Area, Health Services Executive, Dental Clinic, St. Finbarr's Hospital, Cork, Ireland
| | - T Beecher
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - D Browne
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.,Cork Kerry Community Healthcare Area, Health Services Executive, Dental Clinic, St. Finbarr's Hospital, Cork, Ireland
| | - M Cronin
- Department of Statistics, School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - H Guiney
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - D O'Mullane
- Oral Health Services Research Centre, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - H Whelton
- College of Medicine and Health, University College Cork, Erinville, Cork, Ireland
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15
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Goodwin M, Whittaker W, Walsh T, Emsley R, Sutton M, Tickle M, Kelly M, Pretty I. Recruitment and Consent in an observational study. Community Dent Health 2020; 37:287-292. [PMID: 33026721 DOI: 10.1922/cdh_000682020goodwin06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study sought to explore the consent rate and associated potential bias across a cohort in a large longitudinal population based study. RESEARCH DESIGN Data were taken from a study designed to examine the effects of the reintroduction of community water fluoridation on children's oral health over a five-year period. Children were recruited from a fluoridated and non-fluoridated area in Cumbria, referred to as Group 1 and Group 2. RESULTS Data were available for 3138 individuals. The consent rate was 12.91 percentage points lower in Group 2 than Group 1 (95% CI -16.27 to -9.56, p⟨0.001). The population in Group 2 was more deprived (higher Index of Multiple Deprivation (IMD)) than Group 1 before consent was taken. Consent was not associated with deprivation in either group. CONCLUSION The cohort appeared to be unaffected by IMD-related non-consent. However there was a difference in consent rate between the two groups. With the population in Group 1 being more deprived than Group 2, it will be important to incorporate these differences into the analysis at the end of this longitudinal study.
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Affiliation(s)
- M Goodwin
- University of Manchester, School of Dentistry, UK
| | - W Whittaker
- University of Manchester, Population Health, Health Services Research & Primary Care, UK
| | - T Walsh
- University of Manchester, School of Dentistry, UK
| | - R Emsley
- King's College London, Psychiatry, Psychology & Neuroscience, UK
| | - M Sutton
- University of Manchester, Population Health, Health Services Research & Primary Care, UK
| | - M Tickle
- University of Manchester, School of Dentistry, UK
| | - M Kelly
- University of Cambridge, Public Health, UK
| | - I Pretty
- University of Manchester, School of Dentistry, UK
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16
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Mackert M, Bouchacourt L, Lazard A, Wilcox GB, Kemp D, Kahlor LA, George C, Stewart B, Wolfe J. Social media conversations about community water fluoridation: formative research to guide health communication. J Public Health Dent 2020; 81:162-166. [PMID: 33058200 DOI: 10.1111/jphd.12404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/27/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Community water fluoridation (CWF) is one of the greatest public health achievements of the 20th century. Despite this achievement, there are still misunderstandings about the safety of water fluoridation. Previous communication campaigns advocating CWF have been unsuccessful in combating these misunderstandings, suggesting a need for a new way to promote CWF. The goal of this article is to guide research for future campaigns by analyzing the digital conversation regarding community water fluoridation and other forms of fluoride in the state of Texas. METHODS NUVI software extracted tweets from Twitter, and SAS Text Miner 12.1 software revealed topics related to water fluoridation. RESULTS The results uncovered eight topics related to water fluoridation. Overall, the analysis showed mixed reactions toward water fluoridation, fluoride toothpaste, and children's dental health. CONCLUSIONS The findings of the text analysis will guide future research, with the goal of building a pro-CWF effort in Texas.
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Affiliation(s)
- Michael Mackert
- Stan Richards School of Advertising & Public Relations, The University of Texas at Austin, Austin, TX, USA.,Center for Health Communication, The University of Texas at Austin, Austin, TX, USA
| | - Lindsay Bouchacourt
- Stan Richards School of Advertising & Public Relations, The University of Texas at Austin, Austin, TX, USA
| | - Allison Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary B Wilcox
- Stan Richards School of Advertising & Public Relations, The University of Texas at Austin, Austin, TX, USA
| | - Deena Kemp
- Stan Richards School of Advertising & Public Relations, The University of Texas at Austin, Austin, TX, USA
| | - Lee Ann Kahlor
- Stan Richards School of Advertising & Public Relations, The University of Texas at Austin, Austin, TX, USA
| | - Caren George
- Center for Health Communication, The University of Texas at Austin, Austin, TX, USA
| | | | - Josefine Wolfe
- College of Graduate Health Studies, A.T. Still University, USA
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17
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Sendi P, Ramadani A, Zitzmann NU, Bornstein MM. A Systematic Review of WTA-WTP Disparity for Dental Interventions and Implications for Cost-Effectiveness Analysis. Healthcare (Basel) 2020; 8:E301. [PMID: 32858834 DOI: 10.3390/healthcare8030301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022] Open
Abstract
Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money, and its use in dentistry is increasing. Traditionally, in cost-effectiveness analysis, one assumes that the decision maker's maximum willingness to pay (WTP) for health gain is equivalent to his minimum willingness to accept (WTA) monetary compensation for health loss. It has been documented in the literature that losses are weighted higher than equivalent gains, i.e., that WTA exceeds WTP for the same health condition, resulting in a WTA/WTP ratio greater than 1. There is a knowledge gap of published WTA/WTP ratios for dental interventions in the literature. We therefore conducted a (i) systematic review of published WTA-WTP estimates in dentistry (MEDLINE, Web of Science, Cochrane Library, London, UK) and (ii) a patient-level analysis of WTA/WTP ratios of included studies, and (iii) we demonstrate the impact of a WTA-WTP disparity on cost-effectiveness analysis. Out of 55 eligible studies, two studies were included in our review. The WTA/WTP ratio ranged from 2.58 for discontinuing water fluoridation to 5.12 for mandibular implant overdentures, indicating a higher disparity for implant rehabilitations than for dental public health interventions. A WTA-WTP disparity inflates the cost-effectiveness of dental interventions when there is a substantial risk of both lower costs and health outcomes. We therefore recommend that in these cases the results of cost-effectiveness analyses are reported using different WTA/WTP ratios in a sensitivity analysis.
