Root canal therapy of anterior teeth with dens invaginatus

Dens in dente is a developmental anomaly resulting from infolding of the enamel organ into dental papilla prior to calcification of dental tissue. The pulpal tissue of the tooth can be vulnerable for bacterial invasion through direct exposure to the oral cavity or through defective enamel and dentin of the infolding part, thereby increasing the possibility of pulpal necrosis and subsequent apical periodontitis. Treatment planning of teeth with dens invaginatus may be difficult due to the complex root canal morphology. Therefore, thorough knowledge of anatomical variations of dens invaginatus is of great importance for proper treatment planning. The focus of this case report is on Oehler’s type II and III dens invaginatus. The infolding of type III dens invaginatus extends beyond the crown and CEJ. Bacterial invasion through the infolding can easily cause inflammation of the pulpal and periradicular tissue. This case report presents endodontic treatment of type II and III dens invaginatus with the aid of CBCT.

Nurses’ healthy behaviors during the COVID-19 pandemic and related factors / 한국간호교육학회지

Purpose@#This study aimed to examine nurses’ healthy behaviors during the coronavirus disease 2019 (COVID-19) pandemic and related factors. @*Methods@#A cross-sectional study was adapted, and data were collected from 300 hospital nurses between August and November 2021. The nurses’ characteristics, healthy behaviors, COVID-19 stress levels, health self-efficacy, and nursing professional pride were self-reported using structured questionnaires. Multivariable linear regressions were conducted to identify factors related to nurses’ healthy behaviors. @*Results@#Healthy lifestyle was the lowest among the subscales of healthy behaviors. Nurses’ healthy behaviors were related to age (B=0.15, p=.021), COVID-19 stress level (B=-0.08, p=.007), nursing professional pride (B=0.19, p<.001), and health self-efficacy (B=0.38, p<.001). @*Conclusion@#To enhance nurses’ healthy lifestyles during the pandemic, organizational support is needed, such as ensuring facilities for rest or physical activities accessible from the hospital and supplying healthy food in hospitals. Younger nurses, nurses with high levels of COVID-19 stress, and nurses with lower health self-efficacy may benefit from hospital organizations that provide more support and guidance in promoting health behaviors. Furthermore, hospital organizations should promote professional pride by empowering nurses’ efforts and reinforcing their values.

Impacts of alternative clinical practice on nursing professionalism in nursing students during the COVID-19 pandemic / 한국간호교육학회지

Purpose@#This study aimed to examine the impacts of alternative clinical practice on nursing professionalism in nursing students during the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#A cross-sectional study was used for this study. Data were collected from 178 junior and senior nursing students from December 28, 2022 to January 6, 2023. The nursing students’ characteristics, nursing professionalism, clinical competence, extent of alternative clinical practice, and satisfaction with alternative clinical practice were self-reported through an on-line survey. Multiple linear regressions were conducted to examine the impacts of alternative clinical practice on nursing professionalism along with the confounding variables. @*Results@#The nursing students reported that they performed alternative clinical practice for more than half of their clinical practice throughout 2022. The extent of alternative clinical practice (β=-.11, p=.028), satisfaction with content (β=.14, p=.045), and evaluation of the alternative clinical practice (β=.17, p=.007) were found to have impacted nursing professionalism. These variables explained 55.6% of the variance in nursing professionalism. @*Conclusion@#The study results suggest that the alternative nursing practice could impact nursing students’ professionalism. However, it would be possible to develop nursing professionalism if the students’ satisfaction with the alternative clinical practice were increased. Nurse educators need to improve the content and evaluation methods of alternative clinical practice to promote nursing professionalism during the implementation of such alternative clinical practice.

