This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Burt, B.A. Articles by Heller, K.E. Search for Related Content PubMed PubMed Citation Articles by Burt, B.A. Articles by Heller, K.E. Social Bookmarking                         What's this?

The Effects of a Break in Water Fluoridation on the Development of Dental Caries and Fluorosis

Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA

M.A. Keels

Department of Surgery, Duke University Medical Center, Durham, NC

K.E. Heller

Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA

Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children. Study participants were continuously-resident children in Kindergarten through Grade 5 in Durham's elementary schools. There were 1696 children, 81.4% of those eligible, for whom a questionnaire was completed and clinical data recorded. Age cohorts were defined by a child's age at the time that fluoridation ceased. Caries was recorded in children in the Birth Cohort through Cohort 3, and fluorosis for children in Cohorts 1 through 5. Caries was assessed in the primary first and second molars according to the decayed-filled index; fluorosis on the labial surfaces of the upper permanent central and lateral incisors was assessed by the Thylstrup-Fejerskov (TF) index. Mother's education was associated with caries; higher education of the mother had an odds ratio of 0.53 (95% CI 0.40, 0.76) for caries in the child. No cohort effects could be discerned for caries. Overall prevalence of fluorosis was 44%. Prevalence in Cohorts 1, 2, 3, 4, and 5 was 39.8%, 32.3%, 33.0%, 62.3%, and 57.1%, respectively. These cohort differences remained statistically significant in regression analysis. It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years.

Key Words: fluoridation • caries • fluorosis • epidemiology • children.