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18
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Zelko F. Optimizing nature: Invoking the "natural" in the struggle over water fluoridation. Hist Sci 2019; 57:518-539. [PMID: 30428720 DOI: 10.1177/0073275318809764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
For the past seventy years, a host of scientific and public health bodies in the United States have strongly endorsed the practice of adding fluoride compounds to public water supplies as a prophylactic against dental caries. Throughout that period, a constant undercurrent of skepticism and outright opposition has slowed the adoption of the practice in the United States and limited its spread to just a handful of countries around the world. One of the attractions of water fluoridation is its affordability: the fluoride compounds are sourced from the phosphate and aluminum industries, for whom they would otherwise constitute an annoying toxic waste disposal problem. Despite this, proponents have nonetheless succeeded in shaping a narrative that casts fluoridation as "natural" or at least mimicking nature. I demonstrate how fluoridationists were able to persuasively argue that adding a pollutant to the water supply was safe and natural. In the process, I examine how environmental historians and historians of science approach topics such as fluoridation. I suggest that as a result of the influence of science and technology studies and an ontological turn toward hybridity, the two subdisciplines are becoming increasingly convergent.
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Affiliation(s)
- Frank Zelko
- Department of History, University of Hawai'i at Mānoa, USA
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19
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Strunecka A, Strunecky O. Chronic Fluoride Exposure and the Risk of Autism Spectrum Disorder. Int J Environ Res Public Health 2019; 16:E3431. [PMID: 31527457 PMCID: PMC6765894 DOI: 10.3390/ijerph16183431] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022]
Abstract
The continuous rise of autism spectrum disorder (ASD) prevalent in the past few decades is causing an increase in public health and socioeconomic concern. A consensus suggests the involvement of both genetic and environmental factors in the ASD etiopathogenesis. Fluoride (F) is rarely recognized among the environmental risk factors of ASD, since the neurotoxic effects of F are not generally accepted. Our review aims to provide evidence of F neurotoxicity. We assess the risk of chronic F exposure in the ASD etiopathology and investigate the role of metabolic and mitochondrial dysfunction, oxidative stress and inflammation, immunoexcitotoxicity, and decreased melatonin levels. These symptoms have been observed both after chronic F exposure as well as in ASD. Moreover, we show that F in synergistic interactions with aluminum's free metal cation (Al3+) can reinforce the pathological symptoms of ASD. This reinforcement takes place at concentrations several times lower than when acting alone. A high ASD prevalence has been reported from countries with water fluoridation as well as from endemic fluorosis areas. We suggest focusing the ASD prevention on the reduction of the F and Al3+ burdens from daily life.
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Affiliation(s)
- Anna Strunecka
- The Institute of Technology and Business, Okružní 517/10, 370 01 České Budějovice, Czech Republic.
| | - Otakar Strunecky
- The Institute of Technology and Business, Okružní 517/10, 370 01 České Budějovice, Czech Republic.
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20
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Nor NAM, Chadwick BL, Farnell D, Chestnutt IG. The prevalence of enamel and dentine caries lesions and their determinant factors among children living in fluoridated and non-fluoridated areas. Community Dent Health 2019; 36:229-236. [PMID: 31437389 DOI: 10.1922/cdh_4522nor08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the prevalence and severity of dental caries (at dentine and enamel levels of diagnosis) amongst Malaysian children and to investigate determinant factors associated with caries detection at these different thresholds. METHODS This study involved life-long residents aged 12 years-old in fluoridated and non-fluoridated areas in Malaysia (n=595). The survey was carried out in 16 public schools by a calibrated examiner, using ICDAS-II criteria. A questionnaire on socio-demographic and oral hygiene practices was self-administered by parents/guardians. Data were analysed using Mann-Whitney U tests and logistic regression. RESULTS The overall response rate was 74.4%. Caries prevalence at the dentine level or at the dentine and enamel level was significantly (p⟨0.001) higher among children in the non-fluoridated area (D₁₋₆MFT⟩0 = 82.4%, D₄₋₆MFT⟩0 = 53.5%) than in the fluoridated area (D₁₋₆MFT⟩0 = 68.7%, D₄₋₆MFT⟩0 = 25.5%). Considering only the decayed component of the index, no significant differences were observed between the two areas when the detection threshold was set at enamel caries (D₁₋₃) (p=0.506). However, when the detection criteria were elevated to the level of caries into dentine (D₄₋₆) there were clear differences between the fluoridated and non-fluoridated areas (p=0.006). Exposure to fluoridated water proved a significant predictor for lower caries prevalence in the statistical model. Children whose father and mother had a low monthly income had a significantly higher dentine caries prevalence. CONCLUSION Results confirmed existing evidence of the benefit of water fluoridation in caries prevention. Detection criteria set at caries into dentine shows clear differences between fluoridated and non-fluoridated areas. Exposure to fluoridated water and socio-economic status were associated with caries prevalence.
