Reproductive performance of Peregrine falcons relative to the use of organochlorine pesticides, 1946-2021.

Populations of some fish- and meat-eating birds suffered dramatic declines globally following the introduction of organochlorine pesticides during the late 1940s and 1950s. It has been hypothesised that these population declines during the 1950s-1970s were largely driven by a combination of reproductive failure due to eggshell-thinning, egg breakage and embryonic death attributable to DDT and its metabolites, and to enhanced mortality attributable to the more toxic cyclodiene compounds such as aldrin and dieldrin. Using 75 years (1946-2021) of Peregrine falcon (Falco peregrinus) monitoring data (315 unique nest-sites monitored for 6110 nest-years), we studied the breeding performance of a resident Peregrine population in southern Scotland relative to the spatiotemporal pattern of organochlorine pesticide use. We show that (i) Peregrine breeding success and measures of breeding performance increased substantially following the reduction in, and subsequently a complete ban on, the use of organochlorine pesticides; (ii) improvements in Peregrine breeding performance were more dramatic in southeastern Scotland where agriculture was the predominant land use than in southwestern Scotland where there was less arable and more forested land; (iii) Peregrines nesting closer to the coast generally had higher fledging success (that is, a higher proportion of clutches that produced at least one fledgeling) than those nesting inland farther away from the coast; (iv) low temperatures and excessive rain in May negatively affected Peregrine fledging success; and (v) Peregrine abundance increased in parallel with improvements in reproductive performance following the reduction and then complete ban on the use of organochlorine pesticides in the UK. However, recovery was gradual and occurred over four decades, and rate of recovery varied among measures of reproductive performance (egg, nestling and fledgeling production). Our results suggest that the temporal pattern of organochlorine pesticide use strongly influenced Peregrine reproductive parameters but that the pattern of influence differed regionally. Overall results are consistent with the hypothesis that reproductive failure caused by organochlorine pesticides was an important driver of the decline in the south Scottish Peregrine population, and that improvements in all measures of breeding performance following a reduction and eventual ban on organochlorine use facilitated the observed increase in this population.

Integrating data types to estimate spatial patterns of avian migration across the Western Hemisphere.

For many avian species, spatial migration patterns remain largely undescribed, especially across hemispheric extents. Recent advancements in tracking technologies and high-resolution species distribution models (i.e., eBird Status and Trends products) provide new insights into migratory bird movements and offer a promising opportunity for integrating independent data sources to describe avian migration. Here, we present a three-stage modeling framework for estimating spatial patterns of avian migration. First, we integrate tracking and band re-encounter data to quantify migratory connectivity, defined as the relative proportions of individuals migrating between breeding and nonbreeding regions. Next, we use estimated connectivity proportions along with eBird occurrence probabilities to produce probabilistic least-cost path (LCP) indices. In a final step, we use generalized additive mixed models (GAMMs) both to evaluate the ability of LCP indices to accurately predict (i.e., as a covariate) observed locations derived from tracking and band re-encounter data sets versus pseudo-absence locations during migratory periods and to create a fully integrated (i.e., eBird occurrence, LCP, and tracking/band re-encounter data) spatial prediction index for mapping species-specific seasonal migrations. To illustrate this approach, we apply this framework to describe seasonal migrations of 12 bird species across the Western Hemisphere during pre- and postbreeding migratory periods (i.e., spring and fall, respectively). We found that including LCP indices with eBird occurrence in GAMMs generally improved the ability to accurately predict observed migratory locations compared to models with eBird occurrence alone. Using three performance metrics, the eBird + LCP model demonstrated equivalent or superior fit relative to the eBird-only model for 22 of 24 species-season GAMMs. In particular, the integrated index filled in spatial gaps for species with over-water movements and those that migrated over land where there were few eBird sightings and, thus, low predictive ability of eBird occurrence probabilities (e.g., Amazonian rainforest in South America). This methodology of combining individual-based seasonal movement data with temporally dynamic species distribution models provides a comprehensive approach to integrating multiple data types to describe broad-scale spatial patterns of animal movement. Further development and customization of this approach will continue to advance knowledge about the full annual cycle and conservation of migratory birds.

A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation.

