OBJECTIVE: To review the safety and efficacy of fluoridation of drinking water. DESIGN: Search of 25 electronic databases and world wide web. Relevant journals hand searched; further information requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. MAIN OUTCOME MEASURES: Decayed, missing, and filled primary/permanent teeth. Proportion of children without caries. Measure of effect was the difference in change in prevalence of caries from baseline to final examination in fluoridated compared with control areas. For potential adverse effects, all outcomes reported were used. RESULTS: 214 studies were included. The quality of studies was low to moderate. Water fluoridation was associated with an increased proportion of children without caries and a reduction in the number of teeth affected by caries. The range (median) of mean differences in the proportion of children without caries was -5.0% to 64% (14.6%). The range (median) of mean change in decayed, missing, and filled primary/permanent teeth was 0.5 to 4.4 (2.25) teeth. A dose-dependent increase in dental fluorosis was found. At a fluoride level of 1 ppm an estimated 12.5% (95% confidence interval 7.0% to 21.5%) of exposed people would have fluorosis that they would find aesthetically concerning. CONCLUSIONS: The evidence of a beneficial reduction in caries should be considered together with the increased prevalence of dental fluorosis. There was no clear evidence of other potential adverse effects. (+info)
Tooth discolouration and staining: a review of the literature.
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OBJECTIVE: To carry out an extensive review of the literature on tooth staining with particular regard to some of the more recent literature on the mechanisms of tooth staining involving mouthrinses. DESIGN: Comprehensive review of the literature over four decades. CONCLUSIONS: A knowledge of the aetiology of tooth staining is of importance to dental surgeons in order to enable a correct diagnosis to be made when examining a discoloured dentition and allows the dental practitioner to explain to the patient the exact nature of the condition. In some instances, the mechanism of staining may have an effect on the outcome of treatment and influence the treatment options the dentist will be able to offer to patients. (+info)
Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention.
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Widespread use of fluoride has been a major factor in the decline in the prevalence and severity of dental caries (i.e., tooth decay) in the United States and other economically developed countries. When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries. All U.S. residents are likely exposed to some degree to fluoride, which is available from multiple sources. Both health-care professionals and the public have sought guidance on selecting the best way to provide and receive fluoride. During the late 1990s, CDC convened a work group to develop recommendations for using fluoride to prevent and control dental caries in the United States. This report includes these recommendations, as well as a) critical analysis of the scientific evidence regarding the efficacy and effectiveness of fluoride modalities in preventing and controlling dental caries, b) ordinal grading of the quality of the evidence, and c) assessment of the strength of each recommendation. Because frequent exposure to small amounts of fluoride each day will best reduce the risk for dental caries in all age groups, the work group recommends that all persons drink water with an optimal fluoride concentration and brush their teeth twice daily with fluoride toothpaste. For persons at high risk for dental caries, additional fluoride measures might be needed. Measured use of fluoride modalities is particularly appropriate during the time of anterior tooth enamel development (i.e., age <6 years). The recommendations in this report guide dental and other health-care providers, public health officials, policy makers, and the public in the use of fluoride to achieve maximum protection against dental caries while using resources efficiently and reducing the likelihood of enamel fluorosis. The recommendations address public health and professional practice, self-care, consumer product industries and health agencies, and further research. Adoption of these recommendations could further reduce dental caries in the United States and save public and private resources. (+info)
Has the level of dental fluorosis among Toronto children changed?
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We conducted a survey during the 1999 2000 school year to obtain valid estimates of the oral health status of a probability sample of children in the 4 regions of the newly amalgamated city of Toronto. The results will be used in developing recommendations for programs to address the oral health problems identified. The Dental Indices System is the Ontario protocol whereby information on the oral health status and treatment needs of children can be obtained by direct assessment of the children. One of 2 specially trained dental hygienists examined each child's teeth and periodontal tissues using sterilized mouth mirrors and blunt probes with a standard light source. Overall, there were 3657 participants in the survey, of whom 2435 were aged 7 or 13 years; these 2 age groups formed the basis for the analysis. Forty percent of those aged 7 or 13 had had one or more decayed teeth. Approximately 7% of children in the younger age group had at least one condition requiring urgent care. Dental fluorosis of moderate severity (Tooth Surface Index of Fluorosis 2) was found among 14.0% of 7-year-olds, 12.3% of 13-year-olds and 13.2% of the 2 age groups combined. The prevalence of fluorosis was of the same order as all but one of the more recent studies performed in Toronto. The prevalence may fall as the recently imposed reduction in concentration of fluorides in city water takes effect. On the basis of these findings of fluorosis, Toronto Public Health should continue to monitor levels of dental fluorosis and caries and should continue its efforts to inform parents of very young children about the safe use of fluoridated dentifrice. (+info)
Dental fluorosis: chemistry and biology.
