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Cavities Not Increasing, But Decreasing, When Fluoridation
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Fluoride Action Network January 23, 2000 Cavities Not Increasing, But Decreasing, When Fluoridation Stops The latest study to show that cavities do not increase when a community stops fluoridating its water, has been published in the February issue of the journal Community Dentistry and Oral Epidemiology. According to the authors of the study, who compared the cavity rates of two communities in British Columbia, Canada: "The prevalence of caries decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community." The abstract of this study is listed below, along with the abstracts of other recent studies, all of which have found that when fluoridation ends, cavities do not increase. Such findings stand in sharp contradiction to the American Dental Association's dubious assertion that:
According to Paul Beeber, President, New York State Coalition Opposed to Fluoriation, "science proves the ADA is wrong about the claimed benefits of water fluoridation and they are wrong about the safety of water fluoridation, too." A recent Canadian review on fluoridation has provided a reason for fluoridation's inefficacy - namely, swallowing fluoride has little beneficial effect on teeth. According to the review,
The Canadian review's admission marks the change that is currently underway amongst dental researchers concerning the way fluoride works. In the 1940s, when fluoridation was launched, it was believed that fluoride protected teeth by being swallowed and incorporated into the developing tooth enamel, thereby making the tooth "less soluble". This "systemic effect" (which was the key rationale behind putting fluoride in the water), has since been shown to provide little benefit to teeth. According to an article recently published in the Journal of the American Dental Association, the fluoride that is swallowed and incorporated into teeth is "insufficient to have a measurable effect" on reducing cavities. (Ref: Featherstone, J.D.B. (2000). The Science and Practice of Caries Prevention. Journal of the American Dental Association. 131, 887-899) Even the Centers for Disease Control and Prevention is now admitting that the benefits to teeth from fluoride "primarily are topical." The fact that fluoride's benefits are topical makes swallowing fluoride akin to swallowing nail varnish, according to Paul Connett, Professor of Chemistry at St. Lawrence University, New York. "It makes more sense, for those who want to take the risks, to apply fluoride directly to the teeth in the form of toothpaste. This gives people a choice in the matter - and would go a long way towards ending the controversy and divisiveness that arises when public health departments seek to fluoridate an entire community's water supply." Recent Studies Finding Cavities Don't Increase When Fluoridation Stops Community Dent Oral
Epidemiol 2001 Feb;29(1):37-47 Maupome G, Clark DC, Levy SM, Berkowitz J Faculty of Dentistry, University of British Columbia, Vancouver, Canada. gerardo.maupome@kp.org [Medline record in process] OBJECTIVES: To compare prevalence and incidence of caries between fluoridation-ended and still-fluoridated communities in British Columbia, Canada, from a baseline survey and after three years. METHODS: At the baseline (1993/4 academic year) and follow-up (1996/7) surveys, children were examined at their schools. Data were collected on snacking, oral hygiene, exposure to fluoride technologies, and socio-economic level. These variables were used together with D1D2MFS indices in multiple regression models. RESULTS: The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community. While numbers of filled surfaces did not vary between surveys, sealed surfaces increased at both study sites. Caries incidence (assessed in 2,994 life-long residents, grades 5, 6, 11, 12) expressed in terms of D1D2MFS was not different between the still-fluoridating and fluoridation-ended communities. There were, however, differences in caries experienced when D1D2MFS components and surfaces at risk were investigated in detail. Regression models did not identify specific variables markedly affecting changes in the incidence of dental decay. CONCLUSIONS: Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 11153562, UI: 21026421 Caries Res 2000