OBJECTIVES: There is a lack of evidence on the proportion and severity of fluorosis in adult populations exposed and not exposed to fluoridated water over their lifetimes. The aim of this study was to compare the proportion and severity of fluorosis in adults with lifetime exposure to water fluoridation with a nonexposed sample. A secondary aim was to report the gradient of fluorosis severity by age. METHODS: A cross-sectional study recruited a sample with lifetime exposure to water fluoridation and a matched, nonexposed group. 580 participants, aged 18-52 years (mean 34.3, SD 9.4) and 64% female, were recruited in general dental practices located in fluoridated (Birmingham and County Durham) and nonfluoridated areas (Manchester). Three digital images were taken of their incisors and an experienced examiner who was blind to exposure status viewed the images remotely and allocated fluorosis scores using the Thylstrup and Fejerskov (TF) scale. RESULTS: At TF ≥ 1 (any fluorosis), a significantly higher proportion of participants from the fluoridated area had fluorosis (F 39% NF 21.3%, P < 0.001), at the threshold TF ≥ 3 ("aesthetic concern"), the difference was no longer statistically significant (F 4.1%, NF 2.2%, P = 0.25). There was a gradient by age, whereby fluorosis was highest in the youngest and lowest in the oldest age group. CONCLUSIONS: Although fluorosis is more common in adults with lifetime exposure to water fluoridation than those with no exposure, the aesthetic impact of fluorosis seems to diminish with age.

Automatic detection and classification of dental fluorosis in vivo using white light and fluorescence imaging.

OBJECTIVES: To assess a novel method of automatic fluorosis detection and classification from white light and fluorescent images. METHODS: Dental images from 1,729 children living in two fluoridated and two non-fluoridated UK cities were utilised. A novel detection and classification algorithm was applied to each image and TF scores were obtained using thresholding criteria. These were compared to clinical reference standard images. Comparisons between reference and automated assessments were undertaken to record correct and incorrect classifications and the ability of the system to separate the fluoridated and non-fluoridated populations. RESULTS: The automated system performed well and was able to differentiate the two populations (P < 0.0001) to the same degree as the reference standard. When using the highest score from the clinical assessment the agreement between automated and clinical assessments was 0.56 (Kappa SE = 0.0160, p < 0.0001). CONCLUSIONS: Assessment of dental fluorosis is typically undertaken by clinical examiners in epidemiological studies. The training and calibration of such examiners is complex and time consuming and the assessments are subject to bias - frequently because of the examiner's awareness of the water fluoridation status of subjects. The use of remote scoring using photographs has been advocated but still requires trained examiners. This study has shown that image-processing methodologies applied to white light and fluorescent images could automatically score fluorosis and statistically separate fluoridated and non-fluoridated areas. The system requires further refinement to manage confounding factors such as the presence of non-fluoride opacities and tooth stain.

Dispersal: a matter of scale.

Population density around the natal site is often invoked as an explanation for variation in dispersal distance, with the expectation that competition for limiting resources, coupled with increased intra-specific aggression at high densities, should drive changes in dispersal distances. However, tests of the density-dependent dispersal hypothesis in long-lived vertebrates have yielded mixed results. Furthermore, conclusions from dispersal studies may depend on the spatial and temporal scales at which density and dispersal patterns are examined, yet multi-scale studies of dispersal are rare. Here, we present the findings of a long-term study examining factors influencing natal dispersal distances for the non-migratory population of Peregrine Falcons (Falco peregrinus) in the British Isles across distinct spatial and temporal scales. Our smallest scale study included Peregrines ringed as nestlings and subsequently recaptured alive in south Scotland-north England, an area that was intensively studied during the time periods 1974-1982 and 2002-2016. Second, we examined dispersal patterns of birds ringed as nestlings in south Scotland-north England, but subsequently recaptured alive or recovered dead anywhere in the British Isles. Finally, we examined the natal dispersal patterns for Peregrines ringed and recaptured or recovered anywhere in the British Isles from 1964 to 2016. Consistent with prior findings, females dispersed farther than males across all scales. However, the patterns of dispersal were strongly scale dependent. Specifically, we found a lack of a discernible relationship between index of density and dispersal distance in the limited study area, but when region-wide recaptures and recoveries were included in the analyses, a negative relationship was revealed. Our results suggest that conclusions of dispersal studies may be scale dependent, highlighting the importance of spatial and temporal scales in examining and interpreting the relationship between population density and dispersal patterns.

Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality, outcomes and value in primary dental care practice a realistic concept?

