1
|
Levy SM, Warren JJ, Kolker JL, Weber-Gasparoni K. Generalized permanent dentition fluorosis severity becomes less evident over time among a birth cohort. FRONTIERS IN ORAL HEALTH 2023; 4:1198167. [PMID: 37456361 PMCID: PMC10348053 DOI: 10.3389/froh.2023.1198167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives There are relatively few cohort studies which have examined changes in fluorosis appearance over time, and none of these have assessed changes in generalized fluorosis. In this analysis, we quantified and assessed changes in multiple measures of generalized fluorosis severity through childhood, adolescence, and young adulthood. Methods Participants were from the Iowa Fluoride Study, a birth cohort recruited from 1992 to 1995. Permanent dentition fluorosis exams were carried out at ages 9, 13, 17, and 23 years using the Fluorosis Risk Index (FRI). Generalized fluorosis was assessed using mean FRI scores at the tooth- and person-level as well as a five-category measure of generalized fluorosis. Generalized fluorosis prevalence and severity was summarized at each time point and differences in adjacent time points were assessed using gamma statistics, signed-rank tests, and plotting changes in generalized fluorosis between adjacent time points. Results We observed a statistically significant decline in the percentage of non-zero mean FRI scores at later exam ages at both the person- and tooth-levels. Based on our five-category generalized fluorosis measure, there were 34.0%-54.1% of participants with generalized fluorosis at baseline for each tooth group, and these percentages declined to 8.9%-27.2% at the age 23-year exam. Conclusions We observed a statistically significant decline in generalized fluorosis severity scores and overall prevalence at later exam ages across all three measures of generalized fluorosis severity. This trend should be accounted for when estimating the prevalence of fluorosis in a population using fluorosis severity data collected in children and adolescents.
Collapse
Affiliation(s)
- Steven M. Levy
- Department of Preventive & Community Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA, United States
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, United States
| | - John J. Warren
- Department of Preventive & Community Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA, United States
| | - Justine L. Kolker
- Department of Operative Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA, United States
| | - Karin Weber-Gasparoni
- Department of Pediatric Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA, United States
| |
Collapse
|
2
|
Rosário BSM, Rosário HD, de Andrade Vieira W, Cericato GO, Nóbrega DF, Blumenberg C, Hugo FN, Costa MM, Paranhos LR. External control of fluoridation in the public water supplies of Brazilian cities as a strategy against caries: a systematic review and meta-analysis. BMC Oral Health 2021; 21:410. [PMID: 34412623 PMCID: PMC8377988 DOI: 10.1186/s12903-021-01754-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Among the methods currently available to provide fluoride in population levels, fluoridated water is the most successful for presenting high efficacy, safety and good cost–benefit. However, recent studies on external control have shown great variability of fluoride concentrations in the water from treatment stations in Brazilian cities, which must present concentration between 0.6 and 0.8 mg/L to be considered acceptable in most cities. Thus, this study aimed to perform a systematic review of the literature to assess the adequacy of fluoride concentration in the water in Brazilian cities using external control. Methods The protocol was registered in PROSPERO. Six databases were used as primary search sources and three databases were used to partially capture the "gray literature". Only observational studies that assessed the fluoride concentration of artificially fluoridated water from the public supply network were included. The JBI Critical Appraisal Tools for Systematic Reviews was used to assess the risk of bias of the studies. A proportion meta-analyses using random-effect models were performed. The heterogeneity between studies was determined by I2 statistic. Meta-regressions were conducted to identify relevant moderators to be used in stratified meta-analyses. Publication bias was investigated by Egger’s tests. Results The search provided 2038 results, from which 14 met the eligibility criteria and were included in the data extraction of the review. Overall, the water samples were collected from 449 different sources in three Brazilian regions. Thirteen studies presented a low risk of bias. The mean concentration of fluoride ranged from 0.17 to 0.89 ppmF. The meta-analyis demonstrated that more than half of the water samples analyzed had fluoride concentration levels outside the acceptable range (56.6%; 95% CI 45.5; 67.3), with high heterogeneity. Conclusion More than half of the public water supply analyzed in the studies selected had fluoride concentration levels outside the acceptable range, which may affect the risk of developing oral diseases in the Brazilian population, having an important impact on public health. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01754-2.