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This review aims at discussing the pathogenesis of enamel fluorosis in relation to a putative linkage among ameloblastic activities, secreted enamel matrix proteins and multiple proteases, growing enamel crystals, and fluid composition, including calcium and fluoride ions. Fluoride is the most important caries-preventive agent in dentistry. In the last two decades, increasing fluoride exposure in various forms and vehicles is most likely the explanation for an increase in the prevalence of mild-to-moderate forms of dental fluorosis in many communities, not the least in those in which controlled water fluoridation has been established. The effects of fluoride on enamel formation causing dental fluorosis in man are cumulative, rather than requiring a specific threshold dose, depending on the total fluoride intake from all sources and the duration of fluoride exposure. Enamel mineralization is highly sensitive to free fluoride ions, which uniquely promote the hydrolysis of acidic precursors such as octacalcium phosphate and precipitation of fluoridated apatite crystals. Once fluoride is incorporated into enamel crystals, the ion likely affects the subsequent mineralization process by reducing the solubility of the mineral and thereby modulating the ionic composition in the fluid surrounding the mineral. In the light of evidence obtained in human and animal studies, it is now most likely that enamel hypomineralization in fluorotic teeth is due predominantly to the aberrant effects of excess fluoride on the rates at which matrix proteins break down and/or the rates at which the by-products from this degradation are withdrawn from the maturing enamel. Any interference with enamel matrix removal could yield retarding effects on the accompanying crystal growth through the maturation stages, resulting in different magnitudes of enamel porosity at the time of tooth eruption. Currently, there is no direct proof that fluoride at micromolar levels affects proliferation and differentiation of enamel organ cells. Fluoride does not seem to affect the production and secretion of enamel matrix proteins and proteases within the dose range causing dental fluorosis in man. Most likely, the fluoride uptake interferes, indirectly, with the protease activities by decreasing free Ca(2+) concentration in the mineralizing milieu. The Ca(2+)-mediated regulation of protease activities is consistent with the in situ observations that (a) enzymatic cleavages of the amelogenins take place only at slow rates through the secretory phase with the limited calcium transport and that, (b) under normal amelogenesis, the amelogenin degradation appears to be accelerated during the transitional and early maturation stages with the increased calcium transport. Since the predominant cariostatic effect of fluoride is not due to its uptake by the enamel during tooth development, it is possible to obtain extensive caries reduction without a concomitant risk of dental fluorosis. Further efforts and research are needed to settle the currently uncertain issues, e.g., the incidence, prevalence, and causes of dental or skeletal fluorosis in relation to all sources of fluoride and the appropriate dose levels and timing of fluoride exposure for prevention and control of dental fluorosis and caries. (+info)
An update on fluorides and fluorosis.
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Decisions concerning use of fluoride in its many forms for caries prevention are more complicated now than in the past because of the need to balance these benefits with the risks of dental fluorosis. This article reviews pertinent literature concerning dental fluorosis (definition, appearance, prevalence), pre- and post-eruptive use of fluoride, esthetic perceptions of dental fluorosis, fluoride levels of beverages and foods, the Iowa Fluoride Study, and the U.S. Centers for Disease Control and Prevention's "Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States." Water fluoridation and use of fluoride dentifrice are the most efficient and cost-effective ways to prevent dental caries; other modalities should be targeted toward high-risk individuals. (+info)
The biochemistry and physiology of metallic fluoride: action, mechanism, and implications.
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Fluoride is a well-known G protein activator. Activation of heterotrimeric GTP-binding proteins by fluoride requires trace amounts of Al3+ or Be2+ ions. AlFx mimics a gamma-phosphate at its transition state in a Galpha protein and is therefore able to inhibit its GTPase activity. AlFx also forms complexes with small GTP-binding proteins in the presence of their GTPase-activating proteins (GAP). As phosphate analogs, AlFx or BeFx affect the activity of a variety of phosphoryl transfer enzymes. Most of these enzymes are fundamentally important in cell signal transduction or energy metabolism. Al3+ and F- tend to form stable complexes in aqueous solution. The exact structure and concentration of AlFx depend on the pH and the amount of F- and Al3+ in the solution. Humans are exposed to both F and Al. It is possible that Al-F complexes may be formed in vivo, or formed in vitro prior to their intake by humans. Al-F complexes may play physiological or pathological roles in bone biology, fluorosis, neurotoxicity, and oral diseases such as dental caries and periodontal disease. The aim of this review is to discuss the basic chemical, biochemical, and toxicological properties of metallic fluoride, to explore its potential physiological and clinical implications. (+info)
Baseline survey of oral health of primary and secondary school pupils in Uganda.
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BACKGROUND: Among the issues that determine the performance of a child at school is health. In recognition of this, the Uganda government has embarked on a school health program for the success of universal primary education. Although dental health is an important component of school health there is little information on it. OBJECTIVE: This study aimed at collecting information on dental health of pupils in school for evaluation and planning. DESIGN: A cross-sectional study using a multistage cluster sampling technique was used to select 685 children attending schools in 5 districts. Children were clinically examined for common illnesses/conditions. The oral examinations were done using simplified versions of Decayed, Missing, and Filled teeth (DMFT) index and Community Periodontal Index (CPI). Oral examinations also assessed presence of fluorosis. RESULTS: The pupils attending school were aged from 5 to 22 years. Sixty six percent (456) were found to be caries free with a group DMFT of 0.7. The D-component (decay) accounted for approximately 70% of the cases. Fifty nine percent of the pupils were found to have a healthy periodontium. Sixteen percent of the pupils were found to have some degree of fluorosis of whom the majority were from the highland districts of Kabale and Mbale. Urban school pupils were more likely to have caries (OR 1,69; 95% CI 1.21-2.37) than the rural. CONCLUSION: There is an upward trend in the caries prevalence when compared to studies done earlier. This study revealed a need to develop preventive programs alongside improvement of dental health services. (+info)