BACKGROUND: There is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach. METHODS: Improvement in quality and preventive focus of dental practice care delivery was explored through determining the impact of several projects, to share how evidence, skill mix and clinical leadership could be utilised in design, implementation and measurement of care outcomes in general dental practice in order to champion and advocate change, during a period of substantial change within the NHS system. The projects were: 1. A needs-led, evidence informed preventive care pathway approach to primary dental care delivery with a focus on quality and outcomes. 2. Building clinical leadership to influence and advocate for improved quality of care; and spread of learning through local professional networks. This comprised two separate projects: improved access for very young children called "Baby Teeth DO Matter" and the production of a clinically led, evidence-based guidance for periodontyal treatment in primary care called "Healthy Gums DO Matter". RESULTS: What worked and what hindered progress, is described. The projects developed understanding of how working with 'local majorities' of clinicians influenced, adoption and spread of learning, and the impact in prompting wider policy and contract reform in England. CONCLUSIONS: The projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an environment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision points in the patient's journey.

Demography of population recovery: survival and fidelity of peregrine falcons at various stages of population recovery.

Factors influencing vital demographic rates and population dynamics can vary across phases of population growth. We studied factors influencing survival and fidelity of peregrine falcons in south Scotland-north England at two stages of population growth: when the population was recovering from pesticide-related declines and density was low, and when it had largely recovered from pesticide effects and density was high. Fidelity was higher for: adults and subadults than for juveniles, females than for males, and juveniles and adults during the low-density than during the high-density study period. Survival was age specific, with lower survival for juveniles than for older birds (juveniles, 0.600 ± SE 0.063; subadults, 0.811 ± 0.058; adults, 0.810 ± 0.034). Furthermore, there was some evidence that survival was generally lower for all age classes during the low-density period than during the high-density period, possibly due to a chronic, persistent effect of organochlorine pesticides as the population recovered. Evidence for a density-dependent effect on survival was weak, but a negative effect of density on fidelity of juveniles (dispersing age class) during the recovery phase suggests density-dependent dispersal when the population was increasing. Our results show how population density can influence demographic parameters differently and how such influences can vary across phases of population growth.

Summary of: fluoride intake of infants living in non-fluoridated and fluoridated areas.

OBJECTIVES: Data on fluoride exposure of infants are sparse. This study aimed to estimate total daily fluoride intake (TDFI) of infants aged 1-12 months, living in non-fluoridated and fluoridated areas in north-east England. METHODS: Daily dietary fluoride intake was assessed using a three-day food diary coupled with analysis of fluoride content of food/drink consumed, using a F-ISE and diffusion method. A questionnaire with an interview was used to collect information on toothbrushing habits. TDFI was estimated from diet, plus fluoride supplements and dentifrice ingestion where used. RESULTS: Thirty-eight infants completed the study; 19 receiving fluoridated water (mean 0.97 mgF/l) and 19 receiving non-fluoridated water (mean 0.19 mgF/l). Mean (SD) TDFI for the infants living in fluoridated and non-fluoridated areas was 0.107 (0.054) and 0.024 (0.015) mg/kg body weight per day, respectively. Diet was the only fluoride source for 87% of infants and none used fluoride supplements. For infants for whom mouth/teeth cleaning was undertaken, dentifrice contribution to TDFI ranged from 24 to 78%. CONCLUSIONS: Infants living in fluoridated areas, in general, may receive a fluoride intake, from diet only, of more than the suggested optimal range for TDFI. This emphasises the importance of estimating TDFI at an individual level when recommendations for fluoride use are being considered.

Evaluating the use of fluorescent imaging for the quantification of dental fluorosis.

BACKGROUND: The quantification of fluorosis using fluorescence imaging (QLF) hardware and stain analysis software has been demonstrated in selected populations with good correlation between fluorescent image metrics and TF Index scores from photographs. The aim of this study was to evaluate the ability of QLF to quantify fluorosis in a population of subjects (aged 11-13) participating in an epidemiological caries and fluorosis survey in fluoridated and non-fluoridated communities in Northern England. METHODS: Fluorescent images of the maxillary incisors were captured together with standardized photographs were scored blind for fluorosis using the TF Index. Subjects were excluded from the analysis if there were restorations or caries on the maxillary central incisors. RESULTS: Data were available for 1774 subjects (n=905 Newcastle, n=869 Manchester). The data from the fluorescence method demonstrated a significant correlation with TF Index scores from photographs (Kendall's tau = 0.332 p<0.0001). However, a number of additional confounding factors such as the presence of extrinsic stain or increased enamel translucency on some subjects without fluorosis or at low levels of fluorosis severity had an adverse impact on tooth fluorescence and hence the outcome variable. This in conjunction with an uneven distribution of subjects across the range of fluorosis presentations may have resulted in the lower than anticipated correlations between the fluorescent imaging metrics and the photographic fluorosis scores. Nevertheless, the fluorescence imaging technique was able to discriminate between a fluoridated and non-fluoridated population (p<0.001). CONCLUSIONS: Despite confounding factors the fluorescence imaging system may provide a useful objective, blinded system for the assessment of enamel fluorosis when used adjunctively with photographic scoring.

Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 2: the ability of fluorescence imaging to detect differences in fluorosis prevalence and severity for different fluoride intakes from water.

BACKGROUND: To assess the ability of fluorescence imaging to detect a dose response relationship between fluorosis severity and different levels of fluoride in water supplies compared to remote photographic scoring in selected populations participating in an observational, epidemiological survey in Chiang Mai, Thailand. METHODS: Subjects were male and female lifetime residents aged 8-13 years. For each child the fluoride content of cooking water samples (CWS) was assessed to create categorical intervals of water fluoride concentration. Fluorescence images were taken of the maxillary central incisors and analyzed for dental fluorosis using two different software techniques. Output metrics for the fluorescence imaging techniques were compared to TF scores from blinded photographic scores obtained from the survey. RESULTS: Data from 553 subjects were available. Both software analysis techniques demonstrated significant correlations with the photographic scores. The metrics for area effected by fluorosis and the overall fluorescence loss had the strongest association with the photographic TF score (Spearman's rho 0.664 and 0.652 respectively). Both software techniques performed well for comparison of repeat fluorescence images with ICC values of 0.95 and 0.85 respectively. CONCLUSIONS: This study supports the potential use of fluorescence imaging for the objective quantification of dental fluorosis. Fluorescence imaging was able to discriminate between populations with different fluoride exposures on a comparable level to remote photographic scoring with acceptable levels of repeatability.

Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 1: assessing fluorosis risk, predictors of fluorosis and the potential role of food preparation.

BACKGROUND: To determine the severity of dental fluorosis in selected populations in Chiang Mai, Thailand with different exposures to fluoride and to explore possible risk indicators for dental fluorosis. METHODS: Subjects were male and female lifetime residents aged 8-13 years. For each child the fluoride content of drinking and cooking water samples were assessed. Digital images were taken of the maxillary central incisors for later blind scoring for TF index (10% repeat scores). Interview data explored previous cooking and drinking water use, exposure to fluoride, infant feeding patterns and oral hygiene practices. RESULTS: Data from 560 subjects were available for analysis (298 M, 262 F). A weighted kappa of 0.80 was obtained for repeat photographic scores. The prevalence of fluorosis (TF 3+) for subjects consuming drinking and cooking water with a fluoride concentration of <0.9 ppm was 10.2%. For subjects consuming drinking and cooking water >0.9 ppm F the prevalence of fluorosis (TF 3+) rose to 37.3%. Drinking and cooking water at age 3, water used for infant formula and water used for preparing infant food all demonstrated an increase in fluorosis severity with increase in water fluoride level (p < 0.001). The probability estimate for the presentation of aesthetically significant fluorosis was 0.53 for exposure to high fluoride drinking (≥0.9 ppm) and cooking water (≥1.6 ppm). CONCLUSIONS: The consumption of drinking water with fluoride content >0.9 ppm and use of cooking water with fluoride content >1.6 ppm were associated with an increased risk of aesthetically significant dental fluorosis. Fluoride levels in the current drinking and cooking water sources were strongly correlated with fluorosis severity. Further work is needed to explore fluorosis risk in relation to total fluoride intake from all sources including food preparation.

Quantitative light fluorescence (QLF) and polarized white light (PWL) assessments of dental fluorosis in an epidemiological setting.

BACKGROUND: To determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods. METHODS: Subjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean's and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean's and TF indices by raters and fluorescence images were automatically scored using software. RESULTS: Data from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean's and TF index. Agreement (measured by weighted Kappa's) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92. CONCLUSIONS: The study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.

Adolescents' perceptions of the aesthetic impact of dental fluorosis vs. other dental conditions in areas with and without water fluoridation.

