Tooth–Surface Progression and Reversal Changes in Fluoridated and No–Longer– Fluoridated Communities over a 3–Year Period

Abstract

Objective: To compare permanent tooth surface–specific progression/reversal changes between fluoridation–ended (F–E) and still–fluoridated (S–F) communities in British Columbia, Canada, over a 3–year period. Methods: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. Results: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit–and–fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F–E site compared to the S–F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F–E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. Conclusion: Progressions were found to be weakly linked to socio–demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F–E communities had more frequent progressions than a S–F community.

Genetic Susceptibility to Dental Caries on Pit and Fissure and Smooth Surfaces

“…Moreover, differences in environmental factors, such as fluoride varnish and sealants, were not modeled in these analyses, but may have differentially impacted caries scores among study participants leading to noise in the phenotype assessments. Indeed, other studies have shown important differential effects of fluoride exposure, dietary habits, socioeconomic status, and age on PFS and SMS caries [Maupome et al, 2001;Jiang et al, 2005;Warren et al, 2006].…”

“…For example, professionally administered fluoride treatments have been shown to reduce incidence of caries on the SMS, but not PFS, of the first permanent molar [Jiang et al, 2005]. Additional studies have shown a greater effect of fluoridated water on SMS caries progression, and that snack food and socioeconomic factors affect PFS caries progression [Maupome et al, 2001]. Likewise, a longitudinal study reported that tooth brushing frequency and powered beverage consumption were significantly associated with the progression of childhood caries for PFS (but not SMS), and that noncavitated lesions were more likely to progress to cavitated lesions with age for PFS than for SMS [Warren et al, 2006].…”

Does cessation of community water fluoridation lead to an increase in tooth decay? A systematic review of published studies

“…Among these children, authors observed that caries progression, especially on smooth surfaces, was more frequent in the cessation community compared to the comparison (still-fluoridated) community. 20 The two communities had similar exposures to other forms of fluoride, such as fluoridated toothpaste, good oral hygiene and access to oral healthcare. The use of sealants was also high in both sites, though higher in the cessation community.…”

Caries Occurrence in a Fluoridated and a Nonfluoridated Town in Finland: A Retrospective Study Using Longitudinal Data from Public Dental Records

“…Also Kün-zel andFischer [1997, 2000] in Germany and in Cuba, and Maupomé et al [2001a] in Canada have reported that caries did not increase after discontinuation of water fluoridation. However, progression of caries lesions was slightly more common in the community where fluoridation was stopped compared to fluoridated communities [Maupomé et al, 2001b].…”