Collapse
Affiliation(s)
| | - Henrique Damian Rosário
- Department of Dentistry, Dental School, Universidade do Sul de Santa Cantarina (UNISUL), Tubarão, SC, Brazil
| | - Walbert de Andrade Vieira
- Endodontics Division, Department of Restorative Dentistry, School of Dentistry of Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | | | - Cauane Blumenberg
- Department of Social Medicine, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Márcio Magno Costa
- Division of Department of Removable Prosthesis and Dental Materials, School of Dentistry, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Renato Paranhos
- Division of Preventive and Community Dentistry, School of Dentistry, Universidade Federal de Uberlândia (UFU), Campus Umuarama, Av. Pará, 1720, Bloco 2G, sala 1, Uberlândia, MG, 38405-320, Brazil.
| |
Collapse
|
3
|
Marques RB, Lima CCB, de Abreu Costa MLV, de Deus Moura de Lima M, de Fátima Almeida de Deus Moura L, Tabchoury CPM, de Moura MS. Fluoridated water impact on tooth decay and fluorosis in 17-20-year-olds exposed to fluoride toothpaste. J Public Health Dent 2021; 82:385-394. [PMID: 34350986 DOI: 10.1111/jphd.12472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/07/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the impact of water fluoridation on the prevalence and severity of dental caries and fluorosis in individuals aged 17-20 years exposed to fluoride toothpaste. METHODS The study population consisted of 660 students from public schools, residents of areas supplied with fluoridated water (exposed group) or not (not exposed group). Students from both groups had access to fluoride toothpaste throughout life. A questionnaire about socioeconomic demographic aspects, conditions related to access and exposure to fluoridated water, and habits related to oral health was applied. Dental caries was measured by the DMFT index and dental fluorosis by the TF index. The chi-square test, t test, and subsequently logistic regression were applied for data analysis. RESULTS Caries experience (DMFT≠0) was significantly higher in students from areas not exposed to fluoridated water, after adjustments to clinical conditions, demographic socioeconomic profile, and hygiene habits. The DMFT mean (±SD) was significantly higher in students from areas not exposed to fluoridated water than exposed (3.83 [±3.28] and 2.48 [±2.71] respectively). The prevalence of very mild/mild and moderate fluorosis was 41.1% and 21% for students either exposed to fluoridated water or not, respectively. CONCLUSION Exposure to fluoridated water was associated with a lower prevalence and severity of tooth decay, in spite of the use of fluoridated toothpaste. The prevalence of dental fluorosis at all levels was higher in fluoridated areas, however, in both groups, there were few cases with esthetic implications.