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Affiliation(s)
- N A M Nor
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - B L Chadwick
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - D Farnell
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
| | - I G Chestnutt
- Department of Applied Clinical Research and Dental Public Health, Cardiff University School of Dentistry, Cardiff, UK
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21
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Abstract
Breastfeeding is important for health and development. Yet, the interaction between breastfeeding duration and usage of fluoridated water on caries experience has not been investigated. This study examined exposure to fluoridation as an effect modifier of the association between breastfeeding duration and caries. The 2012 to 2014 national population-based study of Australian children involved parental questionnaires and oral epidemiological assessment. Children were grouped by parent-reported breastfeeding duration into minimal (none or <1 mo), breastfed for 1 to <6 mo, breastfed for 6 to 24 mo, and sustained (>24 mo). Residential history and main water source used for the first 2 y of life were collected to group children into exposed (WF) and nonexposed (NF) to fluoridation. Socioeconomic status, infant formula feeding, and sugar-sweetened beverage (SSB) consumption data were collected. The prevalence and severity of caries in children aged 5 to 6 y were primary outcomes. Multivariable regression models with robust error estimation were generated to compute prevalence ratios (PRs) and mean ratios (MRs) for 3 breastfeeding groups against the reference (breastfed for 6-24 mo). Of the 5- to 6-y-old children, 2,721 were in the WF and 1,737 were in the NF groups. The groups had comparable distributions of socioeconomic factors, infant formula feeding, and SSB consumption. There were U-shape distributions of caries experience among breastfeeding groups, being more pronounced among NF children. Among NF children, the minimal and sustained breastfeeding groups had significantly higher PR (1.4 [1.1-1.9] and 1.8 [1.4-2.4]) and MR (2.1 [1.4-3.3] and 2.4 [1.4-4.1]) than the reference group. However, among the WF children, this association between breastfeeding duration and caries attenuated after adjustment for other factors. The study contributes evidence of a nonlinear (U-shape) association between breastfeeding duration and dental caries. Early life exposure to fluoridated drinking water attenuated the potential cariogenic effect of both lack of and sustained breastfeeding.
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Affiliation(s)
- D H Ha
- 1 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A J Spencer
- 1 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - K G Peres
- 1 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.,2 School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Queensland, Australia
| | | | - J A Scott
- 4 School of Public Health, Curtin University, Perth, Australia
| | - L G Do
- 1 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
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22
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Kim HN, Kong WS, Lee JH, Kim JB. Reduction of Dental Caries Among Children and Adolescents From a 15-Year Community Water Fluoridation Program in a Township Area, Korea. Int J Environ Res Public Health 2019; 16:ijerph16071306. [PMID: 30979043 PMCID: PMC6479926 DOI: 10.3390/ijerph16071306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/04/2022]
Abstract
Since 2000, a community water fluoridation program (CWFP) has been implemented in Hapcheon for over 15 years. We aimed to evaluate the caries-reducing effect on permanent teeth after this implementation. In 2015, evaluation surveys were conducted by our study group, 498 subjects aged 8, 10, 12, and 15 years. As the control, 952 similarly aged subjects were selected from the Sixth Korean National Health and Nutrition Examination Survey (2013-2015 KNHANES). Data of a prospective cohort of 671 8-,10- and 12-year-olds, collected when CWFP started, were used for the evaluation. Caries-reducing effects were estimated by decayed, missing and filled teeth (DMFT) scores between CWFP and control groups, pre- and post-program. Confounders including the mean number of sealant teeth and gender were adjusted for. The mean adjusted DMFT scores of 10-, 12- and 15-year-olds in Hapcheon were significantly lower compared to KNHANES DMFT scores; in addition, those of 8-, 10- and 12-year-olds after the 15-year CWFP were significantly lower than in 2000. The caries-reducing effect among 12-year-olds was 37.6% compared to those recorded in KNHANES, and 67.4% compared to those in 2000. In conclusion, the caries-reducing effect was so high that health policy makers should consider CWFP as a priority policy for caries-reducing in Korean children and adolescents.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju 28503, Korea.
| | - Wook-Sung Kong
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea.
| | - Jung-Ha Lee
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea.
| | - Jin-Bom Kim
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea.
- BK PLUS Project, School of Dentistry, Pusan National University, Busan 50612, Korea.
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23
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Chaitanya NCSK, Karunakar P, Allam NSJ, Priya MH, Alekhya B, Nauseen S. A systematic analysis on possibility of water fluoridation causing hypothyroidism. Indian J Dent Res 2018; 29:358-363. [PMID: 29900922 DOI: 10.4103/ijdr.ijdr_505_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Community water fluoridation is widely used worldwide and its role in preventive dental health care is well established. However, there is sufficient evidence of the ill effects of excessive fluoride content in water, causing skeletal and dental fluorosis. Alongside, there was also extraskeletal and dental manifestations of excessive fluorides reported. They include the effect on thyroid function, but the literature regarding this is sparse. Aim The present systematic review aims to analyze the data from controlled studies about the effect of fluoride on thyroid function. Materials and Methods A systematic literature search was performed using PUBMED, MEDLINE, EMBASE, COCHRANE Library, EBSCO search, and the internet search, with language restriction to English. The search included published studies which dealt with the association of fluorine with hypothyroidism, from January 1981 to November 2015. Literature search was done using keywords: fluoride and hypothyroidism, dental fluorosis and thyroid disorders, systemic fluorosis and thyroid disease, excessive water fluoridation and hypothyroidism, thyroid and fluoride, fluorosis and its adverse effects. Results Out of 166 publications, related to search strategy, 37 full articles which were related with the association of fluoride and hypothyroidism were acquired for further inspection. Out of the 37 articles, 10 articles met the inclusion criteria. The data were extracted and placed in an excel sheet and were analyzed. The analysis suggested a positive correlation of excess fluoride and hypothyroidism. Conclusion The present systematic review suggests a positive correlation between excess fluoride and hypothyroidism. This calls the need for further well-controlled studies in this otherwise emerging alarming issue. It also calls for considerable community network through health informatics for problem sensitization.
