Micro-computed tomography assessment of root dentin around fluoride-releasing restorations after demineralization/remineralization.

Using micro-computed tomography (micro-CT), this study assessed the inhibitory effect of three different types of restorations on root-caries formation under a cariogenic challenge. Bovine-root dentin blocks with a cylindrical cavity were divided into three restoration groups: a fluoride-free self-etch adhesive and a resin composite (SE-ES); a self-etch adhesive and a resin composite with multi-ion release (FL-BF); and a glass ionomer cement (Fuji-VII). After the restorative procedures, the specimens were stored in artificial saliva for 1 d, then subjected to a demineralization solution for 4 d and a remineralization solution for 28 d. Mineral density and mean mineral loss of dentin around the restorations were measured using micro-CT. The mean mineral loss values of dentin around the restorations were highest among SE-ES restorations and lowest among Fuji-VII restorations. Fuji-VII showed the highest mineral density and the lowest mineral loss after 28 d of remineralization. The observations made by scanning electron microscopy demonstrated that Fuji-VII created the smallest outer lesion followed by FL-BF and SE-ES. Fuji-VII has a larger inhibitory effect on root caries around the restorations and enhances remineralization more effectively than either FL-BF or SE-ES. Multi-ion and fluoride release from the restorative materials may be beneficial for inhibition of root-dentin caries around the restorations.

Fluoride varnish: a primary prevention tool for dental caries.

Fluoride varnish is an effective tool that has been proven to prevent dental caries both in primary and permanent dentition. Its ease of use, acceptability and efficacy make it an important tool in the primary prevention of dental caries in high-caries-risk children. There has been an increase in third-party reimbursement for fluoride varnish applications in high-risk children and adults.

Effective use of fluorides in the People's Republic of China--a model for WHO Mega Country initiatives.

Poor dental health has been reported in the Chinese National Surveys of Oral Health. With the changing lifestyle and growing consumption of sugars, the incidence of dental caries may well continue to rise, compounded by limited access to professional care. The increasing oral disease burden could become a major public health problem in China, leading to considerable personal and health service costs. There is a desperate need for systematic implementation of preventive programmes. Currently, China is strengthening the prevention of chronic diseases, which provides an excellent opportunity to integrate oral disease prevention into the overall non-communicable disease (NCD) prevention programmes. In order to address this growing public health problem, the World Health Organization (WHO) Global Oral Health Programme advocates the effective use of fluoride as an essential approach to prevent dental caries in the 21st century--part of the WHO Global Oral Health Strategy. Population-wide automatic fluoridation measures are considered the most effective, complemented by appropriate use of toothpastes containing fluoride. There are wide variations of fluoride levels in drinking water in China and, in many areas, the levels of fluoride in drinking water are lower than the recommended levels. The use of toothpaste containing fluoride is still too low in some areas and decreases with age. Those who live in rural areas have limited access to affordable toothpastes containing fluoride. In March 2006, as part of the WHO Mega Country Health Promotion Network initiatives, the WHO Global Oral Health Programme organised a three-day symposium in Beijing, People's Republic of China. The aim of the symposium was to bring together international experience and Chinese expertise to facilitate policy development for effective use of fluoride in China, highlighting the benefits of, and barriers to, the implementation of different fluoridation programmes at the strategic levels as well as for operational planning. This article reports the proceedings of the meeting. In summary, China is a Mega country with much diversity and disparity. The situation in China is unique with endemic fluorosis due to other non-water sources of fluoride in some areas and a considerable dental caries burden in others. It is important to regulate the appropriate exposure to fluoride to obtain the benefits and avoid adverse effects of fluorides, controlling enamel fluorosis without jeopardising the prevention of dental caries. Various complementary fluoridation programmes can be considered for different population groups with varying needs, strategies that bring about additive effects. A multi-tier policy making approach at national, regional and provincial levels can be employed, based on sound evidence. The roles of WHO, Ministry of Health and the National Committee for Oral Health (NCOH) were emphasised. Lessons learned from the Chinese experience will prove invaluable to other countries with similar socio demographic characteristics that are in the same process of developing and implementing fluoridation policies and programmes.

Massachusetts fluoridation update 2006.

Massachusetts has a long history of activity with community water fluoridation. Although the state has 3.8 million people living in 137 fluoridated communities, there are more than 2 million people who do not have these benefits. The Bay State is ranked 35th in the country regarding the percent of people on public water supplies with fluoridation. We can do better than that. We have more than 60 years of experience receiving the health and economic benefits of fluoridation in our country; however, there is still a lot of misinformation about fluoridation, and the unreliable nature of information posted on the Internet exacerbates much of this misinformation. Dental professionals, their patients, and decision-makers must be continuously educated about the safety, health, and economic benefits of community water fluoridation. Patients from 6 months to 16 years of age living in nonfluoridated communities should be prescribed supplemental fluoride. Dental professionals in nonfluoridated communities should assist them to become fluoridated. All dental professionals need to become more involved in the leadership of their communities.

The York review--a systematic review of public water fluoridation: a commentary.