Collapse
Affiliation(s)
- Ravena Brito Marques
- Department of Pathology and Dental Clinic, Universidade Federal do Piauí, Teresina, Piauí, Brazil
| | | | | | | | | | | | - Marcoeli Silva de Moura
- Department of Pathology and Dental Clinic, Universidade Federal do Piauí, Teresina, Piauí, Brazil.,Rua Estudante Danilo Romero, Horto Florestal, Teresina, Piauí, Brazil
| |
Collapse
|
4
|
Saldarriaga A, Rojas-Gualdrón DF, Restrepo M, Bussaneli DG, Fragelli C, de Cássia Loiola Cordeiro R, Santos-Pinto L, Jeremias F. Clinical changes in the severity of dental fluorosis: a longitudinal evaluation. BMC Oral Health 2021; 21:366. [PMID: 34294056 PMCID: PMC8299689 DOI: 10.1186/s12903-021-01729-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental fluorosis (DF) has been one of the most prevalent pediatric dental conditions associated with aesthetic concern and treatment needs. This study aimed to identify the longitudinal clinical change in the severity of DF in 8-12-year-old children and its association with gender, age, severity, and tooth type. METHODS This observational study assessed the dental aspects of the 92 Colombian children in 2015 (mean age at beginning 9.71 years ± 1.23) and 2018 (mean age 13.69 years ± 1.41), from an area with high DF prevalence. DF was recorded in all permanent teeth by two calibrated examiners using the Thylstrup and Fejerskov Index (TFI). DF severity change (maximum-TFI-score) was analyzed with descriptive analysis at the tooth level. Associated factors were evaluated with the generalized linear model, binomial family, and logarithmic link function. RESULTS TFI scores ranged between 1 (very mild) to 6 (severe), being score 2 (41.7%) the most prevalent. After three years, 29.6% of the teeth presented score reduction, 24.1%, increased and 46.3% did not change; the significant association was related to increasing of the basal TFI = 1 score (44.2%) (RR = 9.7; 95% CI 1.7-56.5; p = 0.01) and with canines, premolars and second-permanent-molars teeth group (RR = 3.3; 95% CI 1.9-5.6; p = 0.005). CONCLUSION The present study based on clinical features about DF confirms the dynamic post-eruptive nature of this condition. After three years of follow-up, a considerable proportion of the teeth changed to a higher score. Furthermore, the canines, premolars, and second-permanent-molars showed a higher incidence of an increase in severity of TFI score.
Collapse
Affiliation(s)
- Alexandra Saldarriaga
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
- Research Department, School of Dentistry, CES University, Medellín, Colombia
| | | | - Manuel Restrepo
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
| | - Diego Girotto Bussaneli
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
| | - Camila Fragelli
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
| | - Rita de Cássia Loiola Cordeiro
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
| | - Lourdes Santos-Pinto
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
| | - Fabiano Jeremias
- Department of Pediatric Dentistry and Orthodontics, São Paulo State University (Unesp), Araraquara School of Dentistry, Rua Humaitá, 1680, Araraquara, SP 14801-903 Brazil
| |
Collapse
|
5
|
Dental Fluorosis according to Birth Cohort and Fluoride Markers in an Endemic Region of Colombia. ScientificWorldJournal 2021; 2021:6662940. [PMID: 33746635 PMCID: PMC7960045 DOI: 10.1155/2021/6662940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives To analyze changes in the dental fluorosis (DF) incidence according to a birth cohort and explore current exposure to DF in a case series. Methods Repeated cross-sectional study of two periods: 2015 and 2018. Two standardized examiners registered DF using the Thylstrup-Fejerskov index in permanent teeth of children aged 7–18 years. Period and birth cohort frequencies were estimated by a generalized linear model, binomial family, and logarithmic link function. Period estimates are presented as prevalence ratios (PR) and birth cohort estimates as cumulative incidence ratios (RR); 95% confidence intervals and P values are reported. In a subsample of 37 volunteers (12.29 ± 2.63 years), the fluoride (F) concentration in toenails was measured using the HMDS diffusion method and an ion-specific electrode. Other samples from the local environment such as food, soil, and coal were also collected. Results In 274 children, we found that nonsignificant increases between periods (PR = 1.17; 95% CI: 0.89–1.55) were not explained by birth cohort effects. A total of 37.8% of the subsample had a toenail F concentration ≥2 μg F/g. The salty snacks and seasoning had the highest F concentrations among local environmental samples. Conclusion In this population with a high DF frequency according to birth cohort and the evaluated period, the study of soil, coal, and food samples indicated a continued F exposure. F concentration found in the toenails shows a moderate F exposure; nearly a third of the children and adolescents exceeded the adopted threshold of 2 μg F/g. It is important to monitor and explore changes in exposure in highly affected population.