Otoconial Degeneration After Transient Ischemia Induced by Four-Vessel Occlusion in Rats

Background@#and Purpose Ischemia of the inner ear may damage the otoconia. However, no study has explored any changes in the configuration of otoconia after transient ischemia of the labyrinth. @*Methods@#Nineteen 7-week-old Sprague-Dawley rats were randomly assigned to either the sham (n=5) or the experimental group (n=14). The rats in the experimental group were subjected to global ischemia for 20 minutes using a four-vessel occlusion model, and were sacrificed seven days after the procedure. The rats in the sham group were sacrificed without any procedure. The otolithic organs (utricle and saccule) were dissected out for scanning electron microscope. @*Results@#The otolithic organs in the sham group showed their normal gross configuration with a dense clumping of otoconia with a normal hexagonal morphology and a smooth surface. The otolithic organs in the experimental group also maintained a grossly normal configuration, but each otoconia showed irregular surfaces with numerous cracks or furrows, especially in the periphery of the otoconial bed. @*Conclusions@#The current study showed that otoconial degeneration may occur even after transient ischemia of the labyrinth. This finding supports an association between cerebral ischemia and benign paroxysmal positional vertigo.

Physiological Predictors of Treatment Response to Biofeedback in Patients With Panic Disorder / 정신신체의학

Objectives@#：Biofeedback is a useful non-pharmacological treatment for panic disorder (PD), but no studies have identified physiological markers related to the treatment response. This study investigated predictors of the treatment response for biofeedback in patients with PD. @*Methods@#：A retrospective study based on the electronic medical records of 372 adult patients with PD was performed. Patients received biofeedback treatment at least once, and physiological markers including heart rate, heart rate variability, respiratory rate, skin conductance, skin temperature, and electromyography were collected before the treatment began. The patients were classified as responders or non-responders based on the change inClinical Global Impression-Severity (CGI-S) score. @*Results@#：The response rate to biofeedback treatment was 30.4%. Multivariable logistic regression analysis revealed that a higher CGI-S score at baseline and fewer benzodiazepine prescriptions were associated with a better response to biofeedback treatment. According to subgroup analyses, the baseline CGI-S score, dose of benzodiazepines, and skin conductance are candidate predictors of the response to biofeedback treatment in men, while only baseline disease severity was associated with the treatment response in women. @*Conclusions@#：The present results suggest that skin conductance may be target marker and predictor for biofeedback in male patients with PD.

Clinical Significance of Redundant Nerve Roots of the Cauda Equina in Spine MRI

Purpose@#This study aimed to evaluate the association of redundant nerve roots of the cauda equina (RNRCEs) with the degree and duration of symptoms in patients with lumbar spinal canal stenosis. @*Materials and Methods@#Between January 2017 and December 2018, 224 patients demonstrating central canal stenosis on lumbar spine MRI were included. Various imaging findings associated with spinal canal stenosis were investigated, as were the presence, level, type, and length of RNRCEs, and the presence of nerve root swelling. Clinically, the degree of symptoms and symptom changes after treatment were investigated. Multinomial logistic regression was used for statistical analysis. @*Results@#RNRCEs were present in 142 patients (63.4%). Most RNRCEs were observed above the level of stenosis (47.3%). RNRCE was associated with the number of stenoses and symptom duration (p < 0.05). The presence, level, type, and length of RNRCE and nerve root swelling significantly affected the severity of symptoms (p < 0.05). The type of treatment influenced symptom changes (p < 0.05). @*Conclusion@#The recognition and assessment of RNRCEs on spinal MRI are clinically important because the presence, level, type, and length of a RNRCE may be associated with the degree of symptoms and help predict the clinical outcome according to treatment methods.

Tinnitus Update

This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.

Update on Nystagmus and Other Ocular Oscillations

This review reports on recent advances in understanding nystagmus and other involuntary eye movements. Advances in quantitative evaluations of eye movements using oculography, computational model simulations, genetics, and imaging technologies have markedly improved our understanding of the pathophysiology of involuntary eye movements, as well as their diagnosis and management. Patient-initiated capture of eye movements, especially when paroxysmal, and the online transfer of these data to clinicians would further enhance the ability to diagnose involuntary eye movements.

