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

Impact of 24-month fluoride tablet program on children with disabilities in a non-fluoridated country

The aim of this study was to evaluate the caries preventive effects of a school-based fluoride tablet program in children with disabilities. Two hundred and seventeen children with disabilities were divided into two groups: the intervention group (IG) ingested 1.0mg fluoride tablet daily while the control group (CG) ingested a placebo. The initial oral examinations were conducted prior to fluoride intake and 24-month follow-up examinations were conducted to evaluate the effectiveness of fluoride tablet ingestion. The results from this study demonstrated significant reductions in the DMFT index (the sum of decayed, missing, and filled permanent teeth), 0.63, as well as the DMFS index (the sum of decayed, missing, and filled surfaces of the permanent dentition), 1.25, when compared with the CG. A statistically significant reduction in the DMFT index and DMFS index (30.42% and 36.84%, respectively) suggested an anti-cariogenic benefit to fluoride tablet administration. Greater caries reduction occurred on mesio-distal and bucco-lingual surfaces (53.27% and 52.57%, respectively). Fluoride tablets should be considered as a caries preventive strategy in school-based caries prevention programs for children with disabilities in fluoride deficient areas.

Effectiveness of a School-based Fluoride Mouthrinse Program

The aims of this study were to estimate the caries-preventive effects of a school-based weekly fluoride mouthrinse (FMR) program and to determine whether its effectiveness varied by school-level caries risk. We used clinical and parent-reported data for 1,363 children in grades 1 through 5 from a probability sample of North Carolina (NC) schoolchildren. Children’s caries experience was measured using decayed and filled primary (d2,3fs) and total (d2,3fs+D2,3MFS) tooth surfaces. Program participation was quantified using ‘FMR years’. To estimate caries risk at program entry, children were matched with NC kindergarten-surveillance data representing school-level mean untreated decay (low-risk school: < 1 and high-risk school: ≥ 1 untreated carious teeth). Mean d2,3fs was 4.1 [95% confidence limits (CL) = 3.7, 4.5]. Overall, each ‘FMR year’ was associated with weak reduction of caries prevalence in the primary [prevalence ratio (PR) = 0.98; 95% CL = 0.90, 1.06] and the mixed dentition (PR = 0.98; 95% CL = 0.91, 1.05). We found a trend toward a larger caries-preventive benefit among children in high-risk schools compared with those in low-risk schools ( i.e., 55% vs. 10% caries reduction for 5 to 6 yrs of FMR participation compared to none). Although this difference was not confirmed statistically, our results indicate that children in high-risk schools, as identified by school-level surveillance data, may experience substantial caries-preventive benefits from long-term FMR participation.

Evaluation after 4 years of the combined use of fluoride and dental sealants

This study evaluates the caries-preventive potential in permanent teeth of dental sealants when combined with an ongoing, school-based fluoride program. The investigation was designed as a sequential, cross-sectional comparison. Dental caries findings in 1987 for 416 children ages 7-11 and 14-17 who received dental sealants and fluorides were compared with corresponding data derived from 1983 baseline examinations of children who received fluoride therapy only. In addition, sealant retention status was determined. Overall mean DMFS scores in 1987 for children in two age groups combined were 51% lower than in 1983. Also, a surface-specific treatment effect was demonstrated in pit and fissures for both older and younger age groups. The overall proportion of sealants retained on occlusal surfaces of first molars after an average of 2 yr (92%) compared favorably with similar figures cited in the scientific literature. The results of this study suggest that pit and fissure sealants confer additional caries-preventive benefits beyond those of fluoride therapy alone.

Importance of model parameters in the assessment of intra-oral remineralization

Since the introduction of the Intra-oral Cariogenicity Test by Koulourides et al. (1974), many groups around the world have been developing and using intra-oral models to test new caries-preventive products, as well as to study physiological processes in the oral cavity. In spite of the large numbers of papers reporting these methods, very little research has been done to determine the importance of the many variable parameters which influence the performance of these models. Among these, the following can be identified: (a) panelist criteria, (b) the use of sound vs. pre-demineralized enamel of human or bovine origin, (c) the use of gauze or a recess to accumulate plaque, (d) the method to create incipient lesions, (e) the duration of the experiment, (f) the number of panelists required for statistical significance to be obtained, (g) the assessment techniques for mineral and/or fluoride uptake/loss, and (h) the choice of contralateral, 'cross-over', or 'monadic' experimental designs. Our results, supported by data from the literature, indicate that the choices made with respect to these parameters are of paramount importance in determination of the outcome of the respective study.

Effectiveness of school water fluoridation and dietary fluoride supplements in school-aged children

School water fluoridation and school-based fluoride tablet programs both have been shown in many studies to be effective in preventing dental caries. These studies indicate that school water fluoridation reduces dental decay by approximately 40 percent and school-based fluoride tablet programs by about 30 percent. However, nearly all the studies were done when the prevalence of caries among US schoolchildren was greater than it is today, which makes it difficult to assess their current effectiveness. Data from dental surveys of school-aged children conducted during the past 30 years indicate that overall caries prevalence has declined by more than 75 percent and that of approximal tooth surfaces by more than 90 percent. Recent national data indicate the difference in caries prevalence between children with lifetime residence in either fluoridated or nonfluoridated areas has also diminished, which raises questions about the cost effectiveness of initiating school-based fluoride programs for all areas. There are still groups of children, however, seriously affected by dental caries. It is safe to assume that implementation of school water fluoridation or fluoride tablet programs will result in traditionally reported benefits among these children. Ongoing school-based fluoride programs should not be discontinued until it is known what impact their cessation will have on dental disease.

The role of linking agents in the diffusion of health promotion programs

This article examines the role of state health department dental offices as linking agents in the diffusion of an effective preventive health program, the fluoride mouthrinse program (FMRP) in public schools. The aim of this program is to prevent dental caries by a weekly mouthrinsing by elementary school students. In contrast to the traditional focus of diffusion research on characteristics of the innovation and characteristics of the adopter, this study emphasizes an ecological approach, i.e., the transmittal mechanisms for diffusion. The state dental offices are examined as linking agents, which serve as program advocates or champions for diffusing the FMRP from the national level, where it was developed, to the thousands of local school districts and schools for adoption and continued delivery. Using data from interviews with state dental directors and archival sources, a multivariate model was developed and used to explain the percent of a state's elementary schools using the mouthrinse program. The results support the key role of linking agents in disseminating effective health promotion programs into actual use. Implications are discussed for both research and practice.

The adoption and implementation of the fluoride mouthrinse program: descriptive results from school districts

Systematic research is needed about the dissemination and use of effective caries prevention measures to establish adoption trends and to examine factors related to desired practice. This paper examines the adoption and implementation of the fluoride mouthrinse program (FMRP) in public school districts. It extends a similar study by Silversin and Coombs in 1979 by reporting telephone interview data from the same sample of school districts. The results indicate that the extent of FMRP adoption has increased since 1979, but that the recent rate of new adopters has slowed considerably. About one-quarter of the districts that had ever offered the FMRP have since discontinued it, most frequently by gradual abandonment. The reported accuracy of school level implementation was assessed in terms of seven required components of the FMRP. Only 57 percent of the sample reported implementing six or seven components correctly, showing at best only moderate accuracy of delivery at the local level.