Collapse
|
6
|
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: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
7
|
Al Warawreh AM, Al Tamimi ZH, Al Qatawna MI, Al Momani AA, Al Mhaidat MR, El Naji WS, AlSaraireh S. Prevalence of Dental Fluorosis among Southern Jordanian Population. Int J Dent 2020; 2020:8890004. [PMID: 33224200 PMCID: PMC7673941 DOI: 10.1155/2020/8890004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Jordan is one of the Middle Eastern countries that is classified as a poor water resource country. People in Jordan consume any available water. In the south of Jordan, water resources are limited. The drinking water contains high levels of fluoride, which in turn leads to augmented danger of both skeletal and dental fluorosis. AIMS This study is focused on evaluating the pervasiveness of dental fluorosis among patients of Karak City and assessing the degree and distribution of fluorosis. MATERIALS AND METHODS This research focuses on 2,512 patients ranging from 12 to 52 years old seeking dental treatment in the Dental Department at "Prince Ali ben Al Houssin Hospital" in Karak City. Dental fluorosis status was assessed by using Modified Dean's Fluorosis Index." The data collected were subjected to statistical analysis. RESULTS The dental fluorosis prevalence within our sample was 39.9% in Karak City. Females were more influenced than males, and fluorosis was detected more often in those who drank tap water and was more common in a very mild and localized form. CONCLUSION Fluorosis necessitates constant observation, and future study in terms of the intake in Jordan is recommended in terms of all sources. It would not be too soon to note that the supply of drinking water needs to be changed in South Jordan.
Collapse
|
8
|
Do LG, Ha DH, Bell LK, Devenish G, Golley RK, Leary SD, Manton DJ, Thomson WM, Scott JA, Spencer AJ. Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study: cohort profile. BMJ Open 2020; 10:e041185. [PMID: 33099500 PMCID: PMC7590353 DOI: 10.1136/bmjopen-2020-041185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The long-term goal of the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children. It will then evaluate those factors in their inter-relationship with socioeconomic influences. PARTICIPANTS SMILE is a single-centre study conducted in Adelaide, Australia. All newborns at the main three public hospitals between July 2013 and August 2014 were eligible for inclusion. The final recruited sample at birth was 2181 mother/infant dyads. Participants were followed up with questionnaires when the child was 3 and 6 months of age, and 1, 2 and 5 years of age. Oral epidemiological examinations and anthropometric assessments were conducted at age 2 and 5 years. FINDINGS TO DATE SMILE has contributed comprehensive data on dietary patterns of young children. Intakes of free sugars, core and discretionary foods and drinks have been detailed. There was a sharp increase in free sugars intake with age. Determinants of dietary patterns, oral health status and body weight during the first 5 years of life have been evaluated. Socioeconomic characteristics such as maternal education and household income and area-level socioeconomic profile influenced dietary patterns and oral health behaviours and status. FUTURE PLAN Funding has been obtained to conduct oral epidemiological examinations and anthropometric assessments at age 7-8 years. Plans are being developed to follow the cohort into adolescent years.
Collapse
Affiliation(s)
- Loc G Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Diep H Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucinda K Bell
- Nutrition, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Gemma Devenish
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, Groningen, The Netherlands
| | | | - Jane A Scott
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - A John Spencer
- University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Hong CL, Broadbent JM, Thomson WM. Long-Term Survival of Enamel-Defect-Affected Teeth. Caries Res 2020; 54:350-357. [PMID: 33049745 DOI: 10.1159/000510304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
There has been considerable research focussed on the occurrence and aetiology of developmental defects of enamel, but less is known about the extent to which enamel-defect-affected teeth may be at greater risk for dental caries. The Dunedin Multidisciplinary Health and Development Study is a prospective cohort study of 1,037 children born in Dunedin, New Zealand, between April 1, 1972, and March 31, 1973. Participants were examined for the presence of developmental defects of enamel at the age of 9 years and then repeatedly for the occurrence of dental caries through to the age of 45 years. After controlling for confounding variables, incisor teeth affected by demarcated opacities at the age of 9 were 3.4 times more likely to be restored than teeth unaffected by defects. Incisors with diffuse opacities and hypoplasia or combinations of defects were 2.8 times more likely to be restored. Molars with enamel defects of any type did not have any significantly different risk for being subsequently restored or lost due to caries than unaffected molars, except those affected by diffuse opacities, which were at 0.4 times the risk of being lost due to caries. Dental clinicians should be aware that enamel-defect-affected teeth are not necessarily at greater risk for tooth loss due to caries in the long term, but permanent incisors affected by enamel defects are at higher risk of receiving restorative intervention.