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Background@#and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). @*Methods@#We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. @*Results@#Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). @*Conclusions@#SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.

The Nationwide Incidence of Retinal Vein Occlusion Following Dialysis due to End-stage Renal Disease in Korea, 2004 through 2013

Background@#We investigated the incidence and risk of retinal vein occlusion (RVO) in endstage renal disease (ESRD) patients on dialysis in Korea. @*Methods@#In this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve.Whether the dialysis modality affects the development of RVO was also evaluated. @*Results@#In this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test). @*Conclusion@#This study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.

Significant Domains of Life Satisfaction That Affect Suicidal Behavior in Adolescents

Objectives@#Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. @*Methods@#Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. @*Results@#In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. @*Conclusion@#Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.

Milk Consumption and Bone Mineral Density in Adults: Using Data from the Korea National Health and Nutrition Examination Survey 2008–2011 / 가정의학회지

Background@#Milk consumption is associated with bone mineral density (BMD), but reports are limited in terms of participant age, sex, and number of study subjects. We investigated the association between milk consumption and BMD in South Korean adults (≥20 years). @*Methods@#We analyzed men and women aged ≥20 years who participated in the Korean National Health and Nutrition Examination Survey, 2008–2011. We used linear regression to calculate the mean BMD and 95% confidence interval (CI) based on the frequency of milk consumption. Multivariate logistic regression analysis was used to estimate the odds ratios (ORs) and 95% CI for T-scores ≤-2.5 (osteoporosis) in both men aged ≥50 years and postmenopausal women. @*Results@#In total 8,539 subjects were studied. Drinking milk more than once a day was associated with higher BMD in the total femur and femoral neck in men aged <50 years and lumbar spine in men aged ≥50 years, compared to less than once a week. It was also associated with lower ORs for osteoporosis of the femoral neck and lumbar spine in men aged ≥50 years (OR, 0.35; 95% CI, 0.125–0.979 and OR, 0.34; 95% CI, 0.143–0.804, respectively). In postmenopausal women who consumed milk 2–6 times weekly, higher BMD and lower OR for osteoporosis were observed in the total femur (OR, 0.23; 95% CI, 0.055–0.958). @*Conclusion@#This study suggests that frequent milk consumption could potentially reduce osteoporosis incidence in South Korean adults. Further prospective study is necessary to elucidate the effect of milk consumption on BMD.

Update on Nystagmus and Other Ocular Oscillations

This review reports on recent advances in understanding nystagmus and other involuntary eye movements. Advances in quantitative evaluations of eye movements using oculography, computational model simulations, genetics, and imaging technologies have markedly improved our understanding of the pathophysiology of involuntary eye movements, as well as their diagnosis and management. Patient-initiated capture of eye movements, especially when paroxysmal, and the online transfer of these data to clinicians would further enhance the ability to diagnose involuntary eye movements.

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Background@#and PurposeTo determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). @*Methods@#We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. @*Results@#Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). @*Conclusions@#SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.

The Nationwide Incidence of Retinal Vein Occlusion Following Dialysis due to End-stage Renal Disease in Korea, 2004 through 2013

Background@#We investigated the incidence and risk of retinal vein occlusion (RVO) in endstage renal disease (ESRD) patients on dialysis in Korea. @*Methods@#In this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve.Whether the dialysis modality affects the development of RVO was also evaluated. @*Results@#In this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test). @*Conclusion@#This study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.

