Exposure to fluoridated drinking water and dental caries experience in Australian army recruits, 1996

The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults

BACKGROUND

The aim of this study was to confirm whether the level of lifetime fluoridation exposure is associated with lower dental caries experience in younger adults (15-46 years).

METHODS

Data of the cohort born between 1960 and 1990 residing outside Australia's capital cities from the 2004-2006 Australian National Survey of Adult Oral Health were analysed. Residential history questionnaires were used to determine the percentage of each person's lifetime exposure to fluoridated water (<50%/50+%). Examiners recorded decayed, missing and filled permanent teeth (DMFT). Socio-demographic variables, periodontal risk factors, and access to dental care were included in multivariable least-squares regression models.

RESULTS

In bivariate analysis, the higher level of fluoridation category had significantly lower DMFT (mean 6.01 [SE=0.62]) than the lower level of fluoridation group (9.14 [SE=0.73] p<0.01) and lower numbers of filled teeth (4.08 [SE=0.43], 7.06 [SE=0.62], p<0.01). In multivariate analysis, the higher number of full-time equivalent dentists per 100,000 people was associated with a lower mean number of missing teeth (regression coefficient estimate=-1.75, p=0.03), and the higher level of water fluoridation with a lower mean DMFT (-2.45, p<0.01) and mean number of filled teeth (-2.52, p<0.01).

CONCLUSIONS

The higher level of lifetime fluoridation exposure was associated with substantially lower caries experience in younger rural adults, largely due to a lower number of filled teeth.

Effects of fluoridated drinking water on dental caries in Australian adults

Systematic reviews produce conflicting conclusions regarding dental caries-preventive effects of water fluoridation in adults. The authors investigated the relationship using data from the nationally representative 2004-2006 Australian National Survey of Adult Oral Health. Effects were compared between the pre-fluoridation cohort born before 1960 (n = 2,270) and the cohort born between 1960 and 1990 (n = 1,509), when widespread implementation of fluoridation increased population coverage from < 1% to 67%. Residential history questionnaires determined the percentage of each person's lifetime exposed to fluoridated water. Examiners recorded decayed, missing, and filled teeth (DMF-Teeth) and decayed and filled tooth surfaces (DF-Surfaces). Socio-demographic and preventive dental behaviors were included in multivariable least-squares regression models adjusted for potential confounding. In fully adjusted models, > 75% of lifetime exposure to fluoridation relative to < 25% of lifetime exposure was associated with 11% and 10% fewer DMF-Teeth in the pre-1960 (p < .0001) and 1960-1990 cohorts (p = .018), respectively. Corresponding reductions in DF-Surfaces were 30% (p < .001) and 21% (p < .001). Findings for intermediate fluoridation exposure suggested a dose-response relationship. Results were consistent in sensitivity analyses accounting for missing data. In this nationally representative sample of Australian adults, caries-preventive effects of water fluoridation were at least as great in adults born before widespread implementation of fluoridation as after widespread implementation of fluoridation.

The effect of tobacco use on oral health and dental readiness in the Croatian Army

This study examined tobacco use as a risk factor in the development of periodontal disease as dental emergency and dental readiness among soldiers. A total of 884 soldiers were followed: 650 recruits and 234 professional active veterans. They were categorized into dental readiness classes, and questionnaires were completed about tobacco use. Overall, 62.7% of soldiers reported current smoking, with a higher prevalence of smokers among recruits. The results showed a significant difference in smokers vs. non-smokers in dental readiness, supragingival/subgingival calculus, gingivitis, and Class 3 dental fitness. More recruits (63.8%) smoked than veterans (59.4%), but greater prevalence of daily cigarette smoking and duration of smoking habits was found among veterans. In both groups, soldiers who smoked were characterized by a higher percentage of periodontal health problems and decreased combat readiness compared to soldiers who did not smoke. This indicates a need for oral health prevention program, and cigarette smoking and cessation programs.

The impact of changing dental needs on cost savings from fluoridation

BACKGROUND

Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia.

METHODS

Net costs were estimated as Costs((programme)) minus Costs((averted caries).) Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6-20, 21-45, 46-65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized.

RESULTS

With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal.

CONCLUSIONS

Community water fluoridation remains a cost-effective preventive measure in Australia.

Dental caries experience in young Australian Army recruits 2008

BACKGROUND

Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002-2003, and in Australian adults between 1987-1988 and 2004-2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008.

METHODS

A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water.

RESULTS

Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17-20, 21-25, 26-30 and 31-35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87.

CONCLUSIONS

Caries experience in Australian Army recruits aged 17-25 years increased between 2002-2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

Tooth loss and associated factors in adolescents: a Brazilian population-based oral health survey

OBJECTIVE

To estimate tooth loss among adolescents and its factors associated.

METHODS

Data from 16,833 participants of the Brazilian Oral Health Survey 2002-2003 were analyzed. The outcome studied was tooth loss of at least one tooth. Independent variables included geographical localization, gender, skin color, per capita income, education gap, dental service utilization and fluoridated water supply at the local level. Crude and adjusted prevalence ratios were estimated using Poisson regression for each Brazilian macroregion and nationwide.