Collapse
Affiliation(s)
- Chuen Lin Hong
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand,
| | - Jonathan Mark Broadbent
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - William Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Do LG, Ha DH, Roberts-Thomson KF, Spencer AJ. Dental fluorosis in the Australian adult population. Aust Dent J 2020; 65 Suppl 1:S47-S51. [PMID: 32583583 DOI: 10.1111/adj.12764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of fluoride involves a balance between protection against caries and risk of dental fluorosis. Prevalence and trend of dental fluorosis in the adult population are not frequently reported. OBJECTIVE To describe the prevalence of dental fluorosis in the Australian adult population. METHOD Data from the National Study of Adult Oral Health (NSAOH) 2004-06 and 2017-18 were used. Prevalence of fluorosis was reported using data from the NSAOH 2017-18. Case definitions of fluorosis were as follows: having a TF score of 2+ (TF2+) or a TF score of 3+ (TF3+) on one or more maxillary central incisors. Synthetic cohorts were constructed by year of birth allowing for time trend analysis. RESULTS One in ten Australian adults were found to have dental fluorosis at TF2+. The prevalence of TF3 + was low. Time trend analysis revealed an increase in the prevalence and severity of fluorosis among those born during 1970s to 1980s decade. Such prevalence declined among those who were born after measures were introduced in early 1990s to reduce exposure to discretionary fluorides. CONCLUSION The prevalence of dental fluorosis in the Australian adult population was found to be related to population-level changes in fluoride exposure.
Collapse
Affiliation(s)
- Loc G Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - Diep H Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - Kaye F Roberts-Thomson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - A John Spencer
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
11
|
Curtis AM, Levy SM, Cavanaugh JE, Warren JJ, Kolker JL, Weber-Gasparoni K. Decline in Dental Fluorosis Severity during Adolescence: A Cohort Study. J Dent Res 2020; 99:388-394. [PMID: 32091961 DOI: 10.1177/0022034520906089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dental fluorosis occurs from overingestion of fluoride during tooth formation. However, there is little evidence in the literature on whether or how fluorosis prevalence and severity change over time after tooth eruption. Permanent dentition dental examinations were conducted at ages 9, 13, 17, and 23 as part of the Iowa Fluoride Study, which has followed a cohort from birth. Fluorosis was assessed using the Fluorosis Risk Index (FRI) and Russell's criteria for differential diagnosis. Measures of fluorosis severity at the person and tooth level were calculated: second highest FRI score at the person level (the maximum FRI score for each tooth was determined and the tooth with the second highest maximum FRI score was used) and highest FRI score at the tooth level. At both the person and tooth levels, a decline in mild to moderate fluorosis severity was observed across adolescence and young adulthood. Across each pair of adjacent examinations at the person level, for participants with a baseline second highest FRI of 0, most participants stayed at 0 (82% to 91%). Many participants with a baseline second highest FRI of 1 had a follow-up score of 0 (47% to 54%), while about a third had a follow-up score of 1 (34% to 38%), and a lower percentage had an increase to a score of 2 (9% to 15%). For participants with baseline second highest FRI score of 2, between 25% and 44% of participants had follow-up FRI scores each of 0, 1, and 2. Similar patterns were observed at the tooth level. These results were consistent with most of the existing, limited literature. Overall, fluorosis severity, which was initially mild to moderate, tended to decline during adolescence and young adulthood. Additional study of how this trend affects esthetic perceptions of fluorosis is warranted.