Nov;34(6):462-468 Seppa L, Karkkainen S, Hausen H Institute of Dentistry, University of Oulu, Finland. [Record supplied by publisher] Water fluoridation in Kuopio, Finland, was stopped at the end of 1992. In our previous study, no increase in caries was found in Kuopio 3 years after the discontinuation of water fluoridation. The aim of the present study was to further observe the occurrence and distribution of caries in Kuopio and Jyvaskyla, which was used as the reference town for Kuopio. In 1992, 1995 and 1998 independent random samples of all children aged 3, 6, 9, 12 and 15 years were drawn in Kuopio and Jyvaskyla. The total numbers of subjects examined were 688, 1,484 and 1,530 in 1992, 1995 and 1998, respectively. Calibrated dentists registered caries clinically and radiographically. No indication of increasing caries could be found in the previously fluoridated town during 1992-1998. In both towns the mean dmfs and DMFS values either decreased or remained about the same during the observation period. When all study years and both towns were pooled, 25% of the 12- and 15-year-olds with the highest DMFS counts accounted for 79 and 67%, respectively, of all affected surfaces. The mean numbers of fluoride varnish and sealant applications had markedly decreased in 1993-1998 compared to 1990-1992. The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 11093019 Community Dent Oral Epidemiol 2000 Oct;28(5):382-9 Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Kunzel W, Fischer T, Lorenz R, Bruhmann S Dental School of Erfurt, Department of Preventive Dentistry, Friedrich-Schiller-University of Jena, Germany. Simionoff@zmkh.ef.uni-jena.de In contrast to the anticipated increase in dental caries following the cessation of water fluoridation in the cities Chemnitz (formerly Karl-Marx-Stadt) and Plauen, a significant fall in caries prevalence was observed. This trend corresponded to the national caries decline and appeared to be a new population-wide phenomenon. Additional surveys (N=1017) carried out in the formerly-fluoridated towns of Spremberg (N=9042) and Zittau (N=6232) were carried out in order to support this unexpected epidemiological finding. Pupils from these towns, aged 8/9-, 12/13- and 15/16-years, have been examined repeatedly over the last 20 years using standardised caries-methodological procedures. While the data provided additional support for the established fact of a caries reduction brought about by the fluoridation of drinking water (48% on average), it has also provided further support for the contention that caries prevalence may continue to fall after the reduction of fluoride concentration in the water supply from about 1 ppm to below 0.2 ppm F. Caries levels for the 12-year-olds of both towns significantly decreased during the years 1993-96, following the cessation of water fluoridation. In Spremberg, DMFT fell from 2.36 to 1.45 (38.5%) and in Zittau from 2.47 to 1.96 (20.6%). These findings have therefore supported the previously observed change in the caries trend of Chemnitz and Plauen. The mean of 1.81 DMFT for the 12-year-olds, computed from data of the four towns, is the lowest observed in East Germany during the past 40 years. The causes for the changed caries trend were seen on the one hand in improvements in attitudes towards oral health behaviour and, on the other hand, to the broader availabilty and application of preventive measures (F-salt, F-toothpastes, fissure sealants etc.). There is, however, still no definitive explanation for the current pattern and further analysis of future caries trends in the formerly fluoridated towns would therefore seem to be necessary. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 11014515, UI: 20466443 J Dent Res 2000
Feb;79(2):761-9 Burt BA, Keels MA, Heller KE Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. bburt@umich.edu 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. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db= PMID: 10728978, UI: 20191322 Caries Res 2000
Jan-Feb;34(1):20-5 Kunzel W, Fischer T Department of Preventive Dentistry, Dental School of Erfurt, Friedrich Schiller University of Jena, Germany. In the past, caries has usually increased after cessation of water fluoridation. More recently an opposite trend could be observed: DMFT remaining stable or even decreasing further. The aim of the present study conducted in La Salud (Province of Habana) in March 1997 was to analyse the current caries trend under the special climatic and nutritional conditions of the subtropical sugar island Cuba, following the cessation, in 1990, of water fluoridation (0.8 ppm F). Diagnostic evaluations were carried out using the same methods as in 1973 and 1982. Boys and girls aged 6-13 years (N = 414), lifelong residents in La Salud, were examined. Between 1973 and 1982 the mean DMFT had decreased by 71.4%, the mean DMFS by 73. 