REFERENCES

• Avery JK, editor (1988). Oral development and histology. Philadelphia: Decker, pp. 130-131.
• Bardsen A., Klock KS, Bjorvatn K. (1999). Dental fluorosis among persons exposed to high- and low-fluoride drinking water in western Norway. Community Dent Oral Epidemiol 27:259-267.[Medline] [Order article via Infotrieve]
• Bratthall D., Hansel-Petersson G., Sundberg H. (1996). Reasons for the caries decline: what do the experts believe? Eur J Oral Sci 104:416-422.[Medline] [Order article via Infotrieve]
• Brunelle JA, Carlos JP (1990). Recent trends in dental caries in US children and the effect of water fluoridation. J Dent Res 69(Spec Iss):723-727.[Medline] [Order article via Infotrieve]
• Burt BA ( 1992). The changing patterns of systemic fluoride intake. J Dent Res 71:1228-1237.
• Clark DC, Hann HJ, Williamson MF, Berkowitz J. (1994). Influence of exposure to various fluoride technologies on the prevalence of dental fluorosis. Community Dent Oral Epidemiol 22:461-464.[Medline] [Order article via Infotrieve]
• DenBesten PK (1986). Effects of fluoride on protein secretion and removal during enamel development in the rat. J Dent Res 65:1272-1277.
• DenBesten PK, Crenshaw MA (1984). The effects of chronic high fluoride levels on forming enamel in the rat. Arch Oral Biol 29:675-679.[Medline] [Order article via Infotrieve]
• Evans RW, Stamm JW (1991a). Dental fluorosis following downward adjustment of fluoride in drinking water. J Public Health Dent 51:91-98.[Medline] [Order article via Infotrieve]
• Evans RW, Stamm JW (1991b). An epidemiologic estimate of the critical period during which human maxillary central incisors are most susceptible to fluorosis. J Public Health Dent 51:251-259.[Medline] [Order article via Infotrieve]
• Fleiss JL (1981). Statistical methods for rates and proportions. New York: John Wiley and Sons.
• Hosmer DW, Lemeshow S. (1989). Applied logistic regression. New York: John Wiley and Sons.
• Ishii T., Suckling G. (1986). The appearance of tooth enamel in children ingesting water with a high fluoride content for a limited period during early tooth development. J Dent Res 65:974-977.
• Ismail Al, Brodeur JM, Kavanagh M., Boisclair G., Tessier C., Picotte L. (1990). Prevalence of dental caries and dental fluorosis in students, 11-17 years of age, in fluoridated and non-fluoridated cities in Quebec. Caries Res 24:290-297.[Medline] [Order article via Infotrieve]
• Kunzel W. (1980). Effect of an interruption in water flnoridation on the caries prevalence of the primary and secondary dentition. Caries Res 14:304-310.[Medline] [Order article via Infotrieve]
• Lemke CW, Doherty JM, Arra MC ( 1970). Controlled fluoridation: the dental effects of discontinuation in Antigo, Wisconsin. J Am Dent Assoc 80:782-786.[Medline] [Order article via Infotrieve]
• Levy SM, Kohout FJ, Guha-Chowdhury N., Kiritsy MC, Heilman JR, Wefel JS (1995). Infants' fluoride intake from drinking water alone, and from water added to formula, beverages, and food. J Dent Res 74:1399-1407.
• Pang DT, Phillips CL, Bawden JW (1992). Fluoride intake from beverage consumption in a sample of North Carolina children. J Dent Res 71:1382-1388.
• Pendrys DG, Stamm JW (1990). Relationship of total fluoride intake to beneficial effects and enamel fluorosis. J Dent Res 69(Spec Iss):529-538.[Medline] [Order article via Infotrieve]
• Pendrys DG, Katz RV, Morse DE (1994). Risk factors for enamel fluorosis in a fluoridated population. Am J Epidemiol 140:461-471.[Abstract/Free Full Text]
• Pendrys DG, Katz RV, Morse DE (1996). Risk factors for enamel fluorosis in a nonfluoridated population. Am J Epidemiol 143:808-815.[Abstract/Free Full Text]
• Pitts NB, Fyffe HE (1988). The effect of varying diagnostic thresholds upon clinical caries data for a low prevalence group. J Dent Res 67:592-596.
• SAS Institute Inc. (1996). The SAS system for Windows, release 6.12. Cary, NC: SAS Institute, Inc.
• Selwitz RH, Nowjack-Raymer RE, Kingman A., Driscoll WS (1995). Prevalence of dental caries and dental fluorosis in areas with optimal and above-optimal water fluoride concentrations: a 10-year follow-up survey. J Public Health Dent 55:85-93.[Medline] [Order article via Infotrieve]
• Stephen KW, McCall DR, Tullis JI (1987). Caries prevalence in northern Scotland before, and 5 years after, water defluoridation. Br Dent J 163:324-326.[CrossRef][Medline] [Order article via Infotrieve]
• Suga S. ( 1989). Enamel hypomineralization viewed from the pattern of progressive mineralization of human and monkey developing enamel. Adv Dent Res 3:188-198.[Abstract/Free Full Text]
• Summers CJ, Gooch BF, Marianos DW, Malvitz DM, Bond WW ( 1994). Practical infection control in oral health surveys and screenings. J Am Dent Assoc 125:1213-1217.[Abstract]
• Sunderland EP, Smith CJ, Sunderland R. (1987). A histological study of the chronology of initial mineralization in the human deciduous dentition. Arch Oral Biol 32:167-174.[Medline] [Order article via Infotrieve]
• Szpunar SM, Burt BA ( 1987). Trends in the prevalence of dental fluorosis in the United States: a review. J Public Health Dent 47:71-79.[Medline] [Order article via Infotrieve]
• Thylstrup A., Fejerskov 0 (1978). Clinical appearance of dental fluorosis in permanent teeth in relation to histologic changes. Community Dent Oral Epidemiol 6:315-328.[CrossRef][Medline] [Order article via Infotrieve]
• van Palenstein Helderman WH, Mabelya L., van't Hof MA, Konig KG (1997). Two types of intraoral distribution of fluorotic enamel. Community Dent Oral Epidemiol 25:251-255.[Medline] [Order article via Infotrieve]
• Williams JE, Zwemer JD (1990). Community water fluoride levels, preschool dietary patterns, and the occurrence of fluoride enamel opacities. J Public Health Dent 50:276-281.[Medline] [Order article via Infotrieve]
• Yoder KM, Mabelya L., Robison VA, Dunipace AJ, Brizendine EJ, Stookey GK (1998). Severe dental fluorosis in a Tanzanian population consuming water with negligible fluoride concentration. Community Dent Oral Epidemiol 26:382-393.[Medline] [Order article via Infotrieve]

Journal of Dental Research, Vol. 79, No. 2, 761-769 (2000)
DOI: 10.1177/00220345000790021001


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				P. P. Hujoel, L. G. Zina, S. A.S. Moimaz, and J. Cunha-Cruz Infant Formula and Enamel Fluorosis: A Systematic Review J Am Dent Assoc, July 1, 2009; 140(7): 841 - 854. [Abstract] [Full Text] [PDF]

				M. R. Franzman, S. M. Levy, J. J. Warren, and B. Broffitt Fluoride dentifrice ingestion and fluorosis of the permanent incisors J Am Dent Assoc, May 1, 2006; 137(5): 645 - 652. [Abstract] [Full Text] [PDF]

				T. Aoba and O. Fejerskov DENTAL FLUOROSIS: CHEMISTRY AND BIOLOGY Critical Reviews in Oral Biology & Medicine, March 1, 2002; 13(2): 155 - 170. [Abstract] [Full Text] [PDF]

				E. D. BELTRAN-AGUILAR, S. O. GRIFFIN, and S. A. LOCKWOOD Prevalence and trends in enamel fluorosis in the United States from the 1930s to the 1980s J Am Dent Assoc, February 1, 2002; 133(2): 157 - 165. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Burt, B.A. Articles by Heller, K.E. Search for Related Content PubMed PubMed Citation Articles by Burt, B.A. Articles by Heller, K.E. Social Bookmarking                         What's this?