Collapse
Affiliation(s)
| | - S M Levy
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | |
Collapse
|
12
|
Do LG. Guidelines for use of fluorides in Australia: update 2019. Aust Dent J 2020; 65:30-38. [DOI: 10.1111/adj.12742] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/21/2022]
Affiliation(s)
- LG Do
- National Oral Health Promotion Clearinghouse Australian Research Centre for Population Oral Health The University of Adelaide Adelaide South Australia Australia
| | | |
Collapse
|
13
|
Chedid SJ, Tenuta LMA, Cury JA. Dispensing Device to Deliver Small and Standardized Amount of Fluoride Dentifrice on the Toothbrush. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
14
|
Idon PI, Enabulele JE. Prevalence, severity, and request for treatment of dental fluorosis among adults in an endemic region of Northern Nigeria. Eur J Dent 2019; 12:184-190. [PMID: 29988248 PMCID: PMC6004813 DOI: 10.4103/ejd.ejd_260_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: The objective was to assess the prevalence of all forms of dental fluorosis (DF), the severity, and the request for treatment as a measure of the burden of the condition among adult patients seen at a tertiary health facility in an endemic region of Northeastern Nigeria. Materials and Methods: This was a cross-sectional study that collected required information using a questionnaire from adult dental patients followed by dental examination to assess for DF. Statistical Analysis Used: Associations between sociodemographic distributions (age and gender) and prevalence were analyzed on the Statistical Package for the Social Sciences using the Chi-square test. Analysis was done at 95% confidence interval and the level of statistical significance was set at P < 0.05. Results: Three hundred and twelve patients (41.7%) were diagnosed with DF among the patients who resided in the endemic region with a calculated Community Fluorosis Index of 0.62. The mean age of the affected patients was 33.8 ± 9.2 years, with a majority of the patients in the 16–25 (47.4%) years' age group and a preponderance among females (P = 0.003). A greater proportion of the 312 diagnosed patients, 201 (64.3%), had fluorosis of esthetic concern, while only 9.3% sought treatment. Most of these patients that sought treatment had the severe form of the enamel defect. Conclusions: DF should be considered as a condition of public health importance in this region. It is necessary to conduct a community-based study and fluoride mapping of the northeastern region as well to determine other factors that may contribute to its occurrence in this population.
Collapse
Affiliation(s)
- Paul Ikhodaro Idon
- Department of Dental Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Joan Emien Enabulele
- Department of Restorative Dentistry, School of Dentistry, University of Benin, Benin City, Edo State, Nigeria
| |
Collapse
|
15
|
Whelton H, Spencer A, Do L, Rugg-Gunn A. Fluoride Revolution and Dental Caries: Evolution of Policies for Global Use. J Dent Res 2019; 98:837-846. [DOI: 10.1177/0022034519843495] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.
Collapse
Affiliation(s)
- H.P. Whelton
- Oral Health Services Research Centre and College of Medicine and Health, University College Cork, Cork, Ireland
| | - A.J. Spencer
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - L.G. Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | | |
Collapse
|
16
|
Macey R, Tickle M, MacKay L, McGrady M, Pretty IA. A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation. Community Dent Oral Epidemiol 2018; 46:608-614. [PMID: 30178518 DOI: 10.1111/cdoe.12411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is a lack of evidence on the proportion and severity of fluorosis in adult populations exposed and not exposed to fluoridated water over their lifetimes. The aim of this study was to compare the proportion and severity of fluorosis in adults with lifetime exposure to water fluoridation with a nonexposed sample. A secondary aim was to report the gradient of fluorosis severity by age. METHODS A cross-sectional study recruited a sample with lifetime exposure to water fluoridation and a matched, nonexposed group. 580 participants, aged 18-52 years (mean 34.3, SD 9.4) and 64% female, were recruited in general dental practices located in fluoridated (Birmingham and County Durham) and nonfluoridated areas (Manchester). Three digital images were taken of their incisors and an experienced examiner who was blind to exposure status viewed the images remotely and allocated fluorosis scores using the Thylstrup and Fejerskov (TF) scale. RESULTS At TF ≥ 1 (any fluorosis), a significantly higher proportion of participants from the fluoridated area had fluorosis (F 39% NF 21.3%, P < 0.001), at the threshold TF ≥ 3 ("aesthetic concern"), the difference was no longer statistically significant (F 4.1%, NF 2.2%, P = 0.25). There was a gradient by age, whereby fluorosis was highest in the youngest and lowest in the oldest age group. CONCLUSIONS Although fluorosis is more common in adults with lifetime exposure to water fluoridation than those with no exposure, the aesthetic impact of fluorosis seems to diminish with age.