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Affiliation(s)
- Nallan C S K Chaitanya
- Department of Oral Medicine and Radiology, Principal, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - P Karunakar
- Department of Conservative Dentistry and Endodontics, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Neeharika Satya Jyothi Allam
- Department of Oral Medicine and Radiology, Principal, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - M Hima Priya
- Department of Oral Medicine and Radiology, Principal, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - B Alekhya
- Department of Oral Medicine and Radiology, Principal, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Shaguftha Nauseen
- Department of Oral Medicine and Radiology, Principal, Panineeya Institute of Dental Sciences, Hyderabad, Telangana, India
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24
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Weston-Price S, Copley V, Smith H, Davies GM. A multi-variable analysis of four factors affecting caries levels among five-year-old children; deprivation, ethnicity, exposure to fluoridated water and geographic region. Community Dent Health 2018; 35:217-222. [PMID: 30188616 DOI: 10.1922/cdh_4383weston-price06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the role of factors posited to affect population caries levels across England. BASIC RESEARCH DESIGN Multivariable regression analysis assessing four potential determinants of caries severity and prevalence: deprivation, exposure to fluoridated water, ethnicity and geographic region Participants: Random sample of 121,875 five-year-old children in England in the 2014/15 academic year. MAIN OUTCOME MEASURES Decayed, missing and filled teeth, with decay measured at the dentinal level, (d₃mft), presented as prevalence (dmft⟩0) and extent of decay among children who have any (d₃mft if d₃mft>0). INDEPENDENT VARIABLES Parental reported ethnicity from school records, index of multiple deprivation (IMD) scores, region and exposure to water fluoridation calculated utilising home postcodes. RESULTS The data support wider literature displaying associations between caries and deprivation across a social gradient. The important, new findings are deprivation, some ethnic groups and lack of exposure to water fluoridation are all associated with increased prevalence and severity of caries when considered together and independently. New evidence supports the impact of water fluoridation on health inequalities in that the greatest impact of exposure to fluoridated water was seen in the most deprived children and those from an Asian / Asian British ethnic group. CONCLUSIONS Five-year-old children who were from the most deprived areas, not exposed to fluoridated water, of an Eastern European ethnic group and living in the North West demonstrated the highest prevalence and severity of caries in the survey under scrutiny. This is of public health importance, providing evidence for population groups to target with health improvement activities.
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Affiliation(s)
- S Weston-Price
- Speciality Registrar in Dental Public Health, Public Health England (London)
| | - V Copley
- Principal Analyst, Risk Factors Intelligence, Public Health England
| | - H Smith
- Head of Health Intelligence - National Child and Maternal Health Intelligence Network, Public Health England
| | - G M Davies
- Consultant in Dental Public Health, Public Health England
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Spencer AJ, Do LG, Ha DH. Contemporary evidence on the effectiveness of water fluoridation in the prevention of childhood caries. Community Dent Oral Epidemiol 2018; 46:407-415. [PMID: 29869803 DOI: 10.1111/cdoe.12384] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Water fluoridation's effectiveness has been reaffirmed by systematic reviews. However, most of the included nonrandomised controlled before and after studies were conducted pre-1975. Opportunity for such studies is limited in a steady state of community fluoridation programmes. As an alternative for evidence to support or refute the effectiveness of water fluoridation, this study used data from a recent national child oral health study to examine associations between lifetime exposure to fluoridated water (%LEFW) and childhood caries. METHODS A population-based study of child oral health in Australia was conducted in 2012-2014, using complex sampling and weighting procedures. Parents provided detailed household information and children underwent oral epidemiological examination by trained examiners. Residential history from birth was used to calculate %LEFW. Caries prevalence (dmfs/DMFS>0) and experience (dmfs/DMFS) in both primary (age 5-8) and permanent dentitions (age 9-14) were estimated. Socioeconomic factors that were significantly different by %LEFW were then used as covariates in multivariable log-Poisson regression models for each caries outcome by %LEFW. RESULTS A total of 24 664 children had complete data. Caries prevalence and experience were higher among 5-8-year-old children with lower %LEFW (46.9%; 4.27 surfaces) than those with 100%LEFW (31.5%; 1.98 surfaces) and for the 9-14-year-old children with lower %LEFW (37.0%; 1.34 surfaces) than those with 100%LEFW (25.0%; 0.67 surfaces). In the multivariable models, the prevalence ratios for primary and permanent caries were significant for the two lower exposure groups against the 100%LEFW group. Similarly, the mean ratios for primary dmfs were significant for all three lower exposure groups and for permanent DMFS were significant for the two lower exposure groups against the 100%LEFW group. Mean ratios for the 0%LEFW compared to the 100%LEFW group were 2.10 (1.83-2.40) for dmfs and 1.82 (1.57-2.10) for DMFS. CONCLUSION Analysis of contemporary data representative of the Australian child population found consistent associations between %LEFW and childhood caries, which persisted when socioeconomic differences were adjusted across exposure groups, supporting the continued effectiveness of water fluoridation.
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Affiliation(s)
- A John Spencer
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - Loc G Do
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - Diep H Ha
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
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Gao SS, Chen KJ, Duangthip D, Lo ECM, Chu CH. Oral Health Care in Hong Kong. Healthcare (Basel) 2018; 6:E45. [PMID: 29751605 DOI: 10.3390/healthcare6020045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Hong Kong, as a special administrative region of the People’s Republic of China, is a metropolitan city in Asia with a population of approximately 7.4 million. This paper reflects the oral health care situation in Hong Kong. Water fluoridation was introduced in 1961 as the primary strategy for the prevention of dental caries. The fluoride level is currently 0.5 parts per million. Dental care is mainly provided by private dentists. The government’s dentists primarily serve civil servants and their dependents, with limited emergency dental service for pain relief offered to the general public. Nevertheless, the government runs the school dental care service, which provides dental treatments to primary school children through dental therapists. They also set up an oral health education unit to promote oral health in the community. Hong Kong had 2280 registered dentists in 2017, and the dentist-to-population ratio was about 1:3200. The Faculty of Dentistry at the University of Hong Kong is the only institution to provide basic and advanced dentistry training programs in Hong Kong. Dental hygienists, dental surgery assistants, dental therapists, and dental technicians receive training as paradental staff through the university or the government.
