It would appear that there is a public awareness of both developmental defects and enamel fluorosis although this is not always expressed as dissatisfaction. Further research is required into the clinical impact of both fluorosis and other developmental defects of enamel.

The aim of this study, conducted in 1994, was to examine the association between approximal caries and sugar consumption in teenagers residing in three fluoride-deficient areas in Iceland while controlling for a number of behavioral, residential and microbiological factors. One hundred and fifty subjects (mean age 14 years) selected from the Icelandic Nutritional Survey (INS) were examined radiographically and they completed questionnaires about sugar consumption frequency. Total grams of sugar intake were obtained from the INS for each subject. Caries experience on approximal surfaces, diagnosed from radiographs, was used as the dependent variable in the analyses. Altogether 45.2% of subjects were caries free on approximal surfaces. The overall sample was found to have a mean DFS on approximal surfaces of 2.73 (s=4.36) per subject. Average daily total sugar intake was 170 g per subject and the mean number of sugar-eating occasions between meals was 5.32 (s=6.29) per subject. The regression model indicated that the frequency of between-meal sugar consumption was associated with approximal caries, with frequency of candy consumption being the most important of the sugar variables. In multivariate analysis, no relationship was found between dental caries and total daily intake of sugar, although a significant relationship between total sugar consumption and presence of caries was seen in bivariate analysis. Between-meal consumption of sugar remains a risk factor for the occurrence of dental caries, especially in populations with moderate-to-high levels of dental caries experience.

Two hundred and seventeen approximal spaces, initially caries free, in 58 patients were studied clinically and radiographically, at intervals of 6 months, for 3 years. Samples of approximal dental plaque were removed for culture of Streptococcus mutans, Streptococcus sobrinus, and lactobacilli. During the study approximal caries developed in 16 subjects (27.6%) at 30 sites (13.8%), involving 42 teeth. 56 of 58 (96.7%) subjects harboured S. mutans at some time during the study, 62.1% lactobacilli, and 29.3% had S. sobrinus. The counts of S. mutans were significantly higher in those subjects that also carried S. sobrinus than in the remaining subjects. A persisting high count of S. mutans > 105 colony-forming units per millilitre (CFU/ml) or a count that rose by ≥ 1 × log10 CFU/ml during the study was seen in 25 of 30 sites that subsequently became carious (p < 0.001). Similarly, counts of lactobacilli that were consistently > 103 CFU/ml or rising by ≥l×logo CFU/ml were seen in 17 of 30 sites that became carious (p < 0.001). Although there were strong statistical associations between approximal caries and high or rising counts of these cariogenic bacteria, the bacterial counts were not good predictors of future approximal caries at that particular site.

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