Collapse
Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Laura MacKay
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Michael McGrady
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| |
Collapse
|
17
|
|
18
|
Spencer A, Do L, Mueller U, Baines J, Foley M, Peres M. Understanding Optimum Fluoride Intake from Population-Level Evidence. Adv Dent Res 2018; 29:144-156. [DOI: 10.1177/0022034517750592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Policy on fluoride intake involves balancing caries against dental fluorosis in populations. The origin of this balance lies with Dean’s research on fluoride concentration in water supplies, caries, and fluorosis. Dean identified cut points in the Index of Dental Fluorosis of 0.4 and 0.6 as critical. These equate to 1.3 and 1.6 mg fluoride (F)/L. However, 1.0 mg F/L, initially called a permissible level, was adopted for fluoridation programs. McClure, in 1943, derived an “optimum” fluoride intake based on this permissible concentration. It was not until 1944 that Dean referred to this concentration as the “optimal” concentration. These were critical steps that have informed health authorities through to today. Several countries have derived toxicological estimates of an adequate and an upper level of intake of fluoride as an important nutrient. The US Institute of Medicine (IOM) in 1997 estimated an Adequate Intake (AI) of 0.05 mg F/kg bodyweight (bw)/d and a Tolerable Upper Intake Level (UL) of 0.10 mg F/kg bw/d. These have been widely promulgated. However, a conundrum has existed with estimates of actual fluoride intake that exceed the UL without the expected adverse fluorosis effects being observed. Both the AI and UL need review. Fluoride intake at an individual level should be interpreted to inform more nuanced guidelines for individual behavior. An “optimum” intake should be based on community perceptions of caries and fluorosis, while the ultimate test for fluoride intake is monitoring caries and fluorosis in populations.
Collapse
Affiliation(s)
- A.J. Spencer
- Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, Australia
| | - L.G. Do
- Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, Australia
| | - U. Mueller
- Chemical Safety and Nutrition Section, Food Standards Australia New Zealand, Canberra, Australia
| | - J. Baines
- Formerly of Food Data Analysis Section, Food Standards Australia New Zealand, Canberra, Australia
| | - M. Foley
- Research and Advocacy, Metro North Oral Health Services, Brisbane, Australia
| | - M.A. Peres
- Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, Australia
| |
Collapse
|
19
|
Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015. Br Dent J 2017; 220:335-40. [PMID: 27056513 DOI: 10.1038/sj.bdj.2016.257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/09/2022]
Abstract
The Cochrane Review on water fluoridation for the prevention of dental caries was published in 2015 and attracted considerable interest and comment, especially in countries with extensive water fluoridation programmes. The Review had two objectives: (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. The authors concluded, inter alia, that there was very little contemporary evidence, meeting the Review's inclusion criteria, that evaluated the effectiveness of water fluoridation for the prevention of dental caries. The purpose of this critique is to examine the conduct of the above Review, and to put it into context in the wider body of evidence regarding the effectiveness of water fluoridation. While the overall conclusion that water fluoridation is effective in caries prevention agrees with previous reviews, many important public health questions could not be answered by the Review because of the restrictive criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.