Significant Domains of Life Satisfaction That Affect Suicidal Behavior in Adolescents

Objectives@#Adolescent suicide is a serious national issue in Korea. Recently, life satisfaction has been recognized as a major factor related to this issue. The main purpose of this study was to identify the domains of life satisfaction that affect suicidal behavior in adolescence. @*Methods@#Data were collected from eight middle schools in Incheon, Korea. A total of 1297 students answered questions regarding their demographic characteristics, happiness, self-related life satisfaction domains (appearance, leisure time, physical health, and mental health), depressive symptoms, and suicidal behavior. @*Results@#In the Spearman correlation analysis, female sex, perceived socioeconomic status (SES), happiness, and all four self-related satisfaction scores showed significant correlations with depression and suicidality. Multivariate regression analysis suggested that suicidality was significantly affected by perceived SES, satisfaction with appearance, mental health satisfaction, and depression. Finally, depression was identified as a partial mediator of the association between mental health satisfaction and suicidality, and a complete mediator of the association between female sex and suicidality. @*Conclusion@#Perceived SES, satisfaction with appearance, and mental health satisfaction significantly affected students’ suicidality, with or without the effect of depression. Health authorities, educators, and family members must be aware of this to identify adolescents at suicide risk earlier.

Milk Consumption and Bone Mineral Density in Adults: Using Data from the Korea National Health and Nutrition Examination Survey 2008–2011 / 가정의학회지

Background@#Milk consumption is associated with bone mineral density (BMD), but reports are limited in terms of participant age, sex, and number of study subjects. We investigated the association between milk consumption and BMD in South Korean adults (≥20 years). @*Methods@#We analyzed men and women aged ≥20 years who participated in the Korean National Health and Nutrition Examination Survey, 2008–2011. We used linear regression to calculate the mean BMD and 95% confidence interval (CI) based on the frequency of milk consumption. Multivariate logistic regression analysis was used to estimate the odds ratios (ORs) and 95% CI for T-scores ≤-2.5 (osteoporosis) in both men aged ≥50 years and postmenopausal women. @*Results@#In total 8,539 subjects were studied. Drinking milk more than once a day was associated with higher BMD in the total femur and femoral neck in men aged <50 years and lumbar spine in men aged ≥50 years, compared to less than once a week. It was also associated with lower ORs for osteoporosis of the femoral neck and lumbar spine in men aged ≥50 years (OR, 0.35; 95% CI, 0.125–0.979 and OR, 0.34; 95% CI, 0.143–0.804, respectively). In postmenopausal women who consumed milk 2–6 times weekly, higher BMD and lower OR for osteoporosis were observed in the total femur (OR, 0.23; 95% CI, 0.055–0.958). @*Conclusion@#This study suggests that frequent milk consumption could potentially reduce osteoporosis incidence in South Korean adults. Further prospective study is necessary to elucidate the effect of milk consumption on BMD.

Preventive effect of a 18-year water fluoridation program for dental caries in a rural area of Korea / 대한구강보건학회지

Objectives@#The water fluoridation program in Hapcheon township area has been implemented since 2000. This study aimed to evaluate the caries-preventive effect of water fluoridation on permanent teeth after implementation of an 18-year community water fluoridation program in a suburban area. @*Methods@#A survey was conducted in 2018 with 359 subjects, aged 8, 10, and 12 years, residing in the Hapcheon township area. In this prospective cohort study, the data on caries prevalence obtained from 671 subjects, aged 8, 10, and 12 years, in 2000, when the community water fluoridation program was initiated in the township, were used as a cohort to evaluate the caries-preventive effect after 18 years. The caries-preventive effect of community water fluoridation on permanent teeth was estimated by comparison of the adjusted DMFT scores between the program and the control group, and between the pre- and post-program data after 18 years. The confounding factor, mean number of fissure-sealed teeth, was adjusted to estimate the caries-preventive effect of fluoridation on permanent teeth. @*Results@#Based on the results of the surveys conducted in Hapcheon-eup in 2000 and 2018, the mean number of fissure-sealed permanent teeth was 2.24 in 2000 and 1.38 in 2018. The mean DMFT scores of subjects aged 8, 10, and 12 years in 2018, adjusted for fissure-sealed permanent teeth in the fluoridated area, were significantly lower than those reported by the 2018 Korea National Children’s Oral Health Survey. In addition, the mean values of the adjusted DMFT scores of subjects aged 8, 10, and 12 years in 2018, after the 18-year fluoridation program, were significantly lower than those reported in 2000, the year the fluoridation program was initiated. @*Conclusions@#Community water fluoridation has a high caries-reducing effect; thus, the reintroduction of water fluoridation program is desirable to prevent dental caries.

