A case study in contesting the conventional wisdom: school‐based fluoride mouthrinse programs in the USA

Abstract

This paper presents the events surrounding the dissemination of the results of a major preventive dentistry demonstration program designed and conducted to provide evidence of the effectiveness and actual costs of a combination of commonly used preventive procedures. It then reviews the controversy provoked when the results of that program were counter to the conventional wisdom of the day, prevailing national policy, and public health practice. An analysis of possible reasons for this reaction follows. The paper concludes with some observations about how such a situation might be approached to minimize similar controversy in the future.

The Zero-Inflated Poisson Model and the Decayed, Missing and Filled Teeth Index in Dental Epidemiology

“…The mouthwash programme with 0.2% NaF solution in comparison with the control group also showed a signi®cant reduction in initial dental caries lesions in primary molars. This agrees closely with the hypotheses of Disney et al (1990), who suggested that only the use of popular¯uoride products such as dentifrice, gel and varnish can lead to a signi®cant prevention of dental caries. The reduction achieved by following this programme as described by Ripa et al (1983) could be partly con®rmed in the BELCAP study.…”

Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004

“…É um conjunto de procedimentos de promoção e prevenção em saúde bucal, de baixa complexidade e que dispensam equipamentos odontológicos. Den-tre eles, o município realiza somente os bochechos fluoretados, que podem influir no declínio da cárie dentária, embora segundo Disney et al 23,24 a cárie diminuiu na presença ou na ausência de programas de bochecho de flúor e de outras formas de aplicação tópica de flúor.…”

The limitations of a ‘high‐risk’ approach for the prevention of dental caries

“…An approach which has been challenged by Disney et al. (23) and Petersson (33). An even more serious omission from the FDI/WHO approach is the lack of evidence to support their levels of low or high levels of caries.…”

“…The range of caries scores was wide, both within the individual ethnic groups and according to fluoride status. At the completion of the NPDDP study the data are made available to the public, providing information on the most detailed field study on the impact of caries preventive agents (20–23).…”