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Abstract
BACKGROUND Community water fluoridation is known to play a significant role in enhancing oral health by reducing the incidence of dental caries. However, the level of fluoride in the supplied public water in the Eastern Province of Saudi Arabia is unknown. OBJECTIVE To determine water fluoride levels at the main sources supplying water to households and schools in two major cities (Dammam and Al-Khobar) of the Eastern Province of Saudi Arabia. METHODS From the Directorate of Water Agency and Directorate of Education, the following were identified as the main sources of public water supply in Dammam and Al-Khobar: the water agency, public water tanks and four contracted companies. Two samples were collected from each of these six identified water sources at two different time points (in January and July 2016; 2 samples/site/time point; N = 24) using 500 mL polythene bottles. Each sample was analyzed using an ion chromatography system at different detection limits (including the lowest detection limit of 0.065 ppm) to determine the fluoride level. RESULTS There was no fluoride detected in any sample even at the lowest detection limit, indicating that fluoride levels in the studied water samples were <0.065 ppm. CONCLUSION This study found that in the cities studied, fluoride levels, if any, are considerably below the optimum recommended level for the prevention of dental caries (i.e., 0.7 ppm).
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Affiliation(s)
- Eman Abduljalil Bakhurji
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yazeed Saeed Alqahtani
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Helmi M, Spinella MK, Seymour B. Community water fluoridation online: an analysis of the digital media ecosystem. J Public Health Dent 2018; 78:296-305. [PMID: 29603251 DOI: 10.1111/jphd.12268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 02/13/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Research demonstrates the safety and efficacy of community water fluoridation (CWF). Yet, the digitization of communication has triggered the spread of inaccurate information online. The purpose of this study was to analyze patterns of CWF information dissemination by a network of sources on the web. METHODS We used Media Cloud, a searchable big data platform of over 550 million stories from 50 thousand sources, along with tools to analyze that archive. We generated a network of fluoridation publishers using Media Cloud's keyword identification from August 1, 2015 to July 31, 2016. We defined the media type and sentiment toward CWF for each source and generated a network map of the most influential sources during our study period based on hyperlinking activity. RESULTS Media Cloud detected a total of 980 stories from 325 different sources related to water fluoridation. We identified nine different media types participating in the dissemination of information: academic, government, scientific group, natural medicine, blogs, mainstream media, advocacy groups, user-generated (e.g., YouTube), and "other." We detected five sub-networks within the overall fluoridation network map, each with its own characteristics. Twenty-one percent of sources were pro-fluoridation, receiving 57 percent of all inlinks, 22 percent of sources were anti-fluoridation, and the rest were neutral (54 percent). CONCLUSIONS The dominant neutral sentiment of the network may signify that anti- and pro-sides of the debate are viewed as balanced, not just in number but also in quality of information. Despite high inlinks to pro-sources, anti-fluoridation sentiment maintains influence online.
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Affiliation(s)
- Mohammad Helmi
- Harvard School of Dental Medicine, Oral Health Policy and Epidemiology, Boston, MA, USA.,King Saud University, College of Dentistry, Periodontics and Community Dentistry, Riyadh, Kingdom of Saudi Arabia
| | - Mary Kate Spinella
- Harvard School of Dental Medicine, Oral Health Policy and Epidemiology, Boston, MA, USA
| | - Brittany Seymour
- Harvard School of Dental Medicine, Oral Health Policy and Epidemiology, Boston, MA, USA
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O'Connell J, Rockell J, Ouellet J, Tomar SL, Maas W. Costs And Savings Associated With Community Water Fluoridation In The United States. Health Aff (Millwood) 2018; 35:2224-2232. [PMID: 27920310 DOI: 10.1377/hlthaff.2016.0881] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.
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Affiliation(s)
- Joan O'Connell
- Joan O'Connell is an associate professor in the Department of Community and Behavioral Health at the Colorado School of Public Health, in Aurora
| | - Jennifer Rockell
- Jennifer Rockell is a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health
| | - Judith Ouellet
- Judith Ouellet is a senior professional research assistant in the Division of Health Care Policy and Research at the University of Colorado Denver School of Medicine, in Aurora
| | - Scott L Tomar
- Scott L. Tomar is a professor in the Department of Community Dentistry and Behavioral Science at the College of Dentistry, University of Florida, in Gainesville
| | - William Maas
- William Maas is a dental consultant at William Maas, LLC, in Rockville, Maryland
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James P, Harding M, Beecher T, Parnell C, Browne D, Tuohy M, Kavanagh D, O'Mullane D, Guiney H, Cronin M, Whelton H. Fluoride And Caring for Children's Teeth (FACCT): Clinical Fieldwork Protocol. HRB Open Res 2018; 1:4. [PMID: 32002500 PMCID: PMC6973526 DOI: 10.12688/hrbopenres.12799.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/05/2022] Open
Abstract
Background: The reduction in dental caries seen between Irish national surveys of children’s oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis. To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children’s Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board. Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002). Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires. The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean’s Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.