Risk factors related to periodontal health of adolescents / 대한구강보건학회지

Objectives@#The purpose of this study was to investigate the risk factors related to periodontal health in middle school and high school adolescents. @*Methods@#This study was conducted using data from the Sixth Korean National Health and Nutrition Examination Survey (KNHANES, 2013-2015). Among the 22,948 participants in the Sixth KNHANES, 1,222 participants (aged 12-18 years) who completed the systemic and oral health examinations and questionnaires were included in this study. Independent variables related to demographic socioeconomic status and oral health-related behaviors were the following: age, gender, household income, frequency of daily toothbrushing, smoking, alcohol drinking, annual dental visit, and periodontal treatment. The dependent variables were the prevalence of gingival bleeding or calculus and the number of sextants with gingival bleeding or calculus. @*Results@#Among the total participants, 34.1% were diagnosed with prevalence of gingival bleeding or calculus, and periodontal health was found to be at its worst at 17 years of age (41.6% of participants). Moreover, household income, alcohol drinking, annual dental visits, and frequency of daily toothbrushing were related to prevalence and the number of sextants with gingival bleeding or calculus. The adjusted odds ratio (aOR) for prevalence of gingival bleeding or calculus by alcohol consumption, toothbrushing less than twice per day, and number of DMFT were 5.00 (95% CI: 2.24-11.18), 2.21 (95% CI: 1.21-4.04), and 1.09 (95% CI: 1.02-1.17), respectively. @*Conclusions@#To prevent periodontal disease among adolescents, it is necessary to improve oral health-related behavior and its associated factors and continuous oral health education.

Preventive effect of a 18-year water fluoridation program for dental caries in a rural area of Korea / 대한구강보건학회지

Objectives@#The water fluoridation program in Hapcheon township area has been implemented since 2000. This study aimed to evaluate the caries-preventive effect of water fluoridation on permanent teeth after implementation of an 18-year community water fluoridation program in a suburban area. @*Methods@#A survey was conducted in 2018 with 359 subjects, aged 8, 10, and 12 years, residing in the Hapcheon township area. In this prospective cohort study, the data on caries prevalence obtained from 671 subjects, aged 8, 10, and 12 years, in 2000, when the community water fluoridation program was initiated in the township, were used as a cohort to evaluate the caries-preventive effect after 18 years. The caries-preventive effect of community water fluoridation on permanent teeth was estimated by comparison of the adjusted DMFT scores between the program and the control group, and between the pre- and post-program data after 18 years. The confounding factor, mean number of fissure-sealed teeth, was adjusted to estimate the caries-preventive effect of fluoridation on permanent teeth. @*Results@#Based on the results of the surveys conducted in Hapcheon-eup in 2000 and 2018, the mean number of fissure-sealed permanent teeth was 2.24 in 2000 and 1.38 in 2018. The mean DMFT scores of subjects aged 8, 10, and 12 years in 2018, adjusted for fissure-sealed permanent teeth in the fluoridated area, were significantly lower than those reported by the 2018 Korea National Children’s Oral Health Survey. In addition, the mean values of the adjusted DMFT scores of subjects aged 8, 10, and 12 years in 2018, after the 18-year fluoridation program, were significantly lower than those reported in 2000, the year the fluoridation program was initiated. @*Conclusions@#Community water fluoridation has a high caries-reducing effect; thus, the reintroduction of water fluoridation program is desirable to prevent dental caries.