3% and the percentage of caries-free children had increased from 26. 3 to 61.6%. In 1997, following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence, DMFT and DMFS values remained at a low level for the 6- to 9-year-olds and appeared to decrease for the 10/11-year-olds (from 1. 1 to 0.8) and DMFS (from 1.5 to 1.2). In the 12/13-year-olds, there was a significant decrease (DMFT from 2.1 to 1.1; DMFS from 3.1 to 1. 5), while the percentage of caries-free children of this age group had increased from 4.8 (1973) and 33.3 (1982) up to 55.2%. A possible explanation for this unexpected finding and for the good oral health status of the children in La Salud is the effect of the school mouthrinsing programme, which has involved fortnightly mouthrinses with 0.2% NaF solutions (i.e. 15 times/year) since 1990. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 10601780, UI: 20069258 Gesundheitswesen 1997 Dec;59(12):710-5 [Caries decline in Germany--causes and consequences]. [Article in German] Kunzel W Poliklinik fur Praventive Zahnheilkunde, Friedrich-Schiller-Universitat Jena. The reunification of the two German states has resulted in social transformations in Eastern Germany after 1990, in the wake of which disadvantageous effects on oral health were to be expected. Contrary to the predicted caries increase, a caries decline in the juvenile population could be proven by epidemiological comparative studies (n = 50612) (decrease between 1983-1989 and 1993-1995 by 34.2%). The caries decline is probably caused by a broader availability of fluorides, a high level of individual dental curative and preventive care (fissure sealings) and by changed oral health behaviour and nutritional habits. Reference is made to a possible tangent between a high level of antibiotics consumption and the virulence of oral pathogenic streptococci. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 9483838, UI: 98144832 Other Studies of Interest N Z Dent J 1998 Sep;94(417):109-13 The decline of caries in New Zealand over the past 40 years. de Liefde B In New Zealand, as elsewhere, caries prevalence has declined since the 1950s; this has been accompanied by a change in the intra-oral pattern of the disease. This is illustrated by analysis of data for 12-year-old children. However, because treatment services for children in New Zealand are so comprehensive, the DMF index is primarily a count of restorations placed. This treatment overlay can distort the true caries prevalence and has been a confounding factor in assessment of the change in caries over time. Measurement of the fine gradations of ongoing change in the present low-caries-prevalence population requires the use of a more sensitive indicator than the DMF indices. When the timing of various forms of fluoride supplementation is correlated with the decline in caries, the decline continues beyond the time of maximum population coverage with fluoridated water and fluoridated toothpaste. Thus an explanation of the convergance of caries prevalence in fluoridated and non-fluoridated areas since the 1970s may require a re-assessment of the fluoride effect. This convergence, and the overall decline during the last decade without known additional fluoride supplementation, suggest that factors other than fluoride, such as food additives and antibiotics, may have contributed. Comments: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= Fluoride April
1990; 23(2): 55-67 SUMMARY: Data from dental examinations of 39,207 schoolchildren, aged 5-17, in 84 areas throughout the United States are analyzed. Of these areas, 27 had been fluoridated for 17 years or more (F), 30 had never been fluoridated (NF), and 27 had been only partially fluoridated or fluoridated for less than 17 years (PF). No statistically significant differences were found in the decay rates of permanent teeth or the percentages of decay-free children in the F, NF, and PF areas. However, among 5-year olds, the decay rates of deciduous teeth were significantly lower in F than in NF areas (see results below). Read paper at http://www.fluoridealert.org/DMFTs.htm Nature July 1986 Vol. 322 The Mystery of Declining Tooth Decay Diesendorf, M. Human Sciences Program, Australian National University, Canberra, Australia SUMMARY: Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least eight developed countries over the past thirty years. It is now time for a scientific re-examination of the alleged enormous benefits of fluoridation. |
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