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Affiliation(s)
- Patrice James
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Mairead Harding
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland.,Cork University Dental School and Hospital, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Tara Beecher
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Carmel Parnell
- Louth Meath Dental Service, Health Service Executive , Navan, Co. Meath, C15RK7Y, Ireland
| | - Deirdre Browne
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Marie Tuohy
- National Oral Health Office, St. Joseph's Hospital, Mulgrave Street, Limerick, Co. Limerick, V94C8DV, Ireland.,South Tipperary, Carlow and Kilkenny Health Service Executive Dental Service, Clonmel Community Care, Clonmel, Co. Tipperary, E91HT96, Ireland
| | - Dympna Kavanagh
- Community Pharmacy, Dental, Optical and Aural Policy Section, Department of Health, Dublin, Co. Dublin, DO2VW90, Ireland
| | - Denis O'Mullane
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Helena Guiney
- Oral Health Services Research Centre, University College Cork, Cork, Co. Cork, T12E8YV, Ireland
| | - Michael Cronin
- School of Mathematical Sciences, University College Cork, Cork, Co. Cork, T12YN60, Ireland
| | - Helen Whelton
- College of Medicine and Health, University College Cork, Cork, Co. Cork, T12EDK0, Ireland
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Abstract
BACKGROUND The West Australian School Dental Service (SDS) provides free, statewide, primary dental care to schoolchildren aged 5-17 years. This study reports on an evaluation of the oral health of children examined during the 2014 calendar year. METHODS Children were sampled, based on their date of birth, and SDS clinicians collected the clinical information. Weighted mean values of caries experience were presented. Negative binomial regression modelling was undertaken to test for factors of significance in the rate of caries occurrence. RESULTS Data from children aged 5-15 years were used (girls = 4616, boys = 4900). Mean dmft (5-10-year-olds), 1.42 SE 0.03; mean DMFT (6-15-year-olds), 0.51 SE 0.01. Negative binomial regression model of permanent tooth caries found higher rates of caries in children who were from non-fluoridated areas (RR 2.1); Aboriginal (RR 2.4); had gingival inflammation (RR 1.5); lower ICSEA level (RR 1.4); and recalled at more than 24-month interval (RR 1.8). CONCLUSIONS The study highlighted poor dental health associated with living in non-fluoridated areas, Aboriginal identity, poor oral hygiene, lower socioeconomic level and having extended intervals between dental checkups. Timely assessments and preventive measures targeted at groups, including extending community water fluoridation, may assist in further improving the oral health of children in Western Australia.
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Affiliation(s)
- P Arrow
- West Australian Dental Health Services, Perth, Western Australia, Australia.,Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia, Australia
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Pretty IA, Boothman N, Morris J, MacKay L, Liu Z, McGrady M, Goodwin M. Prevalence and severity of dental fluorosis in four English cities. Community Dent Health 2017; 33:292-296. [PMID: 28537367 DOI: 10.1922/cdh_3930pretty05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/25/2016] [Indexed: 11/11/2022]
Abstract
Objective To assess the prevalence and severity of dental fluorosis in four city-based populations using a robust photographic method with TF index reporting; and to record the aesthetic satisfaction scores of children in all four cities. Basic research design Cross sectional epidemiological survey (surveillance). Participants 1,904 children aged 11-14 years, in four English cities. Interventions Two cities were served by community water fluoridation schemes supplying water at 1mg/l F. The other two cities did not have water fluoridation schemes and had low levels of fluoride naturally present. Main outcome measures The prevalence and severity of dental fluorosis. Scoring was undertaken using high quality digital images by a single calibrated examiner. Results Data suggest that the prevalence of fluorosis at levels greater than TF2 are broadly similar to previous studies (F 10%, NF 2%), with an apparent increase in the total number of TF1 cases across both fluoridated (41%) and non-fluoridated cities (32%) with a commensurate decrease in TF0 (F 39%, NF 63%). Data suggest that the proportion of children expressing dissatisfaction with the appearance of their teeth is the same in fluoridated and non-fluoridated communities although the reasons for this may differ. Conclusions The levels of fluorosis that might be considered of aesthetic concern are low and stable while the increase in TF1 may be due to an increase in self- and professionally-applied fluoride products or the increased sensitivity afforded by the digital imaging system. It is not however a public health problem or concern. Further monitoring appears justified.
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Affiliation(s)
- I A Pretty
- School of Dentistry, The University of Manchester, UK
| | - N Boothman
- School of Dentistry, The University of Manchester, UK
| | | | - L MacKay
- School of Dentistry, The University of Manchester, UK
| | - Z Liu
- School of Dentistry, The University of Manchester, UK
| | - M McGrady
- School of Dentistry, The University of Manchester, UK
| | - M Goodwin
- School of Dentistry, The University of Manchester, UK
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Abstract
Portland, Oregon is the largest city in the United States without community water fluoridation (CWF). A newspaper analysis was conducted of the failed 2013 CWF campaign to evaluate anti-fluoridation and pro-fluoridation messaging provided by newspapers during the campaign. News content was categorized by type and slant (pro-fluoridation, anti-fluoridation, or neutral) and 34 variables were tabulated (23 anti-fluoridation, 11 pro-fluoridation). Results showed overall messaging was slightly pro-fluoridation, as compared to anti-fluoridation or neutral content (35%, 32%, and 33% respectively). Editorial content was 85% pro-fluoridation and 15% anti-fluoridation. The most frequent anti-fluoridation variables were alternatives to water fluoridation, mass/forced medication and concerns about the political process. Conversely, tooth decay and social justice were the most commonly cited pro-fluoridation variables. Newspapers can be influential in shaping public policy opinions in the fight for community water fluoridation.
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Affiliation(s)
- Allison Bianchi
- Advanced Population Health, Health Systems Leadership & Informatics, University of Illinois at Chicago, Chicago, Illinois
| | - Martha Dewey Bergren
- Advanced Population Health, Health Systems Leadership & Informatics, University of Illinois at Chicago, Chicago, Illinois
| | - Patricia Ryan Lewis
- Advanced Population Health, Health Systems Leadership & Informatics, University of Illinois at Chicago, Chicago, Illinois
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35
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Waugh DT, Potter W, Limeback H, Godfrey M. Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation. Int J Environ Res Public Health 2016; 13:E259. [PMID: 26927146 PMCID: PMC4808922 DOI: 10.3390/ijerph13030259] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 11/16/2022]
Abstract
The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.
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Affiliation(s)
- Declan T Waugh
- EnviroManagement Services, 11 Riverview, Dohertys Rd, Bandon, Co. Cork P72 YF10, Ireland.
| | - William Potter
- Department of Chemistry and Biochemistry, KEH M2225, University of Tulsa, Tulsa, OK 74104-3189, USA.
| | - Hardy Limeback
- Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON M5G 1G6, Canada.
| | - Michael Godfrey
- Bay of Plenty Environmental Health, 1416A Cameron Road, Tauranga 3012, New Zealand.