BACKGROUND: The use of fluorides for caries prevention is well established but is linked with an increased risk of dental fluorosis, some of which may be considered to be aesthetically objectionable. Patient opinion should be considered when determining impact on aesthetics. The aim of this study was to assess participant rating of dental aesthetics (from photographic images) of 11 to 13 year olds participating in an epidemiological caries and fluorosis survey in a fluoridated and a non-fluoridated community in Northern England. METHODS: Consented participants were invited to rank in order of preference (appearance) a collage of 10 computer generated images on a touch-screen laptop. The images comprised an assortment of presentations of teeth that included white teeth, a spectrum of developmental defects of enamel and dental caries. Data were captured directly and exported into SPSS for analysis. RESULTS: Data were available for 1553 participants. In general, there were no significant differences in the rank positions between the fluoridated and non-fluoridated communities, with the exception of teeth with caries and teeth with large demarcated opacities. Very white teeth had the highest rating in both localities. Overall, there was a trend for teeth with fluorosis to be ranked more favourably in the fluoridated community; for TF 1 and TF 2 this preference was significant (p < 0.001). CONCLUSIONS: The results of this study suggest teeth that are uniformly very white have the highest preference. The rankings suggest teeth with a fluorosis score of TF 1 may not be considered aesthetically objectionable to this population and age group. The image depicting a tooth with caries and the image with large demarcated opacities were deemed to be the least favoured. Participant preference of images depicting fluorosis falls with increasing severity of fluorosis.

The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation.

BACKGROUND: To determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias. METHODS: Subjects were male and female lifetime residents aged 11-13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0). RESULTS: Data from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester. CONCLUSIONS: Water fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring.

Solving man-induced large-scale conservation problems: the Spanish imperial eagle and power lines.

BACKGROUND: Man-induced mortality of birds caused by electrocution with poorly-designed pylons and power lines has been reported to be an important mortality factor that could become a major cause of population decline of one of the world rarest raptors, the Spanish imperial eagle (Aquila adalberti). Consequently it has resulted in an increasing awareness of this problem amongst land managers and the public at large, as well as increased research into the distribution of electrocution events and likely mitigation measures. METHODOLOGY/PRINCIPAL FINDINGS: We provide information of how mitigation measures implemented on a regional level under the conservation program of the Spanish imperial eagle have resulted in a positive shift of demographic trends in Spain. A 35 years temporal data set (1974-2009) on mortality of Spanish imperial eagle was recorded, including population censuses, and data on electrocution and non-electrocution of birds. Additional information was obtained from 32 radio-tracked young eagles and specific field surveys. Data were divided into two periods, before and after the approval of a regional regulation of power line design in 1990 which established mandatory rules aimed at minimizing or eliminating the negative impacts of power lines facilities on avian populations. Our results show how population size and the average annual percentage of population change have increased between the two periods, whereas the number of electricuted birds has been reduced in spite of the continuous growing of the wiring network. CONCLUSIONS: Our results demonstrate that solving bird electrocution is an affordable problem if political interest is shown and financial investment is made. The combination of an adequate spatial planning with a sustainable development of human infrastructures will contribute positively to the conservation of the Spanish imperial eagle and may underpin population growth and range expansion, with positive side effects on other endangered species.

The water fluoridation debate.

UNLABELLED: Water fluoridation schemes have been employed for over 50 years. Water fluoridation has been a source of continuous debate between those who advocate its use as a public health measure and those who oppose it. There have been no new fluoridation schemes in the U.K. for nearly 30 years owing to principally legislative, but also geographic, financial, and political reasons. However, in early 2008, the U.K. Secretary of State for Health promoted the use of water fluoridation schemes for areas in England with the highest rates of decay. This article, the third and final article of three, aims to discuss the arguments surrounding water fluoridation and its continued relevance as a public health measure. CLINICAL RELEVANCE: This article aims to provide an update for general practitioners for the background and the current status of the water fluoridation debate and to enable them to answer non-clinical questions raised by patients.

Why fluoride?

UNLABELLED: Fluoride has been used in dentistry for over 100 years for the purpose of preventing dental caries. During this time there has been great debate over the mode of action, the optimum method of delivery, and the potential risks associated with its use. This, the first of three papers, will provide a summary of the history of the use of fluoride, the mode of action, benefits and different methods of delivery. It will also discuss the potential risk of dental fluorosis. CLINICAL RELEVANCE: This article aims to provide a background for general practitioners for the appropriate use of fluorides in dentistry, enable them to understand the wider significance of fluoride in dentistry and to be able to answer non-clinical questions raised by patients.

Water fluoridation as a public health measure.

UNLABELLED: Water fluoridation schemes have been used as dental public health measures for over 50 years. This second paper in a series of three aims to provide a background to the history of water fluoridation schemes and the evidence base that led to their implementation. The article will also discuss the processes and chemicals involved in fluoridation during water treatment. CLINICAL RELEVANCE: This article aims to provide a summary for general practitioners of the history and evidence base for water fluoridation, to enable them to understand the role of water fluoridation in caries prevention and to be able to answer non-clinical questions raised by patients.