Following the election of the British government in May 1997, a policy document outlining proposals to improve the health of the nation was published. This document placed a major emphasis on reducing inequalities in health and recognised the continuing poor state of oral health in deprived communities. However, whilst acknowledging the benefits of water fluoridation as a caries preventive measure, the Department of Health suggested that most of the research had been carried out some years ago and furthermore, recognised that strong views were held both for and against fluoridation.

[Fluorosis: diagnosis, risk assessment and epidemiology]. / Fluorose: diagnostic, détermination du risque et épidémiologie.

Fluorosis is the most widespread side-effect of fluoride use and appears as discrete white spots on the enamel up to severe enamel dysplasia. There are different techniques for scoring fluorosis in epidemiological surveys. In the literature there is no uniform way of selection of teeth and data processing. Fluorosis risk is determined by environmental factors such as water and food fluoride content as well as individual factors such as use (or misuse) of fluoride supplements and fluoridated oral hygiene products. In a group of Flemish schoolchildren, fluorosis prevalence is low and mainly related to use of fluoride supplements and toothpaste in childhood.

Role of fluoride in oral health promotion.

Fluoride has played a pivotal role in oral health promotion over the past 50 years. This paper reviews key issues currently impacting on the role of fluoride in preventing dental caries. The understanding of the process of dental caries and the mode of action of fluoride has changed in recent years. Dental caries is a continuous process of demineralisation and remineralization of the enamel and fluoride plays a key role in this process through its action at the plaque enamel interface. It is now accepted that the primary mode of action of fluoride is post-eruptive. The post-eruptive action of fluoride has resulted in new methods of delivering fluoride. The paper discusses the impact of these new methods of delivering fluoride on total fluoride intake in children and on the prevalence of dental fluorosis. The role of different methods of delivering fluoride both on a community and individual basis is presented and recommendations are outlined.

Attitudes to water fluoridation in South Africa 1998. Part III. An analysis of pro- and anti-fluoridation attitudes in South Africa.

A survey on attitudes to water fluoridation in the South African population (N = 2,220) was undertaken in 1998. The purpose of this study was to evaluate responses to, and underlying reasons for pro- and anti-fluoridation attitudes. In response to a structured questionnaire, 61.9% of respondents were in favour of fluoride being added to drinking water and 9% were against it. Reasons supporting and opposing this measure were as follows. Of those who favoured the measure, 30% of respondents said it was because it would reduce tooth decay and 30% said it 'affects health', presumably positively. Other reasons include, 'it purifies water' (10.3%), 'more people will be reached' (9.8%), 'it strenghtens bones' (6%), 'it prevents plaque' (4.6%) and it 'improves the taste of water' (3.1%). There was a 1.3% 'don't know' response. Those opposed to the measure said, 'water should stay as it is' (26.1%), 'if it stays in the system it will create other problems' (15.6%), it 'affects health', presumably negatively (12.3%) and 'it will increase the cost of water' (8.8%). The 'don't know' response was 10.5%. When asked to give reasons for their 'don't know' response in the 'uncertain' category, 90% said they did not know. Given the contradictory and variable responses in both 'yes' and 'no' categories, the possible reasons for these findings could include: the differences between knowledge and beliefs, alternative health and lifestyle practices, levels of education, resistance to change and personality factors, among others. Understanding the assumption people make about fluoridation would help to structure education programmes to provide accurate and comprehensive information.

Recommendations for fluoride use in children. A review.

Fluoride has played a significant role in the improvement of the oral health of all Americans. Because of its effectiveness, cost and frequency of exposure, water fluoridation is the preferred method of delivery. Today, many products containing fluoride are available over the counter and as prescription items. The potential for exposure to multiple sources of fluoride has increased. Therefore, practitioners should prescribe fluoride therapy based on an understanding of patients' total exposure to fluoride and the need for additional amounts.

Criteria for the assessment of adverse effects of chemotherapy on the oral microflora.

Any assessment of an antimicrobial agent for the prevention of dental caries must include a consideration of its possible adverse effects on the oral flora. It must include an examination of the resistance developed by the target pathogens and either developed by, or inherently present in, microorganisms that are known to cause opportunistic infections (yeasts, enteric organisms, Pseudomonas, clostridia, and Staphylococcus aureus). Streptococcus pyogenes should also be included. Insofar as possible, these assessments should be done in preliminary experiments, both in vitro and clinical, rather than in caries trials, so that the large numbers of subjects will not be submitted to unnecessary exposure to the formulation. It must be recognized that some combinations of agent, vehicle, and frequency are more prone than others to cause adverse effects on the oral flora, and will also influence the length of the test period that should be utilized. The microbial assessments should be done on subjects prior to use of the agent, at appropriate frequencies during therapy, and approximately 2 months after the cessation of therapy. Currently, requirements to assess the state of gingival or periodontal health by microbiological examination seem unjustified, because of the relative lack of strong evidence for their diagnostic or predictive value (Ranney, 1989) and because of the ease with which direct measurements of clinical signs and symptoms can be made. Consequently, only the latter should be required.