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Malin AJ, Till C. Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association. Environ Health 2015; 14:17. [PMID: 25890329 PMCID: PMC4389999 DOI: 10.1186/s12940-015-0003-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/04/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND Epidemiological and animal-based studies have suggested that prenatal and postnatal fluoride exposure has adverse effects on neurodevelopment. The aim of this study was to examine the relationship between exposure to fluoridated water and Attention-Deficit Hyperactivity Disorder (ADHD) prevalence among children and adolescents in the United States. METHODS Data on ADHD prevalence among 4-17 year olds collected in 2003, 2007 and 2011 as part of the National Survey of Children's Health, and state water fluoridation prevalence from the Centers for Disease Control and Prevention (CDC) collected between 1992 and 2008 were utilized. RESULTS State prevalence of artificial water fluoridation in 1992 significantly positively predicted state prevalence of ADHD in 2003, 2007 and 2011, even after controlling for socioeconomic status. A multivariate regression analysis showed that after socioeconomic status was controlled each 1% increase in artificial fluoridation prevalence in 1992 was associated with approximately 67,000 to 131,000 additional ADHD diagnoses from 2003 to 2011. Overall state water fluoridation prevalence (not distinguishing between fluoridation types) was also significantly positively correlated with state prevalence of ADHD for all but one year examined. CONCLUSIONS Parents reported higher rates of medically-diagnosed ADHD in their children in states in which a greater proportion of people receive fluoridated water from public water supplies. The relationship between fluoride exposure and ADHD warrants future study.
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Affiliation(s)
- Ashley J Malin
- Department of Psychology, York University, Keele St., 4700, Toronto, Canada.
| | - Christine Till
- Department of Psychology, York University, Keele St., 4700, Toronto, Canada.
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Cochrane NJ, Hopcraft MS, Tong AC, Thean HL, Thum YS, Tong DE, Wen J, Zhao SC, Stanton DP, Yuan Y, Shen P, Reynolds EC. Fluoride content of tank water in Australia. Aust Dent J 2014; 59:180-6. [PMID: 24861392 DOI: 10.1111/adj.12163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aims of this study were to: (1) analyse the fluoride content of tank water; (2) determine whether the method of water collection or storage influenced fluoride content; and (3) survey participant attitudes towards water fluoridation. METHODS Plastic tubes and a questionnaire were distributed through dentists to households with water tanks in Victoria. A midstream tank water sample was collected and fluoride analysed in triplicate using ion chromatography RESULTS All samples (n = 123) contained negligible amounts of fluoride, with a mean fluoride concentration of <0.01 ppm (range: <0.01-0.18 ppm). No statistically significant association was found between fluoride content and variables investigated such as tank material, tank age, roof material and gutter material. Most people did not know whether their tank water contained fluoride and 40.8% preferred to have access to fluoridated water. The majority thought fluoride was safe and more than half of the respondents supported fluoridation. Fluoride content of tank water was well below the optimal levels for caries prevention. CONCLUSIONS People who rely solely on tank water for drinking may require additional exposure to fluoride for optimal caries prevention.
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Affiliation(s)
- N J Cochrane
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Victoria
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Abstract
Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in the prevention of caries. The goals of this clinical report are to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries while minimizing the likelihood of enamel fluorosis.
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Johnson NW, Lalloo R, Kroon J, Fernando S, Tut O. Effectiveness of water fluoridation in caries reduction in a remote Indigenous community in Far North Queensland. Aust Dent J 2014; 59:366-71. [PMID: 24820049 DOI: 10.1111/adj.12190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Children in remote Indigenous communities in Australia have levels of dental caries much greater than the national average. One such, the Northern Peninsula Area of Far North Queensland (NPA), had an oral health survey conducted in 2004, shortly before the introduction of fluoridated, reticular water. Children were again surveyed in 2012, following five years exposure. METHODS An oral examination was conducted on all consenting children enrolled in schools across the community, using WHO Basic Oral Health Survey methodology. RESULTS Few teeth had restorations in both surveys. Age-weighted overall caries prevalence and severity declined from 2005 to 2012 by 37.3%. The effect was most marked in younger children, dmft decreasing by approximately 50% for ages 4-9 years; at age 6, mean decayed score decreased from 5.20 to 3.43. DMFT levels also decreased by almost half in 6-9 year olds. However, significant unmet treatment needs exist at all ages. CONCLUSIONS There has been considerable improvement in child dental health in the NPA over the past 6-7 years. In light of continued poor diet and oral hygiene, water fluoridation is the most likely explanation. The cost-effectiveness for this small community remains an issue which, in the current climate of political antagonism to water fluoridation in many quarters, requires continued study.
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Affiliation(s)
- N W Johnson
- Population and Social Health Research Programme (Lead for Population Oral Health), Griffith Health Institute, Griffith University, Queensland
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Abstract
BACKGROUND AND OVERVIEW Community water fluoridation is an important public health intervention that reduces oral health disparities and increases the health of the population. Promotion of its safety and effectiveness is critical to maintaining its widespread acceptance and ensuring its continued use. Dentists are a potentially important source of knowledge regarding the oral health benefits and safety of water fluoridation. However, few dentists regularly discuss fluorides, and water fluoridation in particular, with patients. The authors aim to describe and discuss the role and importance of dentists' promotion of public water fluoridation, barriers to dentists' involvement and some approaches that might influence dentists to promote water fluoridation more actively. CONCLUSIONS AND PRACTICE IMPLICATIONS Ongoing promotion of fluoridation by dentists is a key factor in ensuring sustained municipal water fluoridation. However, current undergraduate dental curricula do not adequately prepare dentists for this role, and continuing dental education may be insufficient to change clinical practice. Although smoking-cessation literature can shed some light on how to proceed, changing dentists' practice behavior remains a largely unstudied topic. Dental associations are a key resource for dentists, providing information that can assist them in becoming advocates for water fluoridation.