RESULTS

The prevalence of at least one tooth loss was 38.9% (95% CI 38.2%;39.7%). Adolescents living in localities with non-fluoridated water supply were 40% more likely to have tooth loss compared with those living in areas with fluoridated water supply. There was seen a strong association (p<0.01) between non-fluoridated water supply and tooth loss prevalence in the Northeast. In other Brazilian regions this association was confounded for distal variables, mainly socioeconomic variables, reinforcing regional inequalities.

CONCLUSIONS

High prevalence of tooth loss among Brazilian adolescents shows a need for targeted dental actions including prevention at earlier ages, treatment of affected teeth and universal access to fluoridated water.

Risk indicators of caries experience among young adults

BACKGROUND

Significant gains have been documented on the oral health of Australian children. However, the question remains as to whether improvements have extended to the oral health of young adults. This study aimed to determine the risk indicators associated with oral health status in young adults aged 20-25 years.

METHODS

A random sample of young adults was selected from the South Australian electoral roll. Telephone interviews were conducted for 1261 young adults. These provided socio-demographic, health behaviour and dental visiting data. Dental examinations were carried out on 644 subjects by three calibrated examiners in clinical settings.

RESULTS

The mean number of tooth surfaces affected by dental caries (DMFS) was 6.05 with the presence of untreated cavitated decayed surfaces (DS) evident in 28.6 per cent. In regression models the risk indicators associated with DS were being on government benefits, unemployed, usually visiting for a problem rather than a check, visiting a public clinic, drinking 5+ acidic drinks per day and being a current smoker. Risk indicators for higher DMFS scores were usually visiting for a problem, visiting a public clinic, being on government benefits and having made a dental visit in the previous 2 years.

CONCLUSIONS

Socio-demographic factors, dental visiting patterns and general health behaviours are risk indicators for caries in young adults.

Fluorides in dental public health programs

The use of fluorides in dental public health programs has a long history. With the availability of fluoridation and other forms of fluorides, dental caries have declined dramatically in the United States. This article reviews some of the ways fluorides are used in public health programs and discusses issues related to their effectiveness, cost, and policy.

Dental caries experience in Aboriginal and Torres Strait Islanders in the Northern Peninsula Area, Queensland

BACKGROUND

A survey of dental caries experience in children was undertaken in five Aboriginal and Torres Strait Islander communities in the Northern Peninsula Area of Queensland prior to the introduction of water fluoridation.

METHODS

Data were obtained from screening dental examinations conducted by the Australian Army as part of a community assistance programme between May and September 2004 from 486 children aged 4-15 years. The clinical examinations were performed in a dental van using a dental chair, light, mirror and probe by a single calibrated examiner.

RESULTS

Caries experience was high with a mean 6-year-old dmft of 6.37 and a mean 12-year-old DMFT of 3.50. The 6-year-old dmft Significant Caries Index (SiC) for the third of the population with the highest caries experience was 11.65 and the 12-year-old DMFT SiC was 7.08. Only 15.3 per cent of 6-year-old children had dmft = 0 and 28.9 per cent of 12-year-old children had DMFT = 0.

CONCLUSIONS

Dental caries was a significant problem for these remote communities. Aboriginal and Torres Strait Islander children from the Northern Peninsula Area of Queensland had more than four times the caries experience of Australian children for both 6-year-old dmft and 12-year-old DMFT.

Dental Health among Green Marble Mine Laborers, India

Objective

To determine the oral health status among Green Marble Mine laborers; to provide epidemiological data for planning and evaluation of oral health care programme.

Methods

The study area was divided into 4 geographic zones, and participants were selected by stratified cluster sampling technique. A total of 513 subjects were included in final study which were divided among the four age cohort (18-25, 26-34, 35-44, 45-more respectively), following the guidelines for research methodology recommended by WHO oral health surveys 1997. Clinical examination was conducted by one of the three examiners with the aid of an artificial light sorce. The agreement (kappa statistics) for diagnosis of DMFT and CPI was determined (field teams versus expert) 91.2 % two days prior to the examination. Data was analyzed using Bivariate and multivariate analysis.

Results

The mean DMFT and DMFS scores were (2.79±2.44) and (5.47±5.40) respectively. The caries prevalence was 71.1% with maximum in 25-34 years while 148 participants were caries free. A higher prevalence of periodontal disease was present with only 1.75% having healthy gingiva. Mean number of sextant involved was maximum among 35-44 years. Alcohol and Stress due to physical load and noisy environment among laborers have shown highly significant relationship with CPI scores (P<0.001). Fracture of tooth, mainly maxillary central incisor was high (10.5%) as an occupational peril.

Conclusions

The findings highlighted the low caries prevalence, higher periodontal disease which requires primary anticipation. Prevention of tooth fracture and improvement of overall nutritional status, with stress reduction protocol should also be given consideration.