Collapse
|
20
|
Luo Q, Cui H, Deng H, Kuang P, Liu H, Lu Y, Fang J, Zuo Z, Deng J, Li Y, Wang X, Zhao L. Histopathological findings of renal tissue induced by oxidative stress due to different concentrations of fluoride. Oncotarget 2017; 8:50430-50446. [PMID: 28881573 PMCID: PMC5584147 DOI: 10.18632/oncotarget.17365] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/11/2017] [Indexed: 12/26/2022] Open
Abstract
It has been reported that excessive intake of fluoride can induce renal lesions. However, its pathogenesis is still less understood. Therefore, this study was conducted to investigate oxidative damage and the relationships between the oxidative damage and renal lesions in fluoride-treated mice by using the methods of histopathology, biochemistry, flow cytometry and quantitative real-time polymerase chain reaction (qRT-PCR). A total of 240 ICR mice were randomly divided into four equal groups (sodium fluoride was given orally at the dose of 0, 12, 24 and 48 mg/kg body weight for 42 days, respectively). We found that fluoride in excess of 12 mg/kg induced renal oxidative damage, which was characterized by increasing the levels of reactive oxygen species (ROS) production and contents of malondialdehyde (MDA) and protein carbonyls (PC), and decreasing the abilities of anti-superoxide anion (ASA) and anti-hydroxyl radical (AHR), glutathione (GSH) content, as well as activities and mRNA expression levels of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR) and glutathione peroxidase (GSH-Px). Concurrently, fluoride caused degeneration and necrosis of the tubular cells, renal tubular hyaline casts and glomeruli swelling, which were consistent with the alteration of renal function parameters including elevated contents of serum creatinine (Cr), serum uric acid (UA), blood urea nitrogen (BUN), and the activities of urinary N-acetyl-b-D-glucosaminidase (NAG), renal lactate dehydrogenase (LDH), and reduced activities of sodium-potassium adenosine triphosphatase (Na+/K+-ATPase) and acid phosphatase (ACP) in the kidney. The above-mentioned results showed that fluoride in excess of 12 mg/kg induced renal oxidative damage, which then caused renal lesions and dysfunctions. These findings also clearly demonstrated that oxidative damage is one of the mechanisms of fluoride-induced renal lesions and dysfunctions.
Collapse
Affiliation(s)
- Qin Luo
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China
| | - Hengmin Cui
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| | - Huidan Deng
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China
| | - Ping Kuang
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China
| | - Huan Liu
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China
| | - Yujiao Lu
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China
| | - Jing Fang
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| | - Zhicai Zuo
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| | - Junliang Deng
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| | - Yinglun Li
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| | - Xun Wang
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| | - Ling Zhao
- College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, Chengdu, China.,Key Laboratory of Animal Diseases and Environmental Hazards of Sichuan Province, Sichuan Agriculture University, Wenjiang, Chengdu, China
| |
Collapse
|
21
|
The role of parental rearing practices and family demographics on oral health-related quality of life in children. Qual Life Res 2017; 26:2229-2236. [DOI: 10.1007/s11136-017-1568-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
|
22
|
Singhal S, Farmer J, McLaren L. Methodological considerations for designing a community water fluoridation cessation study. Community Dent Oral Epidemiol 2017; 45:193-200. [DOI: 10.1111/cdoe.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/16/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sonica Singhal
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
- Health Promotion, Chronic Disease and Injury Prevention Department; Public Health Ontario; Toronto ON Canada
| | - Julie Farmer
- Discipline of Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - Lindsay McLaren
- Department of Community Health Sciences; University of Calgary; Calgary AB Canada
| |
Collapse
|
23
|
Spencer AJ, Do LG. Caution needed in altering the ‘optimum’ fluoride concentration in drinking water. Community Dent Oral Epidemiol 2015; 44:101-8. [DOI: 10.1111/cdoe.12205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. John Spencer
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide SA Australia
| | - Loc G. Do
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide SA Australia
| |
Collapse
|