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Affiliation(s)
- Molly L R Melbye
- Department of Oral Health Sciences, School of Dentistry, University of Washington, 1959 N.E. Pacific St., Box 357475, Seattle, WA 98195, USA.
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41
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Abstract
AIM To test whether residents of Queensland differ from residents elsewhere in Australia with respect to support for water fluoridation. METHODS Questionnaire data were obtained from an Australia-wide sample of 517 adults. The study occurred in 2008, shortly after the state government mandated fluoridation across Queensland. RESULTS There were no significant differences in fluoridation support or in beliefs regarding the benefits and harms of fluoridation between Queensland and non-Queensland residents. However, respondents from Queensland were more resistant to changing their minds regarding their fluoridation stance, more distrusting of public health officials, and more supportive of decisions to introduce fluoridation being made by the people via a referendum. After controlling for potentially confounding variables, Queenslanders demonstrated significantly more support for water fluoridation than non-Queenslanders. CONCLUSIONS Perceived Queensland characteristics, which political scientists have used to explain aberrant political behavior or public policy, were not relevant to the longstanding pre-2009 disparity in water fluoridation coverage between Queensland and the rest of Australia. The findings of this investigation do not support the assumption that Queenslanders are more opposed to fluoridation than residents elsewhere in Australia.
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Affiliation(s)
- Harry F Akers
- School of Dentistry, University of Queensland, Brisbane, Qld, Australia.
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Lodi CS, Ramires I, Buzalaf MAR, Bastos JRDM. Fluoride concentration in water at the area supplied by the Water Treatment Station of Bauru, SP. J Appl Oral Sci 2006; 14:365-70. [PMID: 19089059 PMCID: PMC4327229 DOI: 10.1590/s1678-77572006000500012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 06/19/2006] [Accepted: 08/29/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the fluoride concentration in the public water supply at the area supplied by the Water Treatment Station of Bauru and classify the samples as acceptable or unacceptable according to the fluoride concentration. MATERIAL AND METHODS Samples were collected from 30 areas at two periods, October 2002 and March 2003. The fluoride concentration in the samples was determined in duplicate, using an ion sensitive electrode (Orion 9609) connected to a potentiometer (Procyon, model 720). Samples with fluoride concentration ranging from 0.55 to 0.84 mg F/L were considered acceptable, and those whose concentration was outside this range as unacceptable. Data were analyzed by descriptive statistics. RESULTS The fluoride concentration of the water samples varied between 0.31 and 2.01 mg F/L. Nearly 56% of the samples were classified as acceptable. CONCLUSION The variations in fluoride concentration at the area supplied by the Water Treatment Station reinforce the need of constant monitoring for maintenance of adequate fluoride levels in the public water supply.
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Affiliation(s)
- Carolina Simonetti Lodi
- Graduate Student in Pediatric Dentistry at the Hospital for Rehabilitation of Craniofacial Anomalies, USP
| | - Irene Ramires
- MSc in Community Dentistry by University of São Paulo, Bauru Dental School, FOB/USP
| | - Marília Afonso Rabelo Buzalaf
- Associate Professor of the Department of Biological Sciences, Discipline of Biochemistry at Bauru Dental School, FOB/USP
| | - José Roberto de Magalhães Bastos
- Chairman Professor of Preventive Dentistry, Department of Pediatric Dentistry, Orthodontics and Community Dentistry, Discipline of Community Dentistry at Bauru Dental School, FOB/USP
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Saliba NA, Moimaz SAS, Tiano AVP. Fluoride level in public water supplies of cities from the northwest region of São Paulo State, Brazil. J Appl Oral Sci 2006; 14:346-50. [PMID: 19089056 PMCID: PMC4327226 DOI: 10.1590/s1678-77572006000500009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/29/2006] [Accepted: 08/25/2006] [Indexed: 11/22/2022] Open
Abstract
It may be difficult for small and medium cities to obtain information about the fluoride content of public water, because of the lack of equipments and technicians. This study aimed to analyze the fluoride levels of the water supplied by the public treatment stations of 40 cities situated in the northwest region of São Paulo State, during a period of 6 months, to verify if fluoridation occurs in a continuous manner and if the fluoride levels are within the recommended. Maps of the water distribution system were obtained from the water treatment companies and utilized to randomize the addresses of the collection sites, so that they included all regions with treated water sources. One water sample by month was collected and analyzed in duplicate using an ion-specific-electrode. Samples with 0.6 to 0.8 mgF/L were considered acceptable. In the 38 cities that regularly provided the samples in the 6 months of the study, water from 144 collection sites was collected and a total of 864 samples were analyzed, of which 61.81 percent were classified as unacceptable. It was observed that 33 cities performed fluoridation but in 78.79 percent of these cities there were variations in the fluoride level among the sites and in the same site during the period of study. One can conclude that most of these cities do not control the fluoride levels in the public water, since fluoridation occurs in a discontinuous manner and in most of the situations not within the recommended concentrations.
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Affiliation(s)
- Nemre Adas Saliba
- UNESP - São Paulo State University, Araçatuba Dental School, Araçatuba, São Paulo, Brazil.
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Nikiforuk G. Fluoride and dental health. Can Fam Physician 1988; 34:1333-1336. [PMID: 21253192 PMCID: PMC2219101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Studies conducted under the widest variety of controlled conditions attest to the safety, efficacy, and cost benefits of fluoridation. A program that combines the use of systemic and topical fluoride results in maximum benefits. The author of this article reviews the metabolism of fluoride and its mechanism of action, and discusses practical modes of employing fluoride in caries prevention with special emphasis on the use of fluoride supplements for infants and young children in areas of non-fluoridated water. The author also discusses the factors responsible for the dramatic decline in caries prevalence in the industrialized nations.
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