Pattern of dental caries experience on tooth surfaces in an adult population

OBJECTIVES

To determine the pattern of caries experience across teeth and surfaces in an adult population depending on age and exposure to water fluoridation.

METHODS

Between November 2002 and March 2003 a total of 973 subjects aged 17-51 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs.

RESULTS

Caries experience was relatively low, with mean DMFS scores of 3.21, 5.12, 9.61, 13.04 and 24.35 for subjects aged 17-20, 21-25, 26-30, 31-35 and 36-51 years respectively. The first molar teeth had the greatest caries experience, and occlusal surfaces had more caries experience than approximal surfaces. Subjects with a lifetime exposure to fluoridated drinking water had significantly lower caries experience than those who had no exposure to fluoridated drinking water.

CONCLUSION

This study showed that caries prevalence, although relatively low in the study population, was found predominantly in occlusal surfaces, with an increasing prevalence in approximal surfaces of posterior teeth in older subjects. Subjects with a lifetime exposure to fluoridated drinking water had a lower level of caries experience than those with no exposure to fluoridated drinking water, and this was more noticeable in approximal surfaces than occlusal surfaces.

Cárie dentária em adolescentes de 15 a 19 anos de idade no Estado de São Paulo, Brasil, 2002

Verificou-se a experiência da cárie dentária em adolescentes de 15 a 19 anos, considerando-se prevalência e severidade da doença, segundo idade, gênero, etnia e fluoretação das águas. Foi um estudo transversal realizado com dados do levantamento epidemiológico do Estado de São Paulo, Brasil, 2002, no qual 1.825 adolescentes foram examinados em seus domicílios, por 132 cirurgiões-dentistas em 35 municípios. Utilizaram-se os testes qui-quadrado, Kruskal-Wallis e Mann-Whitney (alfa= 5%). Com o SiC Index, definiu-se um terço dos indivíduos com maior experiência de cárie. O índice CPO-D foi 6,44 (dp = 4,60) e o SiC Index 11,68. O percentual de livres de cárie foi 9,6%. Não houve diferença entre o CPO-D dos municípios com e sem fluoretação, entretanto houve maior porcentagem de livres de cárie nos municípios com água fluoretada. O gênero masculino teve pior condição em relação à cárie que o gênero feminino. Os não-brancos tiveram maior percentual de dentes cariados e perdidos que os brancos. Sugere-se, portanto, a ênfase em estratégias que possam atenuar os danos causados pela progressão da doença, especialmente no grupo com maior experiência de cárie dentária.

Dental caries experience in Australian Army recruits 2002–2003

BACKGROUND

Recent data have suggested that the trend of decreasing caries experience in Australian children is slowing with increasing dmft and DMFT scores seen in children. However, there are limited data on dental caries experience in young Australian adults.

METHODS

A cross-sectional study of 973 Australian Army recruits was conducted between November 2002 and March 2003. A clinical examination with bitewing radiographs was conducted and a questionnaire was used to elicit socio-demographic information.

RESULTS

Mean DMFT scores were 2.43, 3.44, 5.48, 7.02 and 10.77 for subjects aged 17-20, 21-25, 26-30, 31-35 and 36-51 years respectively. Subjects with a lifetime exposure to fluoridated drinking water had a mean DMFT of 2.80 while subjects with no exposure to fluoridated drinking water had a mean DMFT of 3.91. Multivariate Poisson regression found that age, level of educationand lifetime exposure to fluoridated drinking water had a statistically significant effect on caries experience.

CONCLUSIONS

It appears that there has been a continual decline in caries experience and prevalence in young Australian adults between 1996 and 2002-2003. Lifetime exposure to fluoridated drinking water conferred an appreciable benefit for subjects in this study compared with subjects with no exposure to fluoridated drinking water.

Consumption of nonpublic water: implications for children's caries experience

There are concerns that the consumption of unfluoridated bottled and tank water may put children at increased risk of developing caries.

OBJECTIVES

The aim of this study was to investigate the relationship between nonpublic water consumption (either from bottles or rainwater tanks) and socioeconomic status (SES) and both deciduous and permanent caries experience.

METHODS

A random sample of children enrolled in the School Dental Service of South Australia participated in the study (response rate = 71.8%, n = 9988).

RESULTS

Forty-five per cent of children had greater than 50% lifetime consumption of nonpublic water while 36% of children had 0% lifetime consumption. Increased use of nonpublic water occurred for children from lower socioeconomic groups, two-parent families and children from nonmetropolitan areas, with these results most likely a result of the residential location of the children. Multivariate modelling revealed a significant positive relationship between deciduous caries experience and consumption of nonpublic water, even after controlling for the age and sex of the child, SES and residential location. This relationship was significant only for those children with 100% lifetime availability of fluoridated water. The effect of consumption of nonpublic water on permanent caries experience was not significant. It is postulated that these findings may result from the lower caries activity in the permanent dentition of children aged 10-15 and possible dietary confounders.

CONCLUSION

Recommendations are made for the addition of fluoride to bottled water, especially